Treating the Governess in Henry James' The Turn of the Screw
Arthur Wenk

The Turn of the Screw, arguably the greatest ghost story ever written, compels the reader to decide whether the narrator/protagonist, a young governess, is reliable or delusional.  Proponents of either side have generated a sizeable body of literature with their arguments.  I propose in this paper to take a different approach, that of a psychotherapist assigned by the young woman's physician to offer a psychological assessment and propose a treatment plan.  It may be interesting to compare how the proposed treatment varies according to one's analytical perspective.

Part I:  Assessment

Note:  My patient is the unnamed protagonist of Henry James’ short story, The Turn of the Screw. (James, 1957).  After a nine-page framing introduction, the story purports to be a first-person written account of the experiences of a young governess.  I have treated this 120-page narrative as an extended intake interview.  Textual support for my observations is contained in footnotes.  Unless otherwise indicated, all page references are to James, 1957.

I.  Identification, Chief Complaint, and Reason for Referral
Alice (fictitious name) is a 20-year-old, white, single female referred by her physician, Geoffrey Metcalfe , for psychological assessment.  Her chief complaint is insomnia.  Alice has been unable to sleep since leaving her previous employment.

II.  History of the Present Illness
Alice reports difficulty in sleeping during her several months of employment as a governess at a country estate.  She often wandered about at night.   She reports a number of encounters with apparitions, identified as her predecessor as governess and her employer’s valet, both dead.  Her condition worsened to the point that she believed her charges—Miles, a ten-year-old boy and Flora, an eight-year-old girl—to have been possessed by these apparitions.  Her attempts to compel the children to “confess” to encounters with the apparitions frightened them to the point that the housekeeper took the little girl away to London while the little boy literally died of fright in the governess’s arms.

III.  Past Psychiatric History
Alice reports no history of other psychiatric disorders or suicide attempts.  She also denies psychiatric hospitalization, psychotherapy, or medications.  (Shea, 1998, p.703) 

IV.  No History of Substance Abuse
Alice denies any history of involvement with alcohol or drugs.

V.  Past Social and Developmental History
1.  Education:  Alice had no formal schooling, having grown up in a small town.  Alice reports being impressed by the “roomful of old books at Bly,” in contrast to her own bookless home.   Before adulthood Alice never attended a play.
2.  Family Relationships, Social Network, and Abuse History:  Alice is “the youngest of several daughters of a poor country parson” .  Alice reports no history of psychological, physical, or sexual abuse as a child. (Shea, 1998, p.704)
3.  Employment Record:  Alice had a small amount of experience as a schoolteacher before taking the job of governess to the niece and nephew of a wealthy Londoner whose only demand was that she should never trouble him:  ‘neither appeal nor complain nor write about anything; only meet all questions herself, receive all moneys from his solicitor, take the whole thing over and leave him alone.”
4.  Legal Record:  Alice reports no problems with the law.
5.  Religious Background:  The daughter of a country vicar, Alice peppers her speech with adjectives referring to the supernatural in religious terms.

VI.  Current Social History
1.  Social Relationships:  The brother of one of Alice’s charges describes her as “the most agreeable woman I’ve ever known in her position. … She struck me as awfully clever and nice.” Alice reports no close friends nor any past romantic involvements with men, yet a number of her remarks indicate a preoccupation with her employer, whom she met only twice on the occasion of her engagement as governess.

VII  Family History
Alice never refers to her mother, but indicates a lack of mental stability on the part of her father.  She also refers to being concerned by unnamed problems at home.

VIII.  Medical History and Review of Symptoms
1.  Disorders:  Alice has no history of psychological problems.
2.  Review of Symptoms:  talking to herself , overwhelming physical strain, fainting , insomnia, describing seeing ghosts
3.  Medications:  None
4.  Physician:  Geoffrey Metcalfe, M.D.
5.  Allergies:  None known.

IX.  Mental Status Examination
1.  Appearance and Behaviour:  Alice appeared well-dressed and proper.  She seemed eager to please and, when asked about the circumstances surrounding her presenting complaint of insomnia, offered a length and colourful account of her previous employment.  In contrast to her somewhat diffident demeanour in our session together, Alice’s account is filled with “frantic physical demonstrations of affection.” (Cranfill and Clark, 1965, 29).  She constantly clutches the children and covers them with kisses.
2.  Mood and Affect:  Alice used a very matter-of-fact tone in recounting experiences which, at the time, deeply affected her.   Her affect was complete self-possession, though she described herself as “rather easily carried away.  I was carried away in London!” presumably referring to her infatuation with her employer. 
3.  Speech and Thought Patterns:  Alice consistently used the absence of evidence as support for her conclusions.  Her logic in looking for a boat typifies the reasoning of her entire story:  the absence of something supposedly proves its existence.   She disarmingly uses language that reveals the extent to which her imagination has created the circumstances that affect her.
4.  Thought Content and Perception:  Alice vigorously denies hallucinations or delusions, consistently maintaining that the apparitions she saw were actual supernatural beings come to harm the young children in her charge.  Yet she continually betrays uncertainty about her own sanity.  
5.  Sensorium, Cognitive and Intellectual Functioning:  Alice is alert and intelligent, able to recall the details of her experiences with remarkable clarity and vividness.  Alice shows considerable insight into how others might regard her.   Given her account, one can imagine how the children might have been upset by her behaviour.   Toward the end of her story, she supplies an alternative explanation for the death of Miles, which she attributes to supernatural intervention.   One is impressed that Alice’s account “is primarily a record of feeling.” (Cranfill and Clark, 1965, p.18)  Variations of the word “feel” or “feeling” appear eighty-two times in her record.  For all the minute details of description, Alice recounts “not what is provable, but what she senses or fancies or feels, how things appear or seem to her.” (Cranfill and Clark, 1965, p.19)

X.  Conclusion
Alice’s reported encounters with the ghosts of her predecessor and her employer’s valet seem to have emanated from her strong desire to engage in an adventure, involving her young charges, that would impress her employer.   Instead, her bizarre behaviour seems to have terrified the young children to the point that the young girl, who slept in the same room as the governess, had to be taken away and the young boy ended up dying in the Alice’s arms, evidently frightened to death.  Alice has never wavered in viewing her role as entirely heroic.
It would appear that Alice’s sleep problems originate in cognitive distortions, including hallucinations, and that these issues need to be addressed if she is to receive relief from her presenting problem.  Alice needs to take responsibility for her role in a situation that she has unwittingly created herself.

Part II:  Treatment Plans

1.  Adlerian Treatment Plan
Problem:  Sleeplessness due to fear of apparitions
Definition:  Insomnia
Hallucinations (primarily visual)
Goals:  Eliminate hallucinations; promote normal sleep patterns

Objectives
1.  understand whole person
2.  encourage client to assume responsibility; help client identify how effects of lack of sleep (visions) protect her from moving toward healthy goals in her life
Interventions
1.  create a caring environment for client; determine client’s life style by studying family constellation and early recollections
2.  establish connections between core beliefs and hallucination events
3.  identify purpose of the symptoms
4.  focus on childhood sleep patterns and possible disturbances
5.  investigate client’s feelings of inferiority
6.  investigate client’s infatuation with employer
7.  help client see purpose behind creating visions; point out connection between hallucinations and desire for “heroic feats” to impress employer
8.  help client devise alternative physical explanations for the “apparitions”
9.  foster normal sleep habits
10.  encourage client, promote belief in the possibility of change
11.  ask client to visualize the difference in her life if the hallucinations vanished and sleep returned
12.  ask client to “act as if” normal sleep had been restored

2.  Behavioural Treatment Plan
Problem:  Insomnia
Definition:  Difficulty getting to or maintaining sleep
Abrupt awakening followed by intense anxiety, confusion or disorientation
Goals:  Restore restful sleep pattern; end abrupt awakening
Objectives
1. Follow sleep induction schedule of events
2. Practice deep-muscle relaxation exercises.
3.  Utilize biofeedback training to deepen relaxation response
Interventions
1.  Assign adherence to a strict sleep induction routine, daily exercises, low stimulation prior to sleep, relaxation training, bland diet, and so forth.
2.  Assign self-monitoring of short-term goals.
3.  Train in deep-muscle relaxation exercises with and without audio tape instruction
4.  Practice experiencing the fear of sleeplessness while remaining in a deeply relaxed state.
5.  Administer electromyographic (EMG) biofeedback to reinforce successful relaxation response (Adapted from Jongsma and Peterson, 1995, pp.124-125)

3.  Cognitive Treatment Plan
Problem:  Delusions
Definition:  Perception disturbance (hallucinations, primarily visual)
Bizarre thought content (delusions of grandeur as rescuer)
Relationship withdrawal (preoccupation with egocentric ideas and fantasies)
Goals:  Significantly reduce or eliminate hallucinations and delusions

Objectives
1.  Verbalize an understanding of the underlying needs, conflicts, and emotions that support the irrational beliefs.
2.  Accept and understand that distressing symptoms are due to mental illness
3.  Report diminishing or absence of hallucinations and delusions
Interventions
1.  Assess pervasiveness of thought disorder through clinical interview
2.  Gently confront illogical thoughts and speech to refocus disordered thinking.
3.  Demonstrate acceptance through calm, nurturing manner, good eye contact, and active listening.
4.  Explain diagnosis
5.  Explore feelings surrounding stressors that triggered hallucinations.
6.  Explore family history for serious mental illness.
7.  Encourage focus on the reality of external world versus the client’s distorted fantasy.
8.  Assist in restructuring irrational beliefs by reviewing reality-based evidence and misinterpretation.(Adapted from Jongsma and Peterson, 1995, pp.116-117)

4.  Psychoanalytical Treatment Plan
Problem:  Insomnia
Definition:  Difficulty getting to or maintaining sleep
Abrupt awakening followed by intense anxiety, confusion or disorientation
Goals:  Restore restful sleep pattern; end abrupt awakening

Objectives
1.  Reveal possible sexual abuse incidents that continue to be disturbing; share childhood traumatic experiences associated with sleep experiences.
2.  Discuss experiences of emotional traumas that continue to disturb sleep; verbalize depressive feelings and share possible causes.
Interventions
1.  Explore recent traumatic events that interfere with sleep.
2.  Explore traumas of childhood that surround the sleep experience, including possible sleep phobias.
3.  Investigate “persistent unconscious fantasies of childhood” that may affect sleep (Arlow, 2000, p.42)
4.  Explore possible sexual abuse that has not been revealed.
5.  Assign client to keep a journal of daily stressors and nightly sleep patterns.
6.  Assess role of depression as cause of sleep disturbance.  (Adapted from Jongsma and Peterson, 1995, pp.124-125)

Bibliography

Arlow, Jacob A. (2000).  Psychoanalysis.  In Raymond J. Corsini & Danny Weddings (Eds.), Current Psychotherapies (pp.16-53).  Belmont, CA: Thomson Learning.
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Cranfill, Thomas Mabry and Clark, Robert Lanier (1965)  An Anatomy of The Turn of the Screw.  Austin:  University of Texas Press.
James, Henry (1957).  The Turn of the Screw.  New York:  The Modern Library.
Jongsma, Arthur E. and Peterson, L. Mark (1995) The Complete Psychotherapy Treatment Planner.  New York:  John Wiley & Sons, Inc.
Mosak, Harold H. (2000) Adlerian Psychotherapy.  In Raymond J. Corsini & Danny Weddings (Eds.), Current Psychotherapies (pp.54-98).  Belmont, CA: Thomson Learning.
Mosak, Harold H. and Miniacci, Michael (2005).  The Case of Roger.  In Raymond J. Corsini & Danny Weddings (Eds.), Case Studies in Psychotherapy (pp. 20-45).  Belmont, CA:  Thomson Learning.
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Willen, Gerald, ed. (1960)  A Casebook on Henry’s James’s The Turn of the Screw.  New York:  Thomas Y. Crowell.
Wilson, G. Terence.  (2000).  Behavior Therapy.  In Raymond J. Corsini & Danny Weddings (Eds.), Current Psychotherapies (pp.205-240).  Belmont, CA: Thomson Learning.

Endnotes

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