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HSCS478: ASSIGNMENT 1

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Brittany Jenkins University of New England SID: 220170433 2018 TRIMESTER 1 HSCS478: Assignment 1 3000 Words

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The American Psychological Association (2014) defines psychological trauma to be an emotional reaction to a horrific experience which inhibits a person’s capability to function as they normally would. While the psychological impact of a traumatic event will differ from one individual to another, most people will experience a heightened emotional suffering after going through any traumatic event (American Psychological Association, 2014). This reading will discuss the effects of traumatic experiences, specifically on one’s psychology, emotions and relational development. The traumatic experiences will reflect that of a domestic violence experience/s. it will also consider a trauma and domestic violence focused case study and deliberate the rationale for a specific trauma focused therapy.

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Part A – Traumatic Experiences: Domestic Violence Section I

A domestic violence traumatic experience impacts a person in many ways. Psychological, emotional and relational development of a person are especially impacted. These functions are effected through trauma as an individual is unable to respond to life as they normally would. A traumatic domestic violence experience can lead to anxiety, depression and other emotional distress symptoms (Bacchus, Mezey, & Bewley, 2002). Physical symptoms of stress can also occur. These include suicide attempts, substance abuse, sleep disorders, loss of self-esteem, social isolation and fearfulness of new relationships (Bacchus, Mezey, & Bewley, 2002). Each individual will respond to trauma differently such as, people who have experienced a single incident of trauma from domestic violence find it easier to overcome mentally as they are seen as a ‘survivor’ (Pakeiser & Lenaghan, 1999). However, for those who have experienced domestic violence trauma repetitively the victim is more likely to develop serious long term negative consequences including attachment issues and feelings of helplessness (Pakieser, Lenaghan, & Muelleman, 1999).

Psychologically, a person is effected after a traumatic event. Exposure to such traumatic domestic violence has a negative psychological effect on adjustment (Ramos, Carlson, & McNutt, 2004). Bacchus, Mezey and Bewley (2002) determine that after exposure to a traumatic event with domestic violence a person inhibits normal development and has negative consequences short and long term. Common effects of a traumatic experience include intense and lengthened stress responses, shown by excessive fear and anxiety, which can lead to panic disorder, post-traumatic stress disorder and acute stress disorder (American Psychiatric Association, 2000).

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One of the most common responses from enduring a domestic violence traumatic event is the development of post-traumatic stress disorder (PTSD) (Astin, Lawrence & Foy, 1993). This is a short and long term psychological effect on a person who has suffered a traumatic experience especially if not properly treated. PTSD develops after a traumatic event in which one feels fearful and helpless (Barlow, David & Duran, 1999). Therefore, it is usual for that person to experience nightmares and flashbacks even after they have been removed from the abusive state (Maercker et al., 2000). Domestic violence trauma can also lead a person into social isolation, substance abuse and suicidal ideation Chemtob, Carlson & John, 2004).

Emotional responses of a person who endured a domestic violence traumatic experience are also impacted. A traumatic domestic violence experience is often humiliating and demeaning to the victim and therefore affects their self-confidence and self-esteem (Pakeiser & Lenaghan, 1999). Other common emotional responses from such an experience include fear (of retaliation from the abuser), anxiety and anger (Chemtob, Carlson & John, 2004). Furthermore, they may develop feelings of hopelessness and helplessness that can then lead to depression and even suicide (Violanti, Andrew, Mnatsakanova, Hartley, Fekedulegn, & Burchfiel, 2015).

One of the most intense emotions which develop from domestic violence trauma and PTSD is the feeling of shame (Ozer, Best, Lipsey & Weiss, 2003; Chemtob, Carlson & John, 2004). The feeling of shame comes about as a person may have not lived up to their own personal values or may have had to do things which they do not agree with to survive the experience. Shame may also develop from the abuse they endured, as their appearance or thoughts may have been ridiculed. That person may then perceive themselves as less admirable or weak. Janoff-Bulman (1992) also explains that trauma from domestic violence

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can deeply impair a person’s internal identity and the way they perceive the world. He determines that a person develops a sense of helplessness, fearfulness and shamefulness from the trauma (Janoff-Bulman, 1992). These changes in the internal self-have been associated with development of PTSD (Ehlers & Clark, 2000). Scheff (2011) also determined that disrespect from a traumatic domestic violence experience directly associated with one feel shame and humiliation. It has also been determined that symptoms of PTSD are also associated with relational development difficulties and emotional solidity (Elkitt, 2002). As such, even if a person is able to successfully escape the toxic relationship the negative impact has long terms effects on their future intimate relationships. The National Center for PTSD (2014) states that people who have suffered from a traumatic domestic violence experience may believe that a normal functioning, healthy relationship exists. Therefore, these survivors enter new relationships with fear and have unhealthy expectations. Factors which inhibit the victim from developing a new healthy relationship include flashbacks from the past, particularly in intimate moments within their new relationship, nightmares, problems with communicating effectively and feeling worthless (National Center for PTSD, 2014). Therefore, relational development is impacted when exposed to trauma of domestic violence.

A domestic violence traumatic experience creates a person to have negative psychological and emotions responses and creates their relational development. Specific relational trauma can be shown by a person feeling emotionally unstable in a relationship. One who has suffered a traumatic domestic violence experience may have difficulty saying ‘no’ and be more concerned about pleasing the other party (Chemtob & Carlson, 2004). It can also be shown through hypervigilance, one may feel anxious in a relationship and constantly adjust their thoughts to match someone else’s to avoid conflict. Other people may act

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independently in a relationship and think they are on their own, these thoughts will lead someone to act as though they are distant and self-sufficient (Chemtob & Carlson, 2004).

A person is significantly impacted psychologically, emotionally and relational developmentally through experiencing trauma. This person’s responses change from how they would respond normally in everyday life. These responses include increased anxiety, depression and stress on their life. These then lead to actions such as suicide attempts, substance abuse, disrupted sleep, social withdrawal and fearfulness towards and in new relationships. It is also evident that each individual will respond differently to a traumatic event although commonly the effects taken place negatively impact their life.

Section II

Domestic violence traumatic experiences will not only directly impact the person involved, but also those who are connected or in contact with the victim. Statistics show that the most common family member associated with the domestic violence traumatic event is the children of the mother (Sterne & Poole, 2009). The National Center for PTSD (2014) examines that approximately 50% of children are involved in a traumatic domestic violence event. The Australian Bureau of Statistics (2004) determined that the previous year approximately 410 thousand people had experienced domestic violence with approximately 180 thousand children witnessing the domestic violence. Therefore, the impact on them is also greatly influences on their life. In fact, most of the domestic incidences occur with the child in the same room (Sterne & Poole, 2009).

Children who have suffered domestic violence trauma show signs of hypervigilance, insecure approaches to relationships, often marked by strong emotions such as frustration, hostility and fear (Kenardy, DeYoung, LeBrocque, March, 2011). Sety (2011) determined that

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twenty years of research has clearly identified that children including infants and adolescents are seriously negatively impacted psychologically, emotionally and socially by witnessing traumatic domestic violence. Children commonly re-experience this trauma through reenactments of the trauma by reliving in their current life (Kenardy, DeYoung, LeBrocque, March, 2011). Generally, this shows through copycatting the trauma, for example, aggressive behaviour at school (Kenardy, DeYoung, LeBrocque, March, 2011). Of course, each age group is affected differently through each event of trauma. Young children will demonstrate fear through nightmares and hyperarousal. They will also demonstrate psychical symptoms such as headaches (Kenardy, DeYoung, LeBrocque, March, 2011; Center for Substance Abuse Treatment, 2014). Children who are school aged will show their symptoms commonly through a copycatting means as discussed earlier such as aggressive behaviour and anger. It also shown through loss of focus at school and worsened school grades (Kenardy, DeYoung, LeBrocque, March, 2011). Adolescent children usually develop social isolation, hypervigilance and rebellious tendencies (Hamblen, 2001). Adolescents also commonly seek vengeance through psychical symptoms such as sleeping around, eating and sleeping disorders and substance abuse (Chemtob, Carlson & John, 2004; Hamblen, 2001).

Not only are the psychological and emotional sociology of these children impacted, but their experience to trauma changes their relational development as well. According to statistics from the NCADV (2015), boys who were exposed to a traumatic domestic violence event were twice as likely to abuse their own partners and children later in life. Wolfe, Crooks, Lee, McIntyre-Smith and Jaffe (2003) conducted a study of the literature and found that forty out of forty-one studies determined that children who were exposed to domestic violence developed emotional and behavioural problems. Another study by Trowell, Hodges

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and Leighton-Lang (1997) reported that teachers of children who were involved in domestic violence could clearly identify that these children were more common to behavioural problems, underachievement and more socially isolated. It is evident that not only the direct victim is impacted through experiencing a traumatic domestic violence event. An extensive variety of a child’s development is impacted from exposure to domestic violence which includes social, emotional, behavioural and physical health problems. Part B – Case Study Section I In the case study Steve shows three distinct primary symptoms of trauma these symptoms include; flashbacks which can be experienced through nightmares; avoidance of these invasive memories through excessive alcohol consumption; nervousness, hypervigilance and agitation which leads to sleep disturbances and excessive vigilance (Khaleghi, 2012). Working with these conditions it is best to use a trauma focused behavioural therapy (TF-CBT) as it would be especially understanding to Steve’s unique case. As Steve suffers from post-traumatic stress disorder and has had a history of abuse, violence and trauma, dialectical behaviour therapy (DBT) would be suitable for the initial sessions. A more trauma sensitive technique can then be used to follow up. Each session should take approximately one hour and sought out weekly with set goals. Cognitive behavioural therapy (CBT), has been recognised as one of the most effective approaches for treating PTSD and Trauma (American Psychiatric Association, 2004; Australian Centre for Posttraumatic Mental Health, 2013; Bisson & Andrew, 2007).

The trauma in Steve’s case can lead to intense guilt feelings of helplessness, selfabuse/harm and depression/anxiety issues if not properly treated. PTSD effects a person by

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intrusive negative thoughts about the traumatic experience which cause nightmares/sleep disturbances, emotional numbness and intense physical and emotional reactions. By combining these approaches TFCBT can efficiently treat symptoms of PTSD.

Pre-treatment will do the assessment, contract for commitment and familiarise Steve into the therapy. DBT will be started with Steve which will start with having clear goals and setting out to achieve these before moving onto the next goal. Every session and goal will aim to help Steve think more dialectically – focusing on managing self-harming behaviours/thoughts and obstacles to acting rationally (Mind, 2013). The first stage will focus mainly on the suicidal and self-harming behaviour and thoughts that inhibit Steve from living his life to the best quality. DBT and CBT will assist Steve in rationally resolving these problems (Psych Central, 2007; Mind, 2013). The next stage of Steve’s therapy will focus on his post-traumatic stress related problems. The PTSD and co-existing problems in relation to Steve’s childhood and abuse will not be directly dealt with until the first stage has been successfully overcome. The third stage of Steve’s therapy will focus mainly on his self-esteem and individual treatment goals so that he can successfully have a better-quality life especially with his family. At large, DBT will emphasis providing Steve with four key tools. First, awareness of the present; this will help assist with his PTSD. Secondly, increasing Steve’s distress tolerance rather than trying to escape it, again majorly assisting his PTSD and anxiety and his inability to sleep (Chapman, 2006). Thirdly, regulate his emotions and manage intense feelings rather than numbing through alcohol consumption. Fourthly, relational efficiency which will help Steve be confident and self-assured without feeling unassertive and thus improve his relationships (Chapman, 2006). The TFCBT will mainly help Steve challenge his negative through process which will not only assist his PTSD but also his day to day life. It will do this by helping him identify the impractical beliefs about himself and/or others and to

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challenge them. He will then learn how to substitute these thoughts with rational ones that are healthier to his quality of life. With the information given about Steve’s case it is hard to determine whether or not Steve is at risk of suicide however, he has stated that he feels he is a ‘worthless burden' and 'the world being better off without him' and these statements should be taken seriously. If Steve continues the path he is going and his wife leaves him, this added stressor could definitely lead to suicide ideation and with Steve’s unstable emotional outbursts could lead to the suicide itself. At this stage Steve shows passive suicidal ideation which shows a want to die with his frequent comments to his family, but without a precise plan for carrying out the death. Steve also shows several psychosocial symptoms of suicide risk including feelings of helplessness, emotional pain which is trapping him from experiencing his life to his fullest, outbursts/mood swings and anxiety (Beck, Steer, Kovacs & Garrison, 1985; Hemelrijk, Ballegooijen, Donker, Stratenm & Kerkhof, 2012). Steve also shows physical symptoms of suicide which are demonstrated through his changed in his sleeping pattern (Harris, Syu, Lello, Chew, Willcox & Ho, 2015). All these categories, especially Steve’s suicidal thoughts are certainly considered a risk factor for Steve. Using TFCBF and DBT will successfully help Steve into creating new thinking and learn constructive ways to manage emotion. It will endeavour to help Steve understand his past and present. This therapy will overall help Steve’s quality of living and understand his reactions towards his life and family. Section II It is important to work under supervision for a variety of reasons. Working under supervision will mean that as a counsellor one will use the recourses of another more experiences counsellor to review their technique. This will help the ethical professional and personal development of that counsellor.

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Geldard and Geldard (2001) believe that every counsellor needs supervision to help them avoid burnout in their own person and professional life. Burnout occurs with an overload of a particularly exhausting and demanding occupation mixed with one’s own personal life. It becomes easy for a counsellor to become over attached to a client and the counsellor’s professional boundaries may be hindered. Having a supervisor especially in Steve’s case as it is especially sensitive will help stop any of these boundaries being crossed and causing any issues down the track. The supervisor is also able to identify any complications or symptoms of burnout to the counsellor. Not only will this provide a channel for the counsellor to confidentially talk about a case they will also be able to voice any concerns. The counsellor can also become conscious of their own professional values and approaches towards clients and therapy (Corey, Corey & Callanan, 2007). Reviewing sessions with a supervisor gives a counsellor the opportunity to develop their own performance and skills. It helps the counsellor to learn and implement different objectives to help their session. Reviewing a session is also important for the counsellor to look at the issues in the session and objectively find a resolution. As long as Steve consents, in his risk of suicidal ideation and post-traumatic stress triggers, the best case for treating him with supervision would be to have a supervisor present during the session. A second person would shed light on more experiences and a specialist in this area of veterans could help the counsellor with any potential triggers in the session which will needed to be acknowledged. Supervision will assist the counsellor as they will be able to expand their knowledge and skills. This is important in counselling as the development of new techniques and approaches is essential to keep up to date. If a counsellor does not expand on their knowledge and learn new approaches they are essentially inhibiting their client from gaining the best service.

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As a counsellor, one cannot know everything there is to know or all the skills needed to effectively respond to all the different clients there are. Therefore, at times a counsellor may be challenged with things such as challenges to their value and beliefs. Another person will help the counsellor understand any gaps and help assist neutrally in the session. A counsellor may also face ethical dilemmas so having a supervisor will help assist the counsellor with making a decision where the correct path is not so clearly exhibited. Debriefing these concerns with a supervisor will make sure that professional and ethical decisions are upheld. This can be especially sensitive in this case as Steve has a risk to suicidal ideation and misinterpreted body language or actions could cause issues. Conclusively, professional supervision is needed not only in Steve’s case but for a...