Not really sure if this is the right thing in the right place but I give up now :)

Identifying experiences of distress – naming them – what are they?






Periods of mania, low mood, anger and anxiety, period of inpatient admission. His father alcoholic and violent to mother and children. Worsened when business was struggling. Sexual abuse on several occasions – trauma PTSD – may have thought he was a bad person or questioned sexuality etc. Started drinking when 15 and failed GCSE’s. Parents divorced and dad moved back to Italy and hasn’t kept in contact. Effect of divorce massive – had to move and financially unstable. Jack drunk a lot of alcohol, took drugs and became involved in petty theft. Mother kicked him out of house and slept rough for a few months – loss of basic self care increasing chance of abnormal ideation and experiences like seeing his fathers face. Diagnosed with depression, paranoia and persistent delusional disorder – Robbie Williams. Looking in mirror and seeing fathers face reflected – fear and self-loathing. Avoidance and vigilance
Can you identify possible causes (there might be more than one) of those experiences and/or circumstances that might be contributing to those





Father failing – may have seen himself to blame for his fathers anger, lack of emotional and financial support from family, drugs/alcohol – seen as his model of how men cope with stress, feeling of isolation, lack of sleep, trauma. Feels like he is failing to provide for his family – therefore similar to his father.
What diagnosis might be offered and why?

Remember a formulation is not premised on a functional psychiatric diagnosis



Diagnosed with depression – instead of writing problem as depression can ask ‘in what ways does depression show itself in your life?’, paranoia and persistent delusional disorder – Robbie Williams. Given medication. Due to emotional neglect and drugs/alcohol. Turned to the drugs/alcohol as coping mechanism for his depression.
What kinds of interventions might you suggest in this situation?








CBT therapy for his issues surrounding his dad and sexual abuse – both jack and therapist identify area that caused greatest distress in his life – collaboration, drug/alcohol rehab, an intervention to get him back into education & off the street, maybe put in mental hospital to help recover from the persistent delusional disorder so he no longer feels threatened by Robbie Williams. Evaluate and modify the unhelpful thinking then can positively affect his emotional wellbeing – learn healthier and more adaptive beliefs about himself and world around him.
Service-user’s strengths & achievements?






Loves music/talent, did originally do well at school and popular/sociable, still loves his dad – shows how much love he has to offer, compliant with medication and obviously wants to be helped. Ask if there are areas of his life that he manages more effectively and even enjoys, and how he copes with his low moods. Ability to form and make good use of family relationships in the past.

Formulation of Jack’s case

Jack: A formulation


I have used a cognitive-behavioural approach


Using one of the examples provided, clearly summarise the service user’s experience of distress 


The case study describes that unresolved issues in Jack’s life contribute to his distressful experience. His mood was unstable and fluctuated wildly. He might talk non-stop when in high mood. At other times, he would lapse into tears and felt that his life was a hopeless mess. As the only son in the family, he also experienced great pressure because he was expected to carry on the family business. He experienced violence at home and sexual abuse at work. His parents’ divorce and financial troubles only made matter worse. He also imagined Robbie Williams has stolen his royalty and raped his sister. Finally, he was particularly frightened when he looked in the mirror and saw his father’s face. All these have caused his difficulties.


Provide a plausible explanation of the development and maintenance of the  service user’s difficulties, and how they may relate to one another; drawing on psychological  theory and principles and details provided in example       


As he has witnessed and experienced violence and sexual abuse over long periods, it is easy to develop psychotic symptoms. Other contributing factors are poverty, relocation and lack of social support. As a migrant group, he might not get a sense of belonging in Swindon. His negative patterns of thinking might cause emotional disorders and unusual beliefs. These include hallucinations, alert for threat, distrust, avoidance. Fear of parents or caregivers during childhood might lead to a heightened sense of insecurity and suspicion of being harmed. One example from the case study is that he imagined Robbie Williams has stolen his royalty and raped his sister.


Effectively outline the benefits and limitations of diagnosis- for explaining the service user’s difficulties and devising an intervention


Jack’s symptoms might be diagnosed as schizophrenia or depression. There are benefits of a diagnosis for him. He might think that he was not to blame for his present difficulties because it was his illness that caused them. Besides, he would feel better because he was not alone with such difficulties. It was easier to get referrals and access treatment as well. On the other hand, since his present conditions are the result of traumatic life experience, a diagnosis of psychosis tells little about the underlying causes. Such diagnosis is usually associated with social stigma, making it difficult to get a job. It will also make him feel powerless and discouraged.


Briefly outline an intervention plan clearly related to the service user’s experience of distress and your explanation of the development and maintenance of the service user’s difficulties


It has been established that there is a significant link between childhood trauma and development of psychotic symptoms. As such, a good therapeutic relationship will be an effective intervention to let him talk openly about his life history. Through such collaborative sessions, the therapist can get a better understanding of the thought processes that causes his distress and thus offer a suitable cure for him. Moreover, it is important to give him hope and encouragement as well. One way is to recognise his strength and talent. The case study mentioned that he was sociable and friendly, did well at school, with a talent for music. These merits should be emphasised to help him move forward.






Formulation II || Jack Case Study || Cognitive Behavioral Therapy

Jack Case Study || Maddy Wood

For this assignment, I have chosen to use the cognitive-behavioral therapy psychological approach to attempt to formulate a formulation of Jack’s difficulties.

Using One of The Examples Provided, Clearly Summarise The Service User’s Experience of Distress :

Over his lifetime Jack has experienced several traumatic and abusive events that have caused him to have many distressing experiences over the years. One of the first experiences of distress reported by Jack’s anger and anxiety, which then developed into jack experiencing periods of mania which is often followed by low moods, which have been recorded and noted during his multiple stays at mental health facilities over the years. These “mood swings” experienced by Jack have contributed to his continuing habit of substance use and abuse, which started at the young age of just fifteen.

Provide A Plausible Explanation of The Development & Maintenance of the Service User’s Difficulties, & How They May Relate To One Another :

Over his lifetime Jack has experienced several traumatic and abusive events that have caused him to have many distressing experiences over the years. It was stated that in his early childhood years, Jack was brought up in a reasonably well off family structure that was composed of his mother, father, and two sisters. Shortly this family structure began to crumble once his father’s business began to decline to cause him to turn to alcoholism, which created a person who was field by anger and abuse. A separation soon followed this negative behavior his father began to exhibit, causing Jack to not only lose a role model and a supporter but to force Jack, due to societal constructs, to step up and be the head of the household.

Sexual abuse at the hands of his authority figure in the workplace caused shame, guilt, anxiety, and anger, which manifested themselves into depressive episodes along with manic episodes that were “handled’ through the misuse and abuse of varying substances, specifically alcohol. This misuse and abuse of alcohol could be due to seeing his father, an authority figure in his life, use the same substance as a coping mechanism during his childhood.

After the divorce, Jack, his mother, and his two younger sisters were forced to pick up the life they once knew and move it to a location of lower socioeconomic standing. Jack and his mother were unable to provide the lifestyle they once had to the family, which caused Jack to feel an immense amount of pressure on his shoulders. This pressure could be fueled both by wanting to protect his family and the societal norms of his culture on what a “man of the house” is supposed to be able to do for one’s family. Not only financially did Jack struggle to provide for his family but safety-wise due to the location in which they moved, Jack struggled to protect his family. They were stricken by burglaries, which may have lent a hand into Jack’s feeling of insecurity and continually looking over one’s shoulder.

Lastly, after being kicked out of his house, which he lived with his mother and sisters in, due to his substance use and abuse along with his petty crime habit, Jack was now faced with isolation. This was not the first time Jack felt isolated in his life. The sexual abuse which he was unable to discuss in his childhood, along with his father leaving them during his childhood, isolation, and abandonment were not new feelings. Yet, they were merely heightened now that he was living on the streets. Due to the increase in severity of his distressing experiences, Jack only advanced the severity and occurrence of these symptoms/experiences when his self-care began to decline, which is another common thing that is present among those battling mental health struggles.

Effectively Outline The Benefits & Limitations of Diagnosis – For Explaining Service User’s Difficulties & Devising Interventions :

The benefits of formal psychological diagnosis in Jack’s case is that the diagnosis in which he is given can allow him to visit/continue to see a psychiatrist who can extend or change the medication he is already taking. Jack was quoted as being “compliant” with taking medication for his distressing symptoms and, in fact, found the medication to be “helpful.” With a diagnosis of psychosis, depression, and PTSD medication can be helpful to calm or control some of the distressing symptoms so that therapeutic work can continue alongside the medication. Another benefit of formal psychological diagnosis is that since Jack has a history of positive engagement mental health service, this diagnosis can allow him to travel between different facilities where he can be placed in treatment programs and groups which are specified for his specific diagnoses.

Although a formal psychological diagnosis may, in fact, be beneficial to Jack, there are also some limitations (aka difficulties) that could arise due to his diagnosis. For example, although medication can help dull the “side effects” of psychosis, psychosis is fueled through precursory thoughts and beliefs so therefore without properly working through changing those negative thoughts into more rational thoughts the delusions are unlikely to fade completely, continuing the pattern making, it difficult for Jack to live his daily life.  None of the diagnoses that Jack will most likely be given, depression, psychosis, and PTSD can simply be treated with medication. Therapy visits and outside work on Jack’s part will be necessary to move forward in every aspect of his life, not just maintaining and improving overall mental well-being. Therefore a diagnosis in Jack’s case should be looked at more as a starting point or point of reference for what steps should be taken now and in the future.

Briefly Outline  An Intervention Plan Clearly Related To The Service User’s Experience of Distress & Your Explanation of The Development & Maintenance of The Service User’s Difficulties :

To create the most effective treatment plan for anyone, in this case, Jack specifically, it is vital that we work collaboratively to highlight his strengths while continually working on the areas in which improvement will help tremendously. Mapping is a positive and proven to be a helpful way for individuals and their therapists to see just where all this began and what should be addressed first and foremost. Starting at the most basic level, Jack was found to once have a strong familial relationship with both his parents and his younger siblings. Due to the fact, that Jack is having psychosis in regards to his sisters being raped, it would be in the best interest of Jack to rebuild and reconnect with his younger sisters not only to reopen communication that may have been lost due to years of distress but to reconnect with his loved ones who will be able to support him through the journey which lies ahead.

Along with familial relationships, music is a component of Jack’s life that once brought so much joy that should be established as an outlet as well as be used as a way to push one’s self to face the challenges of psychosis and paranoia. For example, having Jack listen to music could help him through his depressive episodes being that is something that he knows brings him joy and entertainment. It may also serve as a distraction to the negative thoughts and feelings he may be experiencing at the moment. Once the music has been established as something that helps Jack cope, it can be used as a therapeutic tool for when jack pushes himself in other ways through his therapeutic journey. For example, listening to music while he ventures outdoors could provide him a sense of comfort while working through his thoughts of being jumped or judged. Venturing outdoors could as well allow Jack to be faced head-on with Robbie Willson’s merchandise, which could become less threatening through the comfort of listening to music.

Reference(s) :

To Be Filled In Later

Jack Formulation

The Psychodynamic Approach

Jack formulation

Identifying experiences of distress – naming them – what are they

  • Becoming homeless
  • Substance abuse and theft
  • Suffering hallucinations
  • Distance from reality – Robbie Williams stole his fame and fortune, believes that Robbie Williams raped his sister.

Can you identify possible causes (there might be more than one) of those experiences and/or circumstances that might be contributing to those experiences?

  • Sexual abuse at a young age – explains why he believed his sister was raped during a reality break
  • Stealing things – he feels he is entitled to more things than he has in his life, this links to the delusion of Robbie Williams stealing his royalties and his stardom, feel he deserves more than what he has been served.
  • Becoming homeless- started over drinking and getting involved in substance abuse, rude to his mother- ended up being kicked out for a few months.
  • Emotional abuse – not being able to talk to anyone about what happened, having to sleep rough having no one care about him, finding out mother was sick- result in possible more hallucinations.
  • Loss of father – drinking and drugs, in order to escape the reality of the

What diagnosis might be offered and why? Remember a formulation is not premised on a functional psychiatric diagnosis

  • Psychosis/ delusional disorder: person has trouble correctly recognising reality
  • Carry false belief in which is based on an incorrect interpretation of reality.


What kinds of interventions might you suggest in this situation?

  • Some antipsychotic drugs
  • Psychotherapy
  • Support, reassurance and pointing out the difference between symptoms and what reality actually is, can all be helpful if the person is willing to meet with their therapist.


Service-user’s strengths and achievements?

  • Did well at school
  • Was very popular within social aspects- sociable
  • Talented with music
  • Managed to get a Saturday job
  • Put into contact with a project for homeless, helped him settle


Anything else to note?

  • Doesn’t have effective defences that has put him a regressed state of psychotic and blurred realities- Hallucinations.
  • Possible issue with masculinity- not being close to father and then losing father, and only having women role models to grow up with.

Jack’s Formulation

Psychodynamic approach for Jack

A Psychodynamic approach focuses on psychological and emotional pain and is about getting in touch with ones thoughts and feelings by looking at their root issues. The therapist would aim to help the client reformulate what they are experiencing by looking at their past experiences which may be currently being avoided as they have been pushed to the unconscious mind. A ‘triangle of conflict’, also known as the process of defence, is where the therapist attempts to discover meaning in confusing and unclear areas of experience, by identifying the underlying conflicts, rather than using defence strategies to avoid them.

Jack started life off with what was described as a stable upbringing for 10 years, until it collapsed around him and his comfortable life quickly became a very difficult upbringing. He experienced a lot of traumatic events in his adolescent stage of life, from witnessing abuse and reliance on alcohol from his father, being sexually abused by his male boss at the age of 14 and living in a ‘rougher area’ where there was a tendency of being burgled or harassed. Jack has been unable to get closure for these events. He started relying on drinking at age 15, as a coping mechanism, causing him to leave his jobs, and began to have violent arguments at home, no doubt following the behaviour he would have observed his father doing, he was consequently kicked out.

Jack has been diagnosed with depression and was also showing symptoms of ‘paranoia’ and ‘persistent delusional disorder’.  PTSD also seems to be apparent in Jack, hence the choice of the Psychodynamic approach, by identifying the underlying conflicts and where the core issues started. The focus on Jack’s therapy should be around creating a sense of Self. An essential period for the growth of the Self is in your teenage years, where you begin to own your own identity, gender and sexuality. During his adolescent development, Jack experienced a lot of trauma, mainly circling around the male figure. This may constitute to not really knowing who he is, especially as a male himself and growing up without any positive male figures.  As Jack is seeing his dad in the mirror looking back at him which filled him with ‘fear’ and ‘self-loathing’ is a reflection of the fear of who he is or may become.  Jack needs to create a separation between him and his father in order to move forward and think positively about himself and further his passion for music.

Jack formulation (a draft) – Psychodynamic approach

Using one of the examples provided, clearly summarise the service user’s experience of distress

– Jack’s father alcoholic and violent to wife and children at age 10 onward (perhaps before too);
– Sexual abuse at 14;
– Unable to confide in family about sexual abuse;
– failed GCSEs while having strong expectations of having to carry on family business;
– troublesome relationship with father (love/hate);
– inability to hold down a job due to relapse into alcohol;
– forced to move (loss of comfortable house and community);
– financial problems;
– degradation of mother’s health

Provide a plausible explanation of the development and maintenance of the service user’s difficulties, and how they may relate to one another; drawing on psychological theory and principles and details provided in example

Factors related to Jack’s distress are numerous. Some factors related to Jack’s past seem to highlight some of the more impactful ones. These include being exposed to an alcoholic and violent father figure at the age of 10 onwards and being sexually abused at the age of 14. Following the repeated experiences of repeated domestic violence of his father towards his mother and siblings, Jack may have developed complex trauma that would put him at an increased risk for additional trauma exposure as well as increased risk towards addictive behaviours and development of psychiatric disorders (Cook et al.).
Manifestation of these two more salient problematic experiences can be recognised throughout Jack’s life. Jack has developed a maladaptive tendency to withdraw from the harshness of reality with the use of alcohol (from the age of 15) (Cooper et al.), which appears to have cost him to fail his GCSEs, several job placements, furthered his financial problems and led him to lose contact with his mother who kicked him out of the house due to financial strain.

Effectively outline the benefits and limitations of diagnosis – for explaining the service user’s difficulties and devising an intervention

A diagnosis such as schizophrenia seems to have helped the client insofar as they are now receiving medication that is helping them deal with some of their hallucinations and delusions.

Briefly outline an intervention plan clearly related to the service user’s experience of distress and your explanation of the development and maintenance of the service user’s difficulties

The use of a psychodynamic approach is in the hope of addressing the more traumatic experiences such as violence and sexual abuse which did not appear to have had the space to be expressed around the time they happened. It is hypothesised that these more negative experiences are tied to the rise of schizophrenic symptoms and the tendency to “escape into fantasy”. Perhaps due in part to the repression of negative experiences – which weren’t processed at the time they happened – as a survival strategy. Although there is no definitive causal link (more correlational) between maltreatment, abuse and schizophrenia (Sideli et al.) there are different sources that report different cases of people fantasising following emotional/physical abuse as a coping strategy (Somer, 2002).

The downsides of applying a psychodynamic approach is due to the amount of difficulties Jack had to face before and after these traumatic experiences. Perhaps an approach that might help Jack cope with his current problems (difficulty with keeping a job, drinking and lack of social connections), a third wave therapy approach such as ACT (acceptance and commitment therapy) might be more beneficial (Gaudiano et al.).
It is useful to know that however harsh the client has had it, they have still managed to get this far. It will be useful, once reached a more stable baseline, to remind the client of their past and current strengths, whenever they come to the surface during therapy (sociable at school, talent for music). Self-compassion will be difficult to come by when experiences of abuse tend to create feelings of shame, guilt and self-judgement


Cook, Alexandra, et al. ‘Complex Trauma in Children and Adolescents’. Psychiatric Annals, vol. 35, no. 5, May 2005, pp. 390–98. (Crossref), doi:10.3928/00485713-20050501-05.

Cooper, M. Lynne, et al. ‘Coping, Expectancies, and Alcohol Abuse: A Test of Social Learning Formulations.’ Journal of Abnormal Psychology, vol. 97, no. 2, 1988, pp. 218–30. (Crossref), doi:10.1037/0021-843X.97.2.218.

Gaudiano, Brandon, et al. ‘Acceptance and Commitment Therapy for Inpatients with Psychosis (the REACH Study): Protocol for Treatment Development and Pilot Testing’. Healthcare, vol. 5, no. 2, May 2017, p. 23. (Crossref), doi:10.3390/healthcare5020023.

Sideli, Lucia, et al. ‘Do Child Abuse and Maltreatment Increase Risk of Schizophrenia?’ Psychiatry Investigation, vol. 9, no. 2, 2012, p. 87. (Crossref), doi:10.4306/pi.2012.9.2.87.

Somer, E. (2002). Maladaptive Daydreaming: A Qualitative Inquiry. Journal of Contemporary Psychotherapy.

Jacks Case study

Jack’s family started off well off with his mother staying at home raising the family. His idea was to carry out his family’s business therefore he had a positive perception of succeeding with the family’s business. This was a positive psychological idea; however, he may have felt under pressure.

Jacks father was an alcoholic who was violent towards his mother and kids. This started off when he was young, meaning there were issues in his early childhood.  This resulted in Jack coping by taking drugs and drinking as early as 15 as well as him failing his GCSE’s. Causing mental health problems with jack that were unnoticed until later after he had been kicked out and ended up sleeping rough for some months.

Jack was sexually abused at the age of 14 by a male, later with his parents divorcing and his father moving back to Italy. His sisters felt they were better off without him and the family ended up moving to Bristol where his mother had low income and got burgled more than once. His mental health deteriorated, having paranoia and delusions due to his past experiences. Jacks health improves when positivity is in his life, helping at a hospital and working with the homeless. However, his traumatised by his past and when something relates to his experiences it causes jack to go downhill. By acknowledging his situations and relationships with people, improvement can be made for the present and future rather then visualizing the past and letting it affect the his future.

jacko’s formulation

Formulation for Jack (not sure on what approach I used)

Jacks psychological issues may have started from the pressure he was under to potentially take over his fathers business when of age. The fear of his abusive father exacerbated this, witnessing his father be violent to his mother and other siblings may have caused Jack to have even more pressure that he would have to be the protector of the family.
Jacks alcohol abuse may be a learnt behaviour after watching his father abuse alcohol for so long. Regardless of the Fathers abusive nature and excessive alcohol consumption Jack still looked up to his father. Jacks alcohol abuse could have started as an imitation of his father. Due to the alcohol consumption from an early age a once promising student Jack went on to fail his GCSE’s . Jack efforts at school were thwarted by his parents splitting up at this time and his father leaving. These added stress to Jack’s life as he was now the male of the house. Jack also couldn’t comprehend why his father had left and didn’t want any contact with him. Although his father leaving was detrimental to his families life, i.e. losing the family home and forcing Jack’s mother to work, Jack still wanted contact. This feeling of rejection from his idealised father may have caused the start of depression as Jack may have felt he was not good enough. Another close relationship Jack had was with his boss at the age of 14, this was a professional relationship that his boss abused and sexually abused Jack. This added to the fear and uncertainty that all people are abusive and let you down.
The move of house into central Bristol only worsened Jack’s insecurities and substance abuse. Their family home constantly got broken into leading his family and Jack to feel unsafe in his surroundings. Also, Bristol is renowned for its drug culture, this is something Jack could not resist. Then partially funding his habits with petty theft. Due to his substance misuse Jack could not hold down a job for longer than a couple of months. This along with his substance misuses and mood swings resulted in Jack having violent arguments with his mother. Jack’s mother could not deal with Jack anymore and kicked him out. Being homeless made Jacks insecurities worse as he felt unsafe without a home and rejected by his mother, this exacerbated his feeling of being rejected by his father. At this time Jack was referred to psychiatric services who diagnosed jack as depressed. These symptoms seemed to subside briefly as Jack was in touch with a project for the homeless, this gave Jack some stability and purpose.
Jack’s mother then developed some serious health issues and was financially in a bad place. At this time Jack began to develop his on mental health issues getting diagnosed with Paranoia and persistent delusional disorder. The Paranoia may have developed by the constant battle Jack has had his whole life. That when something is good something bad happens and the lack of stability and safety gave him paranoia around his life. Regarding the delusions the excessive substance abuse along with the physical, emotion and sexual abuse have mental scared jack into having these delusions. This was not helped by Jack not receiving the correct care at the time of the incidents as therapy could have aloud Jack to talk about these issues rather than living with the burden of them. the delusions were of Robbie Williams who may be seen as a strong male role model something Jack did not have. This could have made him intimidated of him therefore creating the delusions that he would beat Jack up or had raped his sister. Regarding the delusion of Williams raping Jacks sister, this maybe down accounted for Jack being sexually abused himself and feeling helpless about this and he sees his sister in a similar circumstance to himself due to their similar up bring. This may be why He believes these delusions. Jack also had a delusion of seeing himself as his Dad in the mirror, this maybe down to the fact he believes he has turned into his Dad by being abusive and abusing alcohol. All these delusions enviably saw Jack admitted to hospital at the request of his family. This gave him the stability he needed, and he started to see improvements and became more settled. Jack willing took medication which was very beneficial although not all his delusions had gone. Yet he finally had a professional to talk to this about, which was a positive for Jack.


Hello all,

Apologies for my late entry to the blog. I’ve been responding to rapidly changing events in my psychotherapy practice.

How’s the assignment going?

Thanks for the posts so far. Excellent engagement with aspects of psychological formulation from different approaches.

I’ll be back daily so do post.


Jack Case Study ( Systemic Approach )

While Jack does have concerning issues on his own, such as the bouts of low moods, drinking, substance abuse, and delusions, many of these circumstances seem to be a response to the issues that were prevailing within his home life and how he absorbed the dynamics and roles of his family. By understanding the complexity of Jack’s family history and the situations they endured with their turbulent home life, one could suggest possible solutions to help Jack in the unresolved issues found in his coping methods.
An important figure in Jack’s life is his father. As the other male in the household and the prime caretaker of their family in Jack’s early life, Jack would be seen as close to him by both himself and his family members, which would be distressing considering the father’s abusive behavior. Due to the abuse being prevalent throughout the majority of Jack’s childhood, and worsening when the father was in some form of distress–such as when the father’s business was beginning to go down the drain– the father’s alcoholism would be introduced as the only “healthy” way for Jack to cope with the trauma of being sexually abused alongside the distress of having his parents separate, especially considering how violent his father was to Jack’s mother and his siblings. With this in mind, Jack’s sisters’ dislike towards their father could possibly lead to them not feeling emotionally available to Jack, whether to give him comfort during their parents’ split or to help him with the distress he felt concerning his abuse. This distrust or disdain from his sisters could lead to Jack’s already conflicting feelings towards his father being distressing and hard to accept, seen with his fear and self-loathing when seeing his resemblance to his father, and it pushes him further away from the rest of his family.
While the father’s abusive behavior is important to note when considering the family dynamic, another important aspect that he brought to Jack was the traditional role a man was supposed to have in an Italian family. As his father was often seen as the primary caretaker, Jack was given the expectation for him to do the same, with him being expected to run his father’s business once he was old enough. With this role ingrained in Jack’s mind, Jack likely felt inadequate and worthless when being unable to hold down a job or having his mother take care of the finances, especially since it went against the figure that he likely related to more. This role of caretaker and provider also could lead to Jack acting protectively towards his mother and sisters, likely also being distressed with the amount of harassment and burgling that they endured in the midst of Jack’s spiral in alcoholism and substance abuse.
With Jack being unable to care for the family in terms of financial contribution, and their father–the prime caretaker at the time– being out of the picture, Jack’s family was also stretched unbearably thin with the financial strain. With losing their house and becoming financially unstable, the stress of that financial strain was likely felt by every member of the house, especially the mother who had taken on multiple jobs in order to sustain the whole family. The unfortunate circumstances of their home life with being burgled and harassed often would likely lead to the sisters and mother feeling unsafe and exhausted, and would keep Jack from confiding in them due to both the expectation of Jack needing to be the “strong man” of the house, as well as them not having the energy to give the emotional support that every member of the family likely needed. With no one to depend on and his tendency to lash out violently coming to a head in their home life, Jack likely isolated himself from his family due to not knowing any other healthy way to cope with the amount of stress and trauma he was enduring, feeling rejected, angry, and fearful. With Jack being forced out of the house and later being admitted to the psychiatric ward by his family, this fear of rejection would be fulfilled.
While Jack was diagnosed with depression, paranoia, and persistent delusion disorder in the times that he was given psychiatric services, it is difficult to say whether or not that’s truly the case. While it could give him the benefit that there is someone who won’t reject him and that there is someone who shares his experiences, it could become harmful where he may think that his diagnosis means that it won’t ever change or get better, which may only exacerbate his alcoholism and self-medication. He acknowledges that he thinks “he and his life are a mess”, and while this could be seen as a symptom of depression, considering the circumstances that he came from could lead to the therapist deciding that it’s instead a symptom of his home life. In persisting with these delusions, he’s able to escape the unbearable reality that he lives in, and would be able to protect himself or project realities upon those, such as his sister being raped by Robbie Williams, to cast the trauma he feels elsewhere so he doesn’t need to acknowledge it.
In using the systemic approach, it’d be essential to first establish a good relationship with every member of the family before considering a conversation between Jack and the rest of his family, since the lack of conversation about emotional issues may lead to them either not being open to discussing these issues or lashing out at one another. Before opening that conversation, it’d be important that Jack would first be able to identify the roles each member had in the family, how he saw himself with his family, and better understand the anxieties he had concerning his issues. Along with this, collaborating with the mother and sisters to better understand what they feel anxious about would be necessary. Due to them requesting that he be admitted into the hospital, it is evident that they are still concerned for his safety and well-being. Once they would be mentally prepared and open to jointed sessions, the therapist would utilize the trusting relationship they built with the family to mediate the discussion, guiding the family through the complexities of their dynamic, concerns, and overall feelings throughout the turbulence of their home life. Acknowledging positive aspects about the family, such as their resilience, strength, and open mindedness to consider these therapy sessions would be essential in letting the group feel comfortable and capable of continuing through the difficulty of these sessions. These discussions would definitely be made easier and more fruitful if the family eventually spent time with one another outside of these therapy sessions, whether as a group or one-on-one with one another.
Concerning the issues Jack had himself, it’d be important for him to identify certain issues within the family before connecting them to some of the issues Jack may be having on his own. For instance, it would be important for him to consider the burden that was placed on him from the heavy expectations set from his father’s role in the family, whether it be due to their culture or within the family dynamic, and to reassure Jack of what he can do to contribute to the family with the amount of effort he can give at that time. Along with this, it would be important to have a separate discussion about Jack’s feelings towards his father, and to better understand the link between his father and his methods to cope with stress and how Jack uses alcohol and substances. By acknowledging these connections and how they contribute to the distress and issues that he may be having in the present, it can establish a starting point for them to work off of in terms of unraveling the feelings he may have about these experiences and guide him to work to improve his situation in the present.