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

Jack has experienced many forms of distress throughout his life due to a build-up of ‘unresolved issues’.  Recently, he has experienced feeling “high’ in mood’ but then he often lapses ‘into tears’ demonstrating his current distress fluctuates easily. However, this is a recent development in Jacks history of distress. At the age of 4, he was sexually assaulted leaving him feeling isolated from his family which worsened after moving to a new area Jack experienced harassment and being burgled leaving him feeling vulnerable. He fell into alcoholism which led to arguments with his mother which resulted in him being made homeless and further isolated him from his family. He then struggled when his mother became ill and the family’s financial situation worsened which is when he experienced ‘paranoia’ and ‘persistent delusional disorder’. His fantasy experiences reflect his feelings of anger, loss of control and confused feelings for his father.

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

The experiences Jack has been through during his childhood through to his adult life lead to Jack repeatedly feeling lonely. After Jack was sexually assaulted, he felt alone and isolated. This was exacerbated by his parents’ divorce, losing contact with his father and being forced to leave his local community. Furthermore, the divorce would have been extremely distressing for Jack. This would of had a lasting effect as typically children that experience divorce experience more negative life events than those with married parents (Lindbery & Wadsby,2009). Additionally, those that experience parental divorce find it difficult to adjust in response to these negative events (Lindbery & Wadsby, 2009). Jack begun to struggle to deal with the emotions he felt due to losing contact with his father and Jacks’ sisters as they felt this was a good thing which caused conflict and further emotional distance between them. This led to being isolated from both his mother and sisters more extremely. This reached its peak when he was made homeless and was now both emotionally and physically isolated leading to his diagnosis of depression.

However, the main cause of distress for Jack is his self-loathing due to feeling he has not been able to protect his family. As a child there were ‘strong expectations’ for him to fun the family business thus he felt he had to protect his family. As he grew older his family’s financial worries also grew, he tried to help with his paper round however they still ended up having to leave their community and lost their home. This led to jack feeling a failure and when he could not help the family, he relied on substances to manage feelings of self-loathing. However, when his mother became ill his coping mechanisms failed and he became overwhelmed. This was the trigger event for Jacks delusions which are linked to his childhood trauma (Bailey et al., 2018). His delusion’s cause him a lot of anger as he believes that Robbie Williams ‘raped one of his sisters’ and that he is owed stolen royalties. Furthermore, he is fearful of being attacked by Robin Williams minders. His experiences of ‘psychosis’ is not uncommon in child victims of sexual assault (Bebbington, 2018). Furthermore, childhood trauma increases the risk of psychotic disorder or symptoms in later life and Jack experienced several forms of trauma In his earlier years  (Bebbington, 2018; Spataro et al., 2018; Bailey et al, 2018). Thus, a great deal of Jacks current distress stems from his childhood experiences previously highlighted.

Jack also experiences a great deal of distress due to being fearful of becoming his father. He eludes to how his father was a violent alcoholic who left him feeling abandoned. It was also his ‘male boss’ who sexually assaulted therefore Jack has had a difficult experience with male role models. This caused further confusion and mistrust for males in his life. Jack describes a ‘frightening experience’ of seeing his father’s face when he looked in a mirror, further highlighting his fear that he has become his father (a violent drunk). Jacks main male role model abused alcohol when they were in distress causing it to also be Jacks main coping mechanism despite his previous negative experience of it. Johnson and Pandina (2009) detail that alcohol use is strongly determined by use of the same sex parents and determined dysfunctional coping (such as alcoholism) in sons. This demonstrates the detrimental effect his father has had on Jacks life.

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

Diagnosis would in some ways aid Jack as he blames himself for not protecting his family enough therefore, a diagnostic label may help him blame his condition not himself as a whole. Additionally, it could help his family understand him more and understand how they could support him better and it may also ease tensions between himself and his mother.

There is a great deal of debate over mental illness labels currently and some support against them. Labelling theory indicates that people with psychosis who accept a mental illness label will function less well than those who reject a diagnosis (Warner et al., 1989). As accepting a diagnosis could make Jack feel that he is ‘broken’ and that his distress cannot be changed because ‘it is just the way he is’. This could lead to him going ‘off the rails’ again.  Thus, rejecting a label could be more effective for Jack going forward. Furthermore, the diagnostic label could add to Jacks feelings of shame and failure due to the stigma associated with them (Ben-Zeev, Young & Corrigan, 2010).

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 

Jack has tried fearlessly to protect and support his family throughout his life however, circumstances have caused the family great distress. To help Jack progress it is important he discovers he is not to blame and also develop better coping mechanisms which will ultimately help him hold down a job. Most importantly, Jack needs the support of an alcoholic’s recovery team as this is his main negative coping mechanism. This will enable him to find more positive coping mechanisms which will not affect his ability to hold down a job or cause conflict with his family as his substance abuse does. The alcoholics anonymous meetings will also help him evade relapses, furthermore as he is a very social and previously ‘popular’ child he will hopefully engage with the AA community. This will enable him to make lasting bonds with sponsors and other members. Humphreys et al. (1999) reported that ‘enhanced friendship networks’ and improved active coping mediate reduced substance abuse during self-help programmes.

Furthermore, regular Cognitive Behavioural Therapy sessions would aid Jack in understanding his feelings and to further enhance his coping. Despite struggling to hold down a job, Jack has shown great resilience due to the fact he kept applying and trying new jobs. Jack demonstrates a great desire to improve therefore if he applies this to the sessions and the alcohol recovery programme, he could be very successful. The sessions will also help him feel listened to as he currently does not. It will also allow him to understand his fantasies and how to manage his behaviours in response to them.

References

Ängarne-Lindberg, T., & Wadsby, M. (2009). Fifteen years after parental divorce: Mental health and experienced life-events. Nordic Journal of Psychiatry, 63(1), 32–43. https://doi.org/10.1080/08039480802098386

Bailey, T., Alvarez-Jimenez, M., Garcia-Sanchez, A. M., Hulbert, C., Barlow, E., & Bendall, S. (2018). Childhood Trauma Is Associated With Severity of Hallucinations and Delusions in Psychotic Disorders: A Systematic Review and Meta-Analysis. Schizophrenia Bulletin, 44(5), 1111–1122. https://doi.org/10.1093/schbul/sbx161

Bebbington, P., Jonas, S., Kuipers, E., King, M., Cooper, C., Brugha, T., Meltzer, H., McManus, S., & Jenkins, R. (2011). Childhood sexual abuse and psychosis: Data from a cross-sectional national psychiatric survey in England. The British Journal of Psychiatry, 199(1), 29–37. https://doi.org/10.1192/bjp.bp.110.083642

Ben-Zeev, D., Young, M. A., & Corrigan, P. W. (2010). DSM-V and the stigma of mental illness. Journal of Mental Health, 19(4), 318–327. https://doi.org/10.3109/09638237.2010.492484

Humphreys, K., Mankowski, E. S., Moos, R. H., & Finney, J. W. (1999). Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? Annals of Behavioral Medicine, 21(1), 54. https://doi.org/10.1007/BF02895034

Johnson, V., & Pandina, R. J. (1991). Effects of the Family Environment on Adolescent Substance Use, Delinquency, and Coping Styles. The American Journal of Drug and Alcohol Abuse, 17(1), 71–88. https://doi.org/10.3109/00952999108992811

Spataro, J., Mullen, P. E., Burgess, P. M., Wells, D. L., & Moss, S. A. (2004). Impact of child sexual abuse on mental health: Prospective study in males and females. The British Journal of Psychiatry, 184(5), 416–421. https://doi.org/10.1192/bjp.184.5.416

Warner, R., Taylor, D., Powers, M., & Hyman, J. (1989). Acceptance of the Mental Illness Label by Psychotic Patients. American Journal of Orthopsychiatry, 59(3), 398–409. https://doi.org/10.1111/j.1939-0025.1989.tb01675.x