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Published:September 19th, 2011 09:59 EST
Shrinking Casey Anthony

Shrinking Casey Anthony

By Dr. Judy Kuriansky (Mentor/Columnist)

The latest news about Casey Anthony`s psychological state is that the young woman accused, but acquitted, of the death of her little daughter Caylee, is about to see a female psychiatrist. Reportedly, she had previously been getting help from a "grief counselor." Here are my reactions:

1. Seeing a "psychiatrist" implies that hopefully Casey will be getting a proper diagnosis - since speculation has been rampant about her condition. She has been labeled as narcissistic, psychopathic and a pathological liar. Her mother, Cindy Anthony, has publicly said, "I think there`s something seriously wrong with my daughter," including a deficit in her "thought processes." Cindy has even hypothesized that her daughter has "post partum schizophrenia" "a brain tumor" or "Grand Mal seizures" - which have been questioned by experts and criticized as a way to excuse her behavior.

2. Consulting a psychiatrist implies that Casey will now be assessed for appropriate medication treatment, since "counselors" are usually not medical doctors and psychiatrists are licensed to prescribe medication for psychiatric disorders. Only a few states (e.g. Louisiana) have given prescription rights to licensed psychologists.

3. Likely, antidepressants will be considered, since Casey has multiple reasons in her life to be depressed. Her long and very public trial is very stressful. Further, she has suffered many losses, including the death of her daughter; "loss" of her parents (especially her father saying on TV`s Dr Phil show that she is to blame for her daughter`s death and that she is not welcome in their home); loss of a future "normal` life; damage to her reputation (being called `the most hated woman in America"); and worse, threats to her life.

4. It has been reported that Casey will see a female psychiatrist. The gender of the therapist can be important for some clients, given what is called "transference" whereby the client unconsciously projects feelings, and repeats behaviors, with the therapist that come from past significant relationships. Often relationships from childhood with a parent are re-enacted. This dynamic affects the patient`s degree of openness, trust, honesty, comfort, subject matter, and behaviors in the sessions, as well as what is triggered in the sessions and enacted in life. While it is true that the degree of rapport between the therapist and patient matters most in the outcome of therapy, the matching of genders matters. For Casey, seeing a female can be positive, in that a male can trigger negative transference to the "father" figure, George, who is right now being critical and blaming, which would undoubtedly lead to Casey being furious at, and feeling betrayed by, him and any male authority figure. Conversely, her mother has defended her, and been the more stoic of her parents (George has been suicidal and also therefore not a role model of a strong male figure). Her mother also seems to have similar personality characteristics to Casey, which could predict a more positive identification and transference with a female therapist.

5. Therapists also have what`s called "counter-transference" with patients - projecting past experiences onto the patient relationship. Of course, therapists are trained to recognize and control any entangled emotions and reactions, not letting them interfere with the therapeutic alliance or objectivity. A female therapist would have to be conscious of personal feelings about mothering (especially if she is a mother herself) and about any woman who might have been involved in their child`s death. A female therapist might be more understanding of a woman`s conflicts over mothering, or sympathetic about post-partum conditions, but it is also possible she would struggle with negative reactions like condemnation or hostility towards a woman`s lying, partying, irresponsibility towards mothering, or even being suspected of malicious actions towards a child.

6. Casey`s problems are more serious psychologically than can be adequately handled by just getting medication, or seeing any therapist in private sessions, even a few times a week. Psychiatrists these days usually see patients for short periods of time, mainly to check on their meds, and do not typically have the 45- minute "talk" sessions that psychologists and other mental health counselors typically do.

7. In my opinion, Casey should be in residential treatment, in a protected environment where she has a myriad of treatment sessions, and other therapeutic activities, every day.