Psychology of Trauma – A12

 

Assignment  12 

      

Vignette Analysis III

:
This  assignment focuses on vignette analysis and direct application of  course concepts to the persons and situations presented in the  vignette.   All discussions must take into account the legal and ethical  considerations, as well as cross-cultural issues that pertain to the  situations presented below.

Use  the reading assignments thoroughly in an integrative discussion. All  assignments MUST be typed, double-spaced, in APA style, and written at  graduate level English. Be sure to cite your work according to APA  format. Please keep your responses focused on what is presented in the  vignette. Do not add information but use your creativity to support what  you see in the vignette as written. Avoid elaborations and assumptions.

The  course text is the primary resource for this assignment. You should be  citing the text often to support your discussion (along with the DSM-5).  Outside references should be minimal, except for culture.

Note:  Cultural  information can be found in the DSM-5. You are also encouraged to use  outside Cross Cultural sources as needed, but please reference if doing  so. 

Discussion must be 6-7 pages plus a title and reference page.

Vignette Analysis III

Vignette Analysis III will be covering Chapters 7 and 8 in the course text and the relevant DSM-5 disorders.

Your  discussion must include the relevance of the following areas covered in  the text, directly and specifically to the persons and situations  presented in the vignette:

• Group, couple and family therapy
• Inner emptiness
• Working in the breach
• Unresolved trauma and loss

Vignette Three

Virginia  is a 45 year old African-American woman who was referred by her medical  doctor. Her doctor is concerned about Virginia’s suicidal gestures and  weight loss. Virginia tells you that her doctor is, “overreacting. I’ve always been afraid of being fat, so I like to be on the thin side. Where  I come from, a woman’s looks were her ticket to freedom. My dad left  mom and I when I was 8 because he found a young skinny woman. I begged  him not to leave, but he just laughed at me. I never saw him again.” Virginia  has memories of her dad beating her mom, “it seemed like every day, but  it was probably not that often. He never touched me. If my mom would only have taken better care of herself, stayed thin and pretty, my dad would have never left.” Virginia  tells you that her mom remarried when she was age 13, “to some jerk  with a teenage son who thought I was a sex toy for him and his friends. I  tried telling my mom but she told me to be quiet, that I had it good  and to just put up with it. So, I learned that if I cut myself, the pain  would go away. My mom and I are very close today, and she is worried  about me.”

Virginia  is currently married to her second husband of 6 years. The couple has a  5 year old son who she describes as a “miracle baby given my age and  history.” She admits to having a history of several tumultuous, abusive relationships. She  describes her current husband as “sweet and patient. I don’t know why  he puts up with me. He’s a great father, like the one I wish I had.” She  knows that she deserves to love and be loved, but she is afraid to  allow her husband to get close, “I just know he is going to walk out on  me. I feel like I’m lost in  some time warp. The only way to protect myself is to start screaming and  cussing, while at the same time, begging him to never leave me.” Virginia  denies suicidal ideation at present, though she does admit to some,  “not serious attempts as a teenager.” Your diagnosis for Virginia is  PTSD.

References: 

Courtois, C.A. & Ford, J.D.    (2015).   Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach.   The Guilford Press.      ISBN 978-1462524600

Running head:

Vignette Analysis III

1

Vignette Analysis III 7

Psychology of Trauma- Vignette Analysis III

Laura Kay Utgard

Cal Southern University

Dr. Barbara Lackey

PSY: 87519

August, 2018

Vignette Analysis III

Emotional and psychological trauma is the outcomes of extremely stressful occasions that ruin one’s sense of safety, letting the victim feel deserted in a dangerous world. Traumatic experiences like the one experienced by Virginia in her younger age predisposes her to get involved in actions that put her life in danger like trying to commit suicide. According to Courtois & Ford (2015) “it is not the objective facts that determine whether an event is traumatic, but the victim’s subjective emotional experience of the event.” In the case of Virginia, she faced ongoing, relentless stress during her childhood development in the position of an abusive father. The domestic violence has changed her biological and physical development because she also believes having a slender body is what it takes to be a woman to maintain her husband. This has resulted in the development of post-traumatic stress disorder (PTSD) because she has been exposed to traumatic events in her childhood.

The fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) outlines four major symptoms that PTSD patients experiences. They include alterations in arousal and reactivity, negative alterations in cognitions and mood; avoidance and intrusion. These symptoms are what are causing Virginia to be diagnosed with PTSD. She remembers how her mother was being beaten like almost every day and how she was used as a sex toy by the village boys. The DSM-5 version re-positions emotional distress in a group that comprises negative perceptions and reactions, while stimulation symptoms are transposed in a group comprising ill-tempered and irresponsible behavior. PTSD according to (Kendall-Tackett & Ruglass, 2014) is linked with an array of opposing personal results and significant personal problems, including problems in intimate and family affairs. It is unclear which topic you are addressing here

The inter-relations among the PTSD victims and their family complications are probably multifaceted, showing both the effect of post-traumatic symptoms on other family members and impacts of the family setting. This happened to Virginia, as a kid he was experiencing how his father used to treat her mother. Contrarily, avoidance symptoms may diminish participation in family undertakings, while emotional distress can diminish self-disclosure and intimacy (Courtois & Ford, 2015). Hyperarousal symptoms are associated with irritability and annoyance and can as well precipitate violence and family conflict (Anderson, 2017). Contrarily, prospective studies of veterans show that family environment can reduce the severity of symptoms, or exacerbate complications of interpersonal arrays are dysfunctional. This case, therefore, Virginia experiences these inter-relations problems in her family leading to the development of PTSD due to traumatic events she underwent in her family. Great general analysis, but you needed to address one of the topics listed in the syllabus.

Inner emptiness

The feeling of emptiness Virginia is facing is because she is lacking the purpose to live. She was used as a sex toy while in her teenage, in life, she has been divorced and she is feeling insecure in the society.Well analyzed Developmental trauma like the one Virginia has been facing since she was young results from a series of repeated, often (invisible) childhood experiences of maltreatment, abuse neglect, and situations in which she had little or no control or any perceived hope to escape. Growing up in this abusive environment full of unpredictability, danger, parental inconsistencies, Virginia was left with “hidden traumas” that disrupts not only her psychological well-being but also her neurological and emotional development.

According to researchers, it is easy to identify the state of a child when he or she is explicit, physically, or sexually abused, but the aftermath of having “un-present non-caring parents” would be elusive and escape the collective awareness of a child (Kendall-Tackett & Ruglass, 2014). In some instances, the trauma that leads to emptiness maybe as a result of what caregivers omitted rather than what they commissioned. ?committed

PTSD traumas like the one Virginia is experiencing would unlikely be a result of shock trauma but the physical abuse and psychological injuries caused by emotional abandonment or alienation which in most cases are invisible and unacknowledged. This may have left Virginia with the feeling of confusion, assuming that her traumatic tribulations are not justified (Perrin et al., 2017), which may turn to blame and shaming herself. Even after becoming an adult, she has tried to suppress and deny these painful memories as they dismissively compare her trauma to those who were more “noticeably” abused (Bovin et al., 2016). Better relevance to the topic of emptiness as analyzed and applied to Virginia. Laura

Different studies have postulated that a broad array of psychological difficulties finds their roots in these chronic childhood relational and attachment injuries (Kendall-Tackett & Ruglass, 2014). Children who experience this type of trauma that makes them feel empty inside Relate to Virginiahave a disrupted ability to control their emotions, behaviors, and attention, plus these symptoms often extend into adulthood, leading to clinical presentations such as complex PTSD, chronic physical pain and ADHD, and Bipolar disorders (Perrin et al., 2017). These are not presented. Address only symptoms suggested or indicated in the vignette

Theoretical models to explain Virginia’s clinical presentation

Different models focus on the role of turbulence in memory and contend that changes in the usual progressions of memory are vital to knowing the progression and maintenance of PTSD. One of these theories stipulates that “when trauma-related memories are not properly incorporated into memory, victims may re-experience symptoms of PTSD” (Perrin et al., 2017). The purpose of designing psychological models of abnormality is to interpret the observations in the case of anomalous behavior. The unique frameworks employed by these theories describe the aspects of human functioning and thereby the differentiated facets of abnormality.

The intense affect during the traumatic situation and its associated physiological stimulation have been linked with the development of PTSD. Trying to detach in the course of event progression has been found to be a significant predictor of PTSD. In extraordinary cases of exposure to threat conditions, the strong effect can lead to detachment and inhibit trauma-associated information from being completely consolidated within memory. Inadequate consolidation of memory may make a person like Virginia’s case hold back a limited amount of information concerning the event plus it may make a person’s memory less accessible. The aptitude to have a full access to memory or complete trauma-related memories is a key element of various psychological models of PTSD prevention and management. To which topic are you relating this? Could be unresolved trauma

Another model that associated development of PTSD is the stress hormone that is released during the traumatic event. A group of researchers has found that increased levels of cortisol and adrenaline can interrupt the normal creation of memories, while others have found that stress hormones enhance memory consolidation (Bovin et al., 2016). ???? Related to what concept?

Cognitive theories of PTSD are grounded on the idea that information related to the traumatic situation is unpredictable with the type of data enclosed in a person’s core cognitive schema. In this case, therefore, Virginia who was exposed to a complex traumatic incident attempts to make sense of the experience but has a challenging moment to completely incorporate it into her existing schema. With time, this form of dissociation demonstrates itself in the symptoms and behaviors grouped as PTSD. Maladaptive principles associated with the traumatic incident have also been recognized as a risk factor for the development of PTSD. Seems that you have strayed into theory w/o application of course concepts called for in the vignette

Ethical considerations when dealing with Virginia’s case

A therapist in most cases experiences various complex ethical issues when managing patients that are traumatized. It is vital to any psychoanalysts to establish a strong personal and professional ethics to complement expert values, pertinent laws, and proper codes of ethics. In our presented case, therefore, a therapist who is handling Virginia should be guided by fundamental ethical principles in order to reach across specific codes. One ethical principle to be considered is the practicing autonomy. Being autonomous during the counseling process fosters the right to control one’s life. Thus, the therapist should be in a position to have an informed consent and assisting Virginia to evaluate the implications of her decisions in the context of her personal goals. Another ethical consideration is nonmaleficence whereby a therapist should avoid actions that might cause harm. This is applicable in our case where a therapist refrains from conducting activities that exceed Virginia’s competence. Well analyzed, Laura

The third ethical principle is working under beneficence where the good of the victim comes with strategies used to promote personal and social well-being. Virginia’s challenge is to erase the early childhood memories, thus, the therapist should work towards selecting interventions that will best suit her to overcome the challenges at hand. The fourth ethical principle is to conduct counseling by treating the patient equitably and fostering fairness and equality. Relate to VirginiaThe fifth principle to consider is the ethics of fidelity, where a therapist honors the commitments, keeping promises, fulfilling one’s responsibilities of trust in professional relationships. This is applied well when one listens carefully and acts justly. Same as above

Unresolved trauma and loss

Unresolved Trauma has been haunting Virginia’s life for a long time. She has tried to forget and erase the memories but all have ended up in vain. Therefore, perhaps the most significant thing )actionthat can be done by Virginia to resolve her unresolved trauma is to create a coherent narrative (Kendall-Tackett & Ruglass, 2014). Creating a coherent narrative can be a powerful tool for resolving early childhood trauma. If Virginia can make sense of her history, she can be able to free herself from the burdens of stress. It will help her break destructive intergenerational cycles to become a stronger person in her current life.Examples? eg being more concerned about daughter’s welfare?It will lead her to develop a more secure life within her fears and provide more security for her family.

Treatments

The PTSD treatment in relation to this case is based on the psychological management. Some of the considered psychological treatments methods are trauma-focused cognitive behavioral therapy (TF-CBT) whereby the client’s past memory is confronted and coming to terms with it. Secondly is using eye movement desensitization and reprocessing (EMDR) where in this case Virginia is directed to rapidly move the eyes back and forth while focusing on the traumatic thoughts and images. The third therapy method used is non-trauma focused psychological interventions where stress inoculation training techniques are used where trauma-focused therapy such as TF-CBT does not seem to be functioning. And the last method is internet therapy where self-help is encouraged in situations of no other alternatives.

Conclusion

Psychological trauma is common and leads to PTSD in a considerable number of people exposed to trauma. Therefore, when PTSD is controlled, the burden of associated impacts on the individual sufferings would reduce. Instead of waiting for PTSD to develop, cases such as this of Virginia should be identified early, and preventive interventions offered immediately after the exposure.

I see fine coverage of inner emptiness and ethics related to Virginia, Laura

Organization and clarity issues. The remainder of your analysis, whilech excellent, does not speak to your ability to analyze and apply the topics. See below: +50

Group, couple and family therapy – missing

Inner emptiness – fine analysis

Working in the breach – missing

Unresolved trauma and loss – missing

Please revise and resubmit Laura, I am wondering if you are reviewing my feedback. I wonder if a writing course would help you to apply your excellent potential better. I shall suggest this to your advisor and strongly suggest you do the same. Let me know your thoughts.

References:

Anderson, K. M. (2017). Children’s protective strategies in the context of exposure to domestic violence. Journal of Human Behavior in the Social Environment, 27(8), 835-846.

Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD checklist for the diagnostic and statistical manual of mental disorders–fifth edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379.

Courtois, C.A. & Ford, J.D. (2015). Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach. The Guilford Press. ISBN 978-1462524600

Kendall-Tackett, K. A., & Ruglass, L. M. (2014). Psychology of Trauma 101. Springer Publishing Company.

Perrin, S., Leigh, E., Smith, P., Yule, W., Ehlers, A., & Clark, D. M. (2017). Cognitive therapy for PTSD in children and adolescents. Evidence-based treatments for trauma-related disorders in children and adolescents (pp. 187-207). Springer, Cham.