Cop Case Study Essay
Case Formulation: (Four Ps) There are a number of factors that increased Sophie’s risk of developing depression, anxiety, addiction and becoming socially isolated, such as her possible avoidant attachment style with her parents, her subsequent use of avoidance as her main coping strategy and her chronic pain. Sophie’s early childhood has indications of attachment issues with her parents, due to parental stress, absence and communication and problem solving issues, likely resulting in an insecure/avoidant attachment style (Worden, 2009). This could have been reinforced by her brother’s teasing, forced sexual experience and later abusive relationship, where she received little support. Further to this, early exposure to parental conflict with
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ineffective coping skills (i.e.
drinking and lack of communication), may have resulted in Sophie not learning adaptive ways of coping, resulting in her using alcohol, procrastination and experiential avoidance (EA) to cope with stress. The family trait of, “carrying on without complaint,” also may have contributed to her not being able to effectively process her possibly traumatic first sexual experience and abusive relationship. Added to this is Sophie’s history of chronic pain which commonly co-occurs with psychological illnesses such as depression, anxiety, other issues such as interpersonal issues and substance dependence (Veehof, Oskam, Schreurs, & Bohlmeijer, 2011), and can have serious implications for sufferers, including reduced quality of life, lower general health and financial loss due to a reduced capacity to work (Hann & Mccracken, 2014). Her recent diagnosis of psoriatic arthritis, a degenerative disease with no cure, has left her feeling at a loss as to how to move forward in life, leading to suicidal ideation (SI), which concerned her boyfriend and he
prompted her to seek support. Sophie’s predominant coping strategy of avoidance is a major factor in maintaining her problems, as studies have found avoidance to be correlated with poor mental health outcomes (Hayes et al., 2004). Alcohol use was highly effective in relieving her pain in the short-term, however it has had some detrimental effects on her life, including weight gain, which has contributed to her low self-esteem, embarrassment when out with friends and subsequent shame and social withdrawal. Her procrastination in completing her tax may result in fines and increase her financial stress, and her EA of socialising with friends has left her socially isolated and resentful. Her SI appears to be another way to avoid her issues by dreaming of the peace of death. Added to this is her chronic pain and subsequent physical impairment, which has limited her ability to continue doing what makes her happy, such as dancing and gardening, and will likely affect her ability to work. Sophie’s language suggests some cognitive fusions that are keeping her stuck, such as: “I need to be well in order to be good company,” “No-one will hire me if I’m fat,” and “Death is the only way to find peace,” which may be further perpetuating her need to control her physical and emotional pain through avoidance. Sophie has some protective factors in that she has shown some help seeking behaviour in the past and sought help in the present despite feeling like she didn’t progress with her psychologist. Other positive factors are that she appears to be in a stable relationship with talk of a future together, and he helped her to seek support. She is also educated and has some financial support from her parents and has a seemingly stable housing situation that she loves and manages to continue gardening, although in a limited capacity.
Goals for Treatment The main goal would be to address Sophie’s avoidant strategies to support her to manage her current and future situations, including most importantly managing her SI. Educating and guiding Sophie to learn more adaptive coping strategies would hopefully support her to be able to manage her chronic physical and emotional pain, and in turn help her to reduce her use of avoidance. With this Sophie may be able to take some action towards socialising again and look for work, thus increasing her support system, sense of purpose and financial security.
ineffective coping skills (i.e.
drinking and lack of communication), may have resulted in Sophie not learning adaptive ways of coping, resulting in her using alcohol, procrastination and experiential avoidance (EA) to cope with stress. The family trait of, “carrying on without complaint,” also may have contributed to her not being able to effectively process her possibly traumatic first sexual experience and abusive relationship. Added to this is Sophie’s history of chronic pain which commonly co-occurs with psychological illnesses such as depression, anxiety, other issues such as interpersonal issues and substance dependence (Veehof, Oskam, Schreurs, & Bohlmeijer, 2011), and can have serious implications for sufferers, including reduced quality of life, lower general health and financial loss due to a reduced capacity to work (Hann & Mccracken, 2014). Her recent diagnosis of psoriatic arthritis, a degenerative disease with no cure, has left her feeling at a loss as to how to move forward in life, leading to suicidal ideation (SI), which concerned her boyfriend and he
prompted her to seek support. Sophie’s predominant coping strategy of avoidance is a major factor in maintaining her problems, as studies have found avoidance to be correlated with poor mental health outcomes (Hayes et al., 2004). Alcohol use was highly effective in relieving her pain in the short-term, however it has had some detrimental effects on her life, including weight gain, which has contributed to her low self-esteem, embarrassment when out with friends and subsequent shame and social withdrawal. Her procrastination in completing her tax may result in fines and increase her financial stress, and her EA of socialising with friends has left her socially isolated and resentful. Her SI appears to be another way to avoid her issues by dreaming of the peace of death. Added to this is her chronic pain and subsequent physical impairment, which has limited her ability to continue doing what makes her happy, such as dancing and gardening, and will likely affect her ability to work. Sophie’s language suggests some cognitive fusions that are keeping her stuck, such as: “I need to be well in order to be good company,” “No-one will hire me if I’m fat,” and “Death is the only way to find peace,” which may be further perpetuating her need to control her physical and emotional pain through avoidance. Sophie has some protective factors in that she has shown some help seeking behaviour in the past and sought help in the present despite feeling like she didn’t progress with her psychologist. Other positive factors are that she appears to be in a stable relationship with talk of a future together, and he helped her to seek support. She is also educated and has some financial support from her parents and has a seemingly stable housing situation that she loves and manages to continue gardening, although in a limited capacity.
Goals for Treatment The main goal would be to address Sophie’s avoidant strategies to support her to manage her current and future situations, including most importantly managing her SI. Educating and guiding Sophie to learn more adaptive coping strategies would hopefully support her to be able to manage her chronic physical and emotional pain, and in turn help her to reduce her use of avoidance. With this Sophie may be able to take some action towards socialising again and look for work, thus increasing her support system, sense of purpose and financial security.