Trauma-Focused Cognitive Behavioral Therapy for Domestic Violence Victims

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16th Dec 2019 Dissertation Reference this

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Integrating Theory into Professional Practice

Introduction

Domestic violence, family violence, community violence, child abuse and neglect changes people. The impact it has on an individual differs from person to person. However, through research, adverse childhood experiences (ACE) demonstrates certain commonalities exist and informs the possible outcomes. “We need to intensify educational efforts to expand the availability of trauma-focused (TF) care. Public education, prevention, early identification, intervention, and effective trauma treatment are all necessary to break the cycle of violence” (Withers, 2017). People have to learn to trust themselves, change their thought process, and understand that behavior changes will eventually follow. This is what cognitive –behavioral therapy (CBT) does which boost self-esteem. Hope needs to be instilled within people to have a chance at a better society.According to an evidence summary reported by the Institute for Research and Innovation in Social Services (2012), “strengths-based perspectives (SB) enable people to look beyond their immediate and real problems and dare to conceive a future that inspires them, providing hope that things can improve” (Pattoni, 2012).

According to the American Academy of Pediatrics (2014), some stress in life is normal and may be necessary for development, in ACEs stress has become toxic;” toxic stress response can occur when a child experiences strong, frequent, or prolonged adversity, such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, or the accumulated burdens of family economic hardship, in the absence of adequate adult support. The prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems and increase the risk of stress-related disease and cognitive impairment well into the adult years” (p.2, para 6). ACEs connect early childhood trauma to experiences in adulthood. A new field of research called epigenetics is connecting child maltreatment to brain function. Epigenetics refers to alterations to the gene without modifying the code of a deoxyribonucleic acid molecule. An epigenetic modification occurs when a specific chemical inscription combines with a gene; this determines how the genes respond. When these genes respond by turning on or off, it is known as the genes expressed. Specified changes can be temporary or permanent; said changes can alter the way the genes within the brain cells express themselves. These expressed brain cells can be biologically transferred to a person’s children (Child Welfare Information Gateway, 2015). Nutrition, substance abuse, and exposure to toxins influence the chemical experiences launched by life occurrences that are either positive or negative (Child Welfare Information Gateway, 2015). Epigenetics has discovered that childhood trauma causes brain cell modifications in its victims.

In the movie, Joe the King, a story is told of an underprivileged family succumbed to addiction, abuse, a neighborhood plagued by criminal activity and violence. Along with family dysfunction and poverty; these are circumstances that don’t ensure that a child can safely get through adolescence unscathed. Using a multi-theoretical model to address the needs of the Henry family is an ACE informed- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with a strength-based perspective (SBP).

Sacks & Murphey (2018) used data from the National Survey of Children’s Health to ascertain which children under the age of 18 are more susceptible to experience trauma and the specific location of these children. The findings from The National and State-level Prevalence ACE Study Key are:

  • Poverty, parental divorce or separation report the most common ACEs
  • 45 % of children in the US have experienced at least one ACE.
  • One in ten children experience three or more ACEs, this is considered high risk
  • Children of different races and ethnicities do not experience ACEs equally.

(Sacks & Murphey, 2018)

Trauma changes family dynamics and hinders how a family function (Child Welfare Information Gateway, 2013).

Describe how the selected theory can be used to guide the processes of Assessment

According to the National Child Traumatic Stress Network (NCTSN), a child’s age, culture, and ethnicity influences coping skills and resiliency of the family from the traumatic event. Trauma changes family dynamics and hinders how a family function (Child Welfare Information Gateway, 2013). Physical abuse experienced or witnessed within the family is a considerable risk to children and increases the likelihood for the development of substantial psychiatric, behavioral, and adjustment difficulties. This includes the outward expression of aggression or imploding, displaying a lack of interpersonal and life skills, lacking age-appropriate functioning, and inappropriate emotional reactivity (Child Welfare Information Gateway, 2013). Multiple ACE exposures are detrimental to brain development and overall wellness. Once the number of traumatic episodes has been assessed and measured, the TF-CBT, “is an evidence-based treatment program intended to help children and their families deal with the aftermath of a traumatic experience” (Good Therapy, 2017, para. 1).

As an assessment tool for Joe and Mike Henry I would use this modified questionnaire developed by Elsie Allen Health Center, which is located on the Elsie Allen High School campus in Santa Rosa, CA, it includes 16 questions designed specifically for youth (Appendix A). Theresa and Bob will be given the original 10 ACE questions with the women abuse screening tool the  short version (Appendix B), which is a two-question screening tool for interpersonal violence or DV (Saimen, Armstrong, Manitshana & Govender, 2016). Once each questionnaire is completed and reviewed, each member of the family will be interviewed individually. Theresa will be given an additional assessment that contains 16 questions from the Domestic Violence Risk Assessment checklist. The intervention will be guided by the Barnet Multi-Agency Domestic Violence Risk Identification Flow Chart (Appendix D).

Describe how the selected theory can be used to guide the processes of Intervention

CBT alone is known to treat mental health conditions. It being goal oriented keeps sessions on task and productive. In CBT an individual benefit from a collaborative relationship with the therapist, however, is not told which choices to make. Individuals with behavioral and emotional concerns and those with specific problems affecting their quality of life will benefit from CBT. In focusing on trauma CBT’s problem-solving and goal-oriented approach makes it a good fit. CBT has been effective in the treatment of

  • Depression
  • Anxiety
  • Mood issues
  • Posttraumatic stress
  • Obsessions and compulsions
  • Chronic fatigue syndrome (CFS)
  • Irritable bowel syndrome (IBS)
  • Substance dependency
  • Phobias
  • Disordered eating
  • Persistent pain
  • Erratic sleep patterns
  • Sexual issues
  • Anger management issues

(Good therapy, 2017).

The therapist and individual will know which area to target first. Which makes using an ACE informed approach key ideal when working with individuals to find resolve with their current living experiences by understanding and knowing past traumatic history.

Using TF-CBT as an intervention for the Henry family is ideal. It’s sensitive, short-term, and encourages the sharing of feelings and learning to deal with difficult emotions. TF-CBT can be completed in 16 sessions. Each session lasts about an hour. The environment for these sessions has to be in a safe and stable environment. The five principles critical to this approach is

  • a sense of safety
  • promoting calm
  • a sense of self
  • connectedness
  • hope and community efficacy

(Campbell, 2014)

In TF-CBT, the therapist prioritizes intervention strategies, provides homework, and exercises for the families to practice (Good Therapy, 2017). The SBP is known to be implemented in child welfare, substance abuse treatment, and family services (Dittmann & Jensen, 2014). SBP promotes family stability, support, love, and connectedness. This improves relationships with the adults and fosters the proper physical and emotional growth in children.

TF-CBT is a psychotherapeutic approach for non-offending parents and children who are experiencing serious emotional and behavioral struggles associated with distressing life occurrences. To promote the safety of all family members and to prevent re-traumatization, each parent and child will do sessions individually. This restriction should be maintained until each family member is stabilized. The main goals are to improve family safety, parenting skills, and family growth and communication (Project Best, 2016). The design implements humanistic principles and techniques that are sensitive to trauma for both children and parents. To exhibit cultural competence with an SBP, family’s cultural, ethnic background, religious or spiritual affiliation should be a part of the treatment process. SBP refrains from using derogatory language or language that implies inferiority. SBP is a partnership between the social worker and client that encourages self-efficacy and perseverance (Dittmann & Jensen, 2014). Placing individuals in control of their process is healthy and empowering. This modality is trauma specific, family-centered, and strength driven. When individuals take an active part in their course of treatment it provides a positive and successful experience. Partnering with families to attain optimal safety, recovery, and healing in the aftermath of trauma is the goal. TF-CBT consist of three phases and eight components that use the acronym PRACTICE.

  • Phase One – Stabilization
    • Psychoeducation and parenting skills and
    • Relaxation techniques
    • Affective regulation
    • Cognitive processing of the trauma
  • Phase Two-Trauma narrative
    • Trauma Narration and Processing
  • Phase Three – Integration / Consolidation
    • In vivo mastery of trauma reminders
    • Conjoint child-parent sessions
    • Enhancing future safety and development

(Good Therapy, 2017)

Each parent and child, in the case of the Henry’s, will receive all eight components individually. By verbalizing the traumatic experiences, the individual gains skill sets that help regulate responses to trauma by becoming an authority in refraining from trauma reminders and memories (Cohen & Mannarino, 2015). To recover and develop skills for a new way of living healthy children that have been in a DV situation and survivors need to attend a therapeutic process, it is crucial wellness.  Studies have shown that young boys that have watched their father abuse their mother, the likelihood of them being abusive to their partners increases (Good therapy, 2017).

Describe how the selected theory can be used to guide the processes of Evaluation

CBT uses various techniques and therapeutic tools to help an individual increase their emotional and behavioral awareness in order to start the change in their unhealthy patterns. These tools also help the CBT therapists evaluate progress. When homework (i.e. practical exercises, writing or reading assignments) is completed during an individual’s personal time therapy.is being reinforced. Some CBT techniques are:

(Good Therapy, 2017)

In a 2017 article, Improvements in personal resiliency among youth who have completed TF-CBT: a preliminary examination, assessed various aspects of self-efficacy and resiliency. It affirmed that youth between the ages of seven through 17 impacted by trauma improved their   self-efficacy and resiliency, after completing TF-CBT. The measurable areas of positive change were seen in the development of mastery, relatedness, and emotional reactivity in adverse times. Joe and Mike would benefit from an ACE driven, TF-CBT with an SBP, to develop resiliency.  Which is “managing adversity and recovering emotionally, socially, and physiologically in the aftermath of trauma or stress” (Deblinger et al., 2017, p. 133). Results have shown that 80% of children who had been traumatized demonstrated improvement within 16 sessions (Good Therapy, 2017). Each would progress in time with the aid of this therapeutic intervention (Deblinger et al., 2017).

Weaknesses

  • This modality is short-term but isn’t a quick fix for severe trauma. It may be necessary to address emotional and behavioral issues prior to beginning the sessions.
  • Expertise in the clinician, a traditional approach to therapy, and full cooperation from the family and individuals increase a deeper insight into the psychological and emotional causes of their behavior.
  • Suicidal adolescents and substance abusers may temporarily experience a worsening of symptoms at the gradual exposure component.
  • To be of some assistance the pace and sequence of phases may need to be tailored to the child. Chronic adolescent runaways, cutters, or other para-suicidal behaviors may need a stabilizing therapy approach before TF-CBT is attempted

(Good Therapy, 2017).

Strengths

The effectiveness of TF-CBT is measured at moderate to high levels when compared to a control group and other forms of CBT interventions. These are the TF-CBT results in the treatment of the mental health disorders.

  • Posttraumatic stress disorder (PTSD) symptoms:
    • high effectiveness
    • Strong findings indicate that TF-CBT decreases PTSD symptoms over time
  • Depressive symptoms:
    • moderate effectiveness
  • Most findings of TF-CBT studies was a decrease in depressive symptomology.
    • Behavior problems and sexual behavior problems:
    • moderate effectiveness
    • In the majority of the studies, TF-CBT decreased these behaviors over time; however, TF-CBT did not consistently show greater reductions compared with control groups.
  • Parenting practices for a non-offending parent(s):
    • moderate effectiveness
    • A couple of studies showed that TF-CBT increased parenting practices and improved the parent’s emotional response to the child’s trauma over time.

(Ramirez de Arellano et al., 2014)

 

Explain how the theory guides social work practice with both individuals and families.

A theory is a system of concepts that assist in explaining why occurrences happen in a certain way and are able to predict outcomes (SocialWorkDegree.net, n.d.). Social work is grounded by theories in order to help people help themselves through empowerment. Social workers facilitate positive changes in the behavior of individuals, families, and community. Helping people is a complex and by making theories the foundation for social work practice allows social workers to better understand the task, set goals, and foresee possible outcomes (SocialWorkDegree.net, n.d.). Various theories use information from other disciplines, such as biology, psychology, and economics. Three main categories of theories assist in understanding the relationship between human development, personality, family systems, and political power on the thought process and how behavior is impacted. Social work is guided by many theories. A few are:

(SocialWorkDegree.net, n.d.)

Orienting Theories describe and explain behavior, specifically how problems develop. These types of theories attempt to explain societal ills such as poverty, mental illness, crime, and racial discrimination.

  • General systems theory focus on understanding the human condition and consideration of cross-cultural elements, systems theory has helped drive social work’s understanding of human behavior in the social environment.
  • The psychodynamic theory focuses on the emotional development and the key role it has on human behavior. Social workers implement this when dealing with a client who has suffered past trauma or abuse.
  • Social learning theory focuses on the development of cognitive functioning with an understanding of how, in an individual, those cognitive structures enable adaptation and organization. Social workers dealing with problem behavior, employ this theory when the focus is to change the reinforcement that perpetuates the behavior.
  • Conflict theory attempts to explain how power structures and disparities impact the lives of people. Life is characterized by conflict, open or through exploitation, instead of consensus. The unequal division of power in society perpetuate various forms of oppression and injustice through structural inequality. This ranges from the unequal distribution of wealth to racial discrimination. Dominant groups maintain social order through manipulation and control. People advance their own interest over the interests of others. However social change can be achieved by interrupting periods of stability (conflict). Social workers address the imbalance in these power relationships, aiming to even the scales, therefore, reducing grievances between groups and individuals.

(SocialWorkDegree.net, n.d.)

Practice Perspectives are a certain way that social work is viewed and thought about and are commonly used to assess relationships between people and their environment by offering a conceptual lens of social functioning. Social workers commonly use three perspectives as a framework to offer guidance.

  • Ecosystems perspective assume that problems faced by an individual arise from life transitions, environmental forces, and interpersonal pressures. The social worker using this perspective has to take into consideration the following in a client’s environmental context:
    • how the individual exists within families,
    • how the families exist within communities and neighborhoods,
    • how individuals, families, and neighborhoods exist in a political, economic, and cultural environment
    • how the environment impacts the actions, beliefs, and choices of the individual.

When social workers are faced with a client who is having trouble functioning within their environment, the emphasis is placed on using the client’s ability to adapt to their environment by guiding them to process information differently and positive energy exchanged instead of negative. This perspective is required active participation.

  • Strengths perspective assumes that strength exists in every individual, family, group, organization, and community. By focusing on these strengths difficulties are overcome. The social worker facilitates the client’s use of their internal natural strength, allowing them to decide what helping strategies will be effective or ineffective.
  • Feminist perspective takes into consideration gender roles and the lack of power experienced by women in society. Social workers employ this perspective which emphasizes the equality and empowerment of women.

(SocialWorkDegree.net, n.d.)

Practice Models focus on children, youth, and families by providing guidance and expectations that improve outcomes and address the problems themselves. These models incorporate various theories as a basic tool to facilitate change step-by-step in client sessions. The social worker’s choice of perspective will influence their choice of both theory and model. A few common practice models that social workers and client’s use include:

  • Problem-solving brainstorming possible solutions, pick a solution, try it out, and evaluate effectiveness.
  • Task-centered breaking the problem down into achievable tasks, using rehearsals, deadlines, and contracts to maintain drive and motivation.
  • Solution-focused identifying the solution, the desired future, and then working together to establish the steps that will lead to the solution.
  • Narrative re-authoring their own life by reexamining oft-told stories to get at a more basic truth.
  • Crisis reducing the impact of an immediate crisis, learning to respond more effectively to stressful events by employing both internal and external resources, and restoring the individual to a pre-crisis level of functioning.

(SocialWorkDegree.net, n.d.)

Critique and apply knowledge to understand the person and environment.

In Joe the King, Joe Henry is a 14-year-old, small in stature, malnourished, and an unkempt prepubescent boy who supports his family by working part-time, washing dishes after school at a dirty and greasy diner. Joe and his brother Mike both have jobs after school. As a result, Joe was tardy all the time, slept in class, and wasn’t able to work up to his potential in school. Being late to school would land Joe in detention where he met the guidance counselor, Len Coles. According to Ridgard (2015), providing students exposed to violence with effective interventions may help to decrease the disproportionality of discipline, given that children’s exposure to violence is directly related to truancy and suspension from school (Ridgard et al., 2015). To survive and to feed him and his brother, Joe resorted to committing minor criminal activity (stealing). Mike got away with misbehavior because the attention was solely on Joe and the situations he would get himself into. Joe exhibited little fear and would mouth off (curse out) whomever. Joe was an outcast and his friends were misfits as well. However, his brother surrounds himself with popular classmates who are of a higher socio-economic status. He often dismisses Joe when around those friends. Despite being very close to his brother, Joe refused to get involved in a fight that his brother was going to have after he finished work. Mike expected Joe to stand alongside him or jump in this fight. Joe had made it home and at the last minute, Joe decided to go back to the school to help his brother. As he was on his way, he met up with Mike who had been badly beaten. Mike became was very angry at Joe and refused to speak to him,

As the pressures mounted and Joe’s stress levels increased so did the frequency and intensity of the crimes he committed. As a spontaneous thought to resolve his problems, Joe burglarized his employer for cash he kept hidden upstairs above the diner, In the process of the crime, Joe assaulted a coworker. The only person who figured out that it was Joe who had broken into the diner was his coworker Jorge. Jorge kept his secret. With the money he stole, Joe pays his father’s gambling debts and replaces his mother’s 50s records collection that his father destroyed in one of his fits of rage.

The guidance counselor in an attempt to help Joe called Joe’s employer in an attempt to advocate for Joe and in the process, he mentioned the injury to Joe’s forearm. Len thought he was hurt on the job. Joe was immediately terminated. After learning that Joe had the injury to his forearm, his employer speculated that Joe is the one who burglarized the diner. He called the police reported his suspicions. Joe was arrested and sentenced to time in a juvenile detention center. This is one of the end results of an accumulation of ACEs (Baglivio et al., 2017).

Statistically, Joe needs a therapeutic intervention as a priority over any member of his family. Youth involved in the judicial system are more likely to have experienced multiple forms of trauma, with one third reporting exposure to multiple types of trauma each year (Dierkhising et al., 2013) and “ 50% reporting exposure to four or more types of trauma by age 18” (Baglivio, 2017, p. 167). A child that witnesses marital violence is a contributing factor to having behavioral problems that lead to incarceration as an adult (Baglivio, 2017).

Assessment using Knowledge Typology

Using the following information from the movie Joe the King, the following assessment is made, using the “six types of knowledge: traditional, authority, intuition, common sense, science, and personal experience” (Lundahl & Hull, 2015, p. 39), using information gathered about the Henry family. It is essential for social workers to gain a deeper, detailed understanding of what each source or knowledge includes in assessing this family. According to a course room post for unit two discussion one by Lisa Jones,

  • Tradition- Assess what the current traditions of the Henry family are. Assist the family in understanding how the current traditions have not been working and gradually incorporate healthier and more socially acceptable traditions
  • Authority- Assess any visual signs of child abuse (bruising, whelps or other markings on the bodies of the children). If noted, children must be removed from the home.
  • Intuition- helps formulate a theory after an assessment is conducted.
  • Common sense- Observe the cleanliness of the children, assess the condition of the living space (cleanliness and smell), and check for food in the cabinets and refrigerator. When conducting the assessment and asking questions, common sense tells a social worker that the family members may be dishonest in answering questions.
  • Science- the sciences will allow the formulation of individual and family treatment plans using the educational background of the social worker.
  • Personal experience –Is performing all task and treatment of clients in a compassionate, empathetic, and ethical manner without bias.

Family Assessment and for each family member

According to a course room post for unit two discussion two by Lisa Jones, biological factors influence family dynamics of the Henry family by displaying poor responses to stress.  Trauma impedes brain function thus causes overly aggressive (violent) behavior or behavior that is passive and withdrawn (victim), it also causes antisocial behaviors. Trauma can cause family members to be susceptible to chronic illnesses, learning disabilities, and delinquency.  Psychological symptoms may present as anxiety, depression, or other undiagnosed mental health disorders. Individuals can exhibit a low sense of self –worth and an inability to express emotions appropriately. The societal systems in place are criminal activity, addiction, inability to maintain work, inability to retain information, poverty, a delay in maturation, and a lack of proper social and life skills. Each individual in the Henry family would have a different response to the same factors. According to Dewis and Whaley (1999), the following individual assessments have been made:

  • Bob (Joe’s father) – alcohol dependent, gambling, and nicotine addiction. Mentally, physically, and emotionally abusive. Avoidant and detachment behaviors
  • Theresa (Joe’s mother) – Mentally and emotionally abusive, DV victim, low sense of self, detached and depressed
  • Mike (Joe’s older brother) – exhibits avoidant behaviors of household realities. Detaches by surrounding himself with people of a higher socioeconomic status. He has a predisposition for addiction and addictive behaviors, malnourishment leading to physical diseases and bone disorders, propensity to live in poverty, prone to learning disabilities, having violent traits (a bully) or become a victim, low self- esteem, risky behaviors, possibly mental health.
  • Joe- is nicotine addicted and has a predisposition for other addictions and addictive behaviors, malnourishment with possible health issues, possible mental illness, propensity to live in poverty, prone to learning disabilities and violent behaviors, become a victim, low self- esteem, and risky criminal behaviors.

Cultural competence

TF-CBT has the capabilities to be implemented with diverse populations (Warfield, 2013). TF-CBT is best implemented by a therapist who has the ability to be innovative in establishing therapeutic alliances with clients. Tailoring TF-CBT to the diverse population can be a challenge, however, this treatment is adaptable and flexible. To address the unique needs of each child and their family TF-CBT has to be provided in a developmentally pertinent fashion. This modality has been culturally modified with White, Black, Native and Latino populations. It also has been adapted to assist the hearing-impaired. Studies have been conducted with refugees and internationally (Project Best, 2016). In a case study using unaccompanied refugee minors (URMs) that is a population that has been identified as a vulnerable group for developing posttraumatic stress symptoms (PTSS). This case study used a sample size of six adolescent URMs to evaluate the practical use of TF-CBT with PTSS (Unterhitzenberger et al., 2015). Adolescent URMs as a result of their status, increased the likelihood of psychopathology. Being in an unfamiliar country, separated from family or other significant people in their lives. The ACE identified is displacement. Therapists for this study were to report treatment differences in the application or content of a therapeutic session in comparison to a standard TF-CBT session. The therapist reported minor modifications to the protocol for TF-CBT. In conclusion, this study increased the number of sessions for the URMs in comparison to the 16 standard sessions. After receiving the added sessions, a decrease of symptoms was noted in comparison to the moderate to high levels of PTSS assessed prior to treatment in comparison to non-refugees and accompanied refugees (Unterhitzenberger et al., 2015). In another study conducted by Murray (2014), noted the treatment gap for mental health services which mostly neglected children and adolescents of Zambia in low- and middle-income communities (LMIC). Research suggests that evidence-based mental health treatments can be culturally modifiable when used in these communities, TF-CBT was the chosen intervention. The results demonstrated that TF-CBT is a collaborative intervention process with high feasibility, as long as there is community involvement. To increase the success of outcomes, the modifications have to be primarily focused on the implementation rather than changing the goals of TF-CBT (Murray et al, 2014).

Documented examples supporting the application of this theory to a particular case study.

According to Good therapy (2017), “several types of therapy are helpful in the process of assisting a person who has become dependent on drugs or alcohol.  In particular, CBT a person-centered therapy that relies on the person’s inert want for change has demonstrated effectiveness in this area. It is sometimes a supplemental form of support for someone who is attending a self-help group, such as Alcoholics Anonymous. Some therapies are specifically geared toward facilitating a 12-step program” (Good therapy, 2017).

Case Examples of Drug and Alcohol Abuse

Self-medicating with alcohol:

Clara, 57, has been a heavy drinker of beer and vodka for almost 45 years. However, since her husband’s alcohol-related death, her drinking has increased dramatically: Instead of weekend binges and a few daily cocktails after work, she has taken to drinking throughout each day, and she recently lost her job for missing days while hungover. She was also arrested for driving drunk and lost her license as a result. She is estranged from her two children, who, she believes, blame her for their father’s death. Clara recognizes her problem, but her anxiety and depression compel her to continue self-medicating. Eventually, she is convinced by a friend that she needs to seek help. She knows that she cannot quit on her own, so Clara agrees to enter a treatment facility. With medical help, she is able to maintain sobriety, and she begins an intensive program of therapy and 12-step groups after she leaves the facility. Soon, she begins to deal with her grief, not just over the death of her husband, but also over the many losses and regrets that come from a life spent intoxicated. Facing these realities tempts Clara to drink, and she suffers several relapses, but she is eventually able to break the habit of drinking and begins to restore her relationships with her children, which brings her a great sense of healing, accomplishment, and peace.

(Good therapy, 2017)

Bob is a parent who is an alcoholic, according to the statistics, he is more likely to abuse or neglect partners and/or children, is emotionally unavailable which weakens the attachment between parent and child. Families, such as the Henry’s, who are affected by addiction may experience financial difficulties. Some children of addicted adults (Mike and Joe) may have difficulties in school due to anxiety and other stressors and may find themselves acting as parents to siblings as well as the parent(s). This can make it difficult for the child to have appropriate boundaries and healthy relationships later in life (Good therapy, 2017).

Gambling Addiction Therapy Case Example

According to an article in Scientific American (2013), around 2 million Americans have a gambling addiction. Around 1 in 165 men will experience gambling addiction in their lifetimes compared to 1 in 500 women. An estimated 98% of action gamblers are men. Escape gamblers are more likely to be women. Gambling addiction can have devastating effects on your finances, relationships, and emotional well-being. When treating gambling addiction, research suggests psychotherapy is more effective than medication. Modalities like CBT can help individuals “retrain” their brains to reduce the urge to gamble. According to the Arizona Council on Compulsive Gambling, people who gamble compulsively can be divided into two main types of’ action or escape gamblers. Bob falls into the action category. It may take a few years for action gamblers to become addicted. Once that happens, it can take 10 to 30 years before they get treatment. Action gamblers tend to have low self-esteem. They may hide their insecurities with sociable and overconfident behavior. They often feel “high” while gambling. Action gamblers usually prefer games of skill like craps and poker, believing they have a system to beat the game. They are unlikely to quit gambling unless a trained professional helps them confront their underlying issues. Escape gamblers often start when they are 30 years or older and have led productive lives prior to developing an addiction. Bob could possibly be an escape gambler, however, there is not enough concrete information to substantiate him experiencing loss, abuse, and/or trauma. Which are criteria to fit into this category of a gambler. These people usually gamble to numb themselves to pain (Good therapy, 2017).

Developing a Gambling Addiction While Hiding Addictive Behaviors:

Henry, 43, has been feeling a bit down lately. He used to visit the casino with friends to enjoy an occasional night out. Henry enjoyed his last visit so much that he has begun returning to the casino on his own, spending hours at a time at a single blackjack table. His friends ask why he is suddenly making trips to the casino by himself, but Henry brushes off their concerns. He begins to spend more and more time at the casino, hoping to win money, since when he wins, he feels good. Sometimes, especially after nights of big losses, he lies to his wife about where he has been. One night, Henry dips into his children’s college fund to make up for his gambling losses. He suspects he is losing control and decides to get professional help. In therapy, Henry realizes he is not even enjoying the gambling. He is using gambling to numb his recent symptoms of depression. The therapist helps Henry discover several underlying emotional reasons for his behavior at the casino, many of which he was not even aware. In therapy, Henry learns skills to cope with his impulses to gamble. He continues working with the therapist to overcome his depression.

(Good therapy, 2017)

Case Example for Domestic violence perpetrator  

Domestic violence perpetrator is able to change through intervention and therapy:

Rico, 29, enters a batterer intervention program voluntarily after slapping his wife, Lucretia, so hard that she fell back against the wall and bruised her skull. Though he has slapped her in the past during arguments and often ends arguments by threatening acts of violence, he always tells her that he does not mean to really hurt her, just to “shut her up,” and that he truly wishes to change after seeing how he hurt her this time. In the program, he learns new ideas about gender equality and household roles, how to refrain from violent acts when upset, and potential methods to redirect violent thoughts into nonviolent actions. Rico’s mother always obeyed his father and never argued or challenged him, and Rico realizes that he has come to expect this behavior from his own wife. He also realizes that he has come close to thinking of her more as his possession than an actual person with her own ideas, job, and friends and that he has been encouraging her to stay home more, have children, and take care of him, rather than pursuing her own needs and desires. When the program concludes, he suggests that the two of them attend couples counseling sessions in order to discuss their goals and plans for the future, something they have never really spent much time doing. Lucretia agrees, and slowly, she is able to regain her trust in her husband as he continues to show change and improvement, as well as consideration for her needs and interests.

(Good therapy, 2017)

Case Examples for family issues

Family therapy “will address verbal and non-verbal communication styles of the family and any individual issues that interfere with the cohesiveness of the family system. By working with a therapist, families can learn to understand one another better, communicate more effectively, and work proactively to disrupt unhealthy patterns” (Good therapy, 2017).

Troubled teen:

The Jay family brings their daughter, Amelia, 13, in for therapy due to her “anger problem.” In a session with her parents, as the parents discuss Amelia’s poor behavior, Amelia is by turns withdrawn and sullen, then suddenly talkative, sarcastic, and silly. Alone with the therapist in the second session, she is quiet and sad, but more direct and focused. The therapist begins family sessions again, this time asking that Amelia’s younger brother attend as well and concentrating on communication patterns between the members of the family. Although the parents insist Amelia is the reason for their visit, with their young son in session Amelia is sweet and attends to him while the parent seems to have little to say to one another and barely make eye contact. The therapist is able to point this out to them privately, and soon begins couples therapy with them, seeing Amelia separately and not discussing her anger with her unless she brings it up, which she doesn’t. After two or three months, the family is getting along much better, and the parents have identified several areas of their marriage to work on in therapy.

(Good therapy, 2017)

Case Example of Teen Physical Abuse

Abuse victim reaches out in therapy: 

Elijah, 17, sees a therapist twice a month to address the obsessive-compulsive behavior. He has been in therapy for several months. During one session, he pushes up his sleeve and the therapist notices cigarette burns on his arm. She asks Elijah about them, and at first he denies their presence, but eventually, he admits that his father has been abusive toward him for several years. Elijah reports that his father has recently been laid off and that his frustration with Elijah has led him to become more aggressive and abusive. He tells the therapist he does not feel safe when he is alone with his father, but when his mother is around, his father does not hurt him. He says he doubts his mother will believe him. The therapist tells Elijah she is required to report all instances of child abuse and asks him whether he would like to tell his mother first. Elijah reluctantly agrees with the therapist that it may be best. She gives Elijah a list of resources and helps him develop a plan to protect his own safety, whatever the result of the report. When Elijah’s mother comes to pick him up for therapy, the therapist asks her to join the session so Elijah can begin the conversation in a safe space.

(Good therapy, 2017)

Case Examples of Domestic Violence Survivor

Rebuilding self-esteem is a common goal in therapy. Most forms of abuse can break one’s confidence. CBT can help you challenge unrealistic expectations of yourself

Patterns of abusive romantic relationships: 

Julie, 32, has been in and out of several abusive romantic relationships with women over the last decade. She recognizes the pattern but continues to forgive abusive behaviors by her partners. She often blames herself for their actions. Therapy helps Julie see how her abusers are like her mother. This insight alone improves Julie’s ability to set boundaries. The support of her therapist helps Julie to accept her own needs as legitimate. She begins advocating for herself with her partners.

(Good therapy, 2017)

Couple in Therapy for “Blow Ups”:

Danielle and Randy, both 26 years old, present for couples counseling. Halfway through the first session, the therapist asks for more information about the “fights” and “blow-ups” they report. Danielle reports Randy recently pushed her down, and that he sometimes pulls things – the phone, the TV remote – out of her hand. Randy admits to this, and counters by accusing Danielle of pushing him once, which Danielle says was self-defense. The therapist informs the couple that he will see them separately, effective immediately. They agree to this, and the therapist begins by meeting alone with Randy. The therapist spends the session forming an alliance with Randy, rather than confronting his violent behaviors. In a brief meeting with Danielle, the therapist provides the name of a colleague who can see her and obtains a release of information from Danielle so the therapist can share his impression of the couple with the new therapist. Randy’s therapy centers on anger management, as well as on his beliefs about women and lack of empathy. Progress is quite slow. Danielle, meanwhile, explores her codependency and soon resolves to leave the relationship.

(Good therapy, 2017)

Conclusion

Research has proven that ACE scores are directly related to serious emotional problems, health risk behaviors, social problems, adult disease and disability, mortality, high health care costs, and worker performance problems (Greeson, Briggs,  Layne, Belcher, Ostrowski, Kim, & Fairbank, 2014).Higher scores correlate with the occurrence of chronic disease, mental health, suicide attempts, a likelihood of substance abuse, promiscuity, and will increase being a victim of sexual assault or DV(Greeson et al., 2014). In an article (2017) written by Dr. Melissa, Withers says, some believe that traumatic reactions are normal reactions to abnormal situations. Another truth is that coping reaction to post-trauma remain misunderstood and this lack of understanding goes beyond an empathetic gap or the lack of an appropriate response from victims of trauma. The result can be judgmental attitudes that re-victimize those who have survived trauma. What trauma-informed care means is treating the whole person, taking into account past trauma and the resulting coping mechanisms when attempting to understand behaviors while treating the patient (Withers, 2017). CBT is the most widely used evidence-based psychological treatment. It focuses on patterns in cognition, coping strategies, and emotional regulation. CBT focuses on the relationship between thoughts, feelings, and behavior, and identifying maladaptive thoughts.  SB approaches are effective in the development and maintaining of hope in individuals and enhanced well-being (Pattoni, 2012).

To conclude, this paper demonstrates that an ACE driven TF-CBT with an SBP recognizes the importance of being trauma-informed using ACEs as a guide. SBP encourages the thought processes to think differently, thus behavior changes soon follow. This treatment builds stronger families which decreases stress levels, which decrease ACE prevalence which improves brain function which benefits future generations.

 

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