"I don't want to be here": Projectuality versus eventuality in the life, symptoms, and treatment of Ms. T

Ms. T.'s case is a rich and moving example of a complex clinical case requiring integrative psychotherapy. In this brief commentary, I highlight the centrality of intentional processes in Ms. T.'s life, symptoms, and treatment, using an existential-psychoanalytic-integrative framework. Drawing from previous work on the tension between projectuality, or goal-directedness, and eventuality, or life stress blocking goal-directedness (Shahar, 2011), I argue that Ms. T.'s somatization conveys a subjective experience of life as not worth living ("I don't want to be here"). Such an experience is brought about by an accumulation of traumatic stress, culminating with Ms. T.'s loss of custody over her children. As an older adult, Ms. T. exhibits characteristic of Depressive Personality Disorder (DPD), a diagnosis that sheds light on her dejection, mistrust of others, and conversion symptoms. I concur with Dr. Kores that Behavioral Activation should lead the way in this integrative treatment, but I also call for the "existentializing" and psycho-dynamizing of this powerful intervention.