- Clearly summarize the service user’s experience of distress
It is evident from Jack’s case study that he has experienced many highly traumatic and distressing events which have impacted his mental health. Jack has been described as suffering from periods of low mood where he would ‘lapse into tears’ and periods of mania, where he would experience ‘quite high’ moods. Jack’s experience with significant male role models in his life such as his violent father leaving and the sexual abuse he received from his boss during a crucial part of his development may have contributed to the delusions he began experiencing after a particularly stressful time in his life (being made homeless and learning of his mother’s health problems). The delusions he frequently spoke about included Robbie Williams raping his sister and wanting to kill him, as well as commonly seeing his father’s reflection when looking in the mirror. These delusions highlight the fear that Jack experiences as a result of his past trauma. Furthermore, Jack suffered from substance abuse; taking drugs and drinking to cope with the unspoken trauma of his sexual abuse and the loss of 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 the example
Due to the emotional pain inflicted on Jack as a result of his previous life experiences, this formulation adopts a psychodynamic approach, which focuses on how Jack’s current situation has been shaped by his history and past relationships (Hinshelwood, 1991). In particular, Jack’s relationship with his father, his unstable home life and sexual abuse are all factors that will be considered.
Throughout the case study, it is evident that Jack identifies with his father. He has a complicated mixture of emotions for his father and struggles to understand whether he loves or hates him. Jack has also previously spoken of hallucinations he has had where upon looking in a mirror, he sees his father’s face in the reflection, this could imply that Jack is afraid of becoming his father. This is also highlighted in behaviours that Jack may have subconsciously adopted from his father, such as violence in the home, which Jack witnessed and was a victim of from a young age and issues with substance abuse as Jack, although aware of his father’s issues with alcohol, began drinking himself at the age of fifteen. The unresolved issues of dealing with his father’s abuse may have led Jack to abuse substances as a way of coping with unresolved trauma. Jack’s coping mechanisms are clearly not fully effective in preventing the emotional pain he experiences, the delusions and hallucinations he experiences may be a form of defensive withdrawal to prevent these past traumas from resurfacing, although it is very clear that these delusions are based around Jack’s fears and anxieties.
- Effectively outline the benefits and limitations of diagnosis – for explaining the service user’s difficulties and devising an intervention
Receiving a diagnosis of depression may impact Jack positively as it could help him to gain access to mental health services. Furthermore, by having a psychiatric diagnosis, this may help Jack to understand how his past has impacted his present and importantly, may reassure him and even encourage him to consider treatment options (Malla, Joober & Garcia, 2015). However, the effects of a diagnosis of depression may lead to self-fulfilling prophesy, which according to Scheff (1966), may cause Jack’s depressive symptoms to dominate his self-concept, further decreasing his mental state. For Jack especially, this may prove problematic as he is evidently vulnerable and struggles with self-efficacy and control over his behaviours (as shown through his drinking habit). Furthermore, the stigma associated with a diagnosis of mental illness has been found to lower self-concept, which particularly for vulnerable individuals, can further decrease self-esteem (Pasman, 2011). Therefore, although a psychiatric diagnosis of depression may potentially help Jack to receive medical care and understand how his past has influenced his present emotions, thoughts and behaviours, it could also have adverse effects on his mental health, causing Jack to feel more anxious and defenceless.
- 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 users difficulties
Jack’s evident fragility, instability in relationships and dependence on delusions to limit his emotional pain suggests that a supportive therapeutic relationship may be the most beneficial to Jack. Dynamic Supportive Therapy includes forming a relationship between the patient and the therapist and involves listening and being empathetic to the patient and increasing the patient’s coping skills, whilst also being a perceived role model to the patient (Misch, 2006). Dynamic supportive Therapy may be particularly beneficial to Jack as not only will it teach him effective methods of coping with his trauma but will also help him to build a healthy relationship and gain trust in his therapist; skills that will help his mental functioning and allow him to accept his past to regain control of his future.
References
Hinshelwood, R. D. (1991). Psychodynamic formulation in assessment for psychotherapy. British Journal of Psychotherapy, 8(2), 166-174.
Malla, A., Joober, R., & Garcia, A. (2015). “Mental illness is like any other medical illness”: a critical examination of the statement and its impact on patient care and society. Journal of psychiatry & neuroscience: JPN, 40(3), 147.
Misch, D. A. (2006). Basic strategies of dynamic supportive therapy. Focus, 9(2), 173-268.
Pasman, J. (2011). The consequences of labeling mental illnesses on the self-concept: A review of the literature and future directions. Social Cosmos, 2, 122-127.