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. DOI.org (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. DOI.org (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. DOI.org (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. DOI.org (Crossref), doi:10.4306/pi.2012.9.2.87.
Somer, E. (2002). Maladaptive Daydreaming: A Qualitative Inquiry. Journal of Contemporary Psychotherapy.