Psychotherapy Modalities On Trauma
Introduction This paper examines application of 2 different psychotherapy modalities on trauma. The psychotherapy approaches, namely, psychodynamic therapy approach and Focusing-oriented psychotherapy, will be explored through examination of a case. Different approaches use different interventions, which are rooted in perspective theories. Examining how a clinician could work with the case in this paper through the lens of each approach would help us understand the theories’ strengths and challenges.
Trauma and PTSD diagnosis Many people in the world, regardless of age, gender, race, or language have experienced a traumatic event including, death of family or friend, sexual abuse, natural disaster, emotional abuse, domestic violence, and …show more content…
war (Krippner, Pitchford, & Davies, 2012). When a person experiences an overwhelming sense of powerlessness and helplessness, it takes over his or her ordinary (coping) mechanism. In other words, the traumatic event diminishes the individual’s sense of “control, connection, and meaning.” (Herman, 1992, p. 33) Herman (1992) stated:
Traumatic reactions occur when action is of no avail. When neither resistance nor escape is possible, the human system of self-defense becomes overwhelmed and disorganized… Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory. Moreover, traumatic events may sever these normally integrated functions from one another. (p. 34)
The degree in which an individual experiences and is influenced by the traumatic event depends on his or her developmental history, temperament, personal meaning of the event, and the context of which the event occurred. Also, the manner of which a person experiences such event as well as his or her response to it varies. Therefore, the individual’s experience and response to the event is attributed to negative consequences of trauma rather than the content of the event (Krippner, et al., 2012). The latest Diagnostic and statistical manual of mental disorders (5th ed.) (DSM5) published by American Psychiatric Association (APA) (2013) describes the diagnostic class related to trauma in its separate section (i.e., the title under “Trauma- and stressor- related disorders”) (p.
265). The posttraumatic stress disorder (PTSD) is placed under this category. According to APA (2013), people would be diagnosed with PTSD when they experience intrusive symptoms such as flashback, recurring dream and/or memory of the event, psychological and/or physiological distress when being exposed to cues related to the event, after being exposed to actual or threatened harm, death and/or violence. People with PTSD characteristically avoid stimuli that remind them of the event, have negative cognition s and mood (e.g., low self-esteem, fear, guilt, depressed mood, and feelings of detachment), and experience hyper-reactivity and/or hyper-arousal (e.g., irritability, anger, hypervigilance, sleep disturbance, and difficulty concentrating) (APA, 2013; also see Herman, 1992). These physical as well as psychological symptoms interfere with social, occupational, and/or academic functions for individuals with PTSD (APA, 2013). It is important to note that those people who do not meet full criteria for PTSD after being exposed to a traumatic event may still experience significant difficulties in their lives (APA, 2013, Burstow, …show more content…
2005).
Case Presentation: Cindy In this section, I will present a case of Cindy (pseudonym), with whom I recently started to work. I have seen her for a few sessions only. To protect her identity, some facts have been altered.
Background and mental status
Cindy is a 26 year-old, Caucasian, single, heterosexual, female.
She comes from an intact family. She reported that she grew up in the west coast of the US. Her parents live approximately 1.5 hours away from her residence. She reported that she has a good relationship with them. Nevertheless, she stated that she has not told them about the traumatic event. . She currently lives by herself near her work. She is college educated and currently employed at a large corporation. She is driven and eager to advance her career. She indicated that she has some close female friends. She reported that she gets along well with her co-workers. She sought psychotherapy for anxiety and post-traumatic symptoms. She comes to the session dressed appropriately to the weather. She is oriented times 4. Her mood is anxious. Her affect is congruent. She makes eye contact throughout the session and she answers my questions without hesitation. She is engaging and appears to be curious about her experiences. Nevertheless, her insight on her symptoms is limited. She attributes the symptoms to the traumatic event. Yet, she struggles to make sense of her experience and symptoms.
Traumatic
event
Approximately 2 years ago, she was dating a man who physically assaulted her. On one evening, they attended a party, which he planned for his team at work. They were at a restaurant. According to her, he often ignored her whenever they attend a public function. This evening was no exception. He acted as if he did not know her. She decided to enjoy the evening anyway and she socialized with people at the party. Later the evening, she was acquainted with a female guest, who was a new to the town. After talking with the guest and finding out that she was ready to start dating, Cindy asked her if she would be interested in meeting a Cindy’s friend. The Guest agreed. Cindy then sent a text message to her friend. Unexpectedly, her friend came to the restaurant about an hour later. When Cindy’s boyfriend saw that Cindy was talking with her friend and the female guest across the room, he approached her. Cindy recalled that she knew that he was angry. He asked her “what he (Cindy’s friend) is doing here?” He then started yelling at her saying “who do you think you are?” and “how dare you bringing him here!” She apologized and asked him to take her home. He continued to yell at her all the way to their apartment, where she moved to a few weeks prior. When they arrived at the apartment, she immediately started packing her bag to leave. He yelled at her for a while. Then, when he realized that she was leaving, he took her keys and left the apartment. As soon as he left, she locked the apartment door. After a while, he returned and forcefully entered the room by breaking the lock. Cindy noted that her memory after he came in to the apartment is fragmented. However, she recalled that he started to throw her across the room and “body slamming” her against furniture. During the attack, she lost some of her front teeth. She said that she must have fought him as he had some scratches on his arms. After he broke her teeth, he left again. Cindy called her best friend, who advised her to call the police. So she did. The police came shortly after. Cindy later found out that her boyfriend met with the police in the front of their building. He told the police that Cindy became aggressive and attacked him. He also told them that her teeth came out when she bit his shirt. Cindy spoke to the police when they came up to the room, where they found her covered with bruises, teeth missing, and crying. The room was disarrayed with broken furniture. The police took her statement and sent her to a hospital in the area. According to Cindy, her boy-friend was charged with second degree domestic assault. However, he talked her to speak to the prosecutor and reduce the charge. Thus she did. He pled guilty to fourth degree domestic assault, which is a gross misdemeanor. He was fined but was not incarcerated; instead, he received work release. Cindy reported that she returned to him after he was convicted and apologized to her. She said that she believed him. She noted that she was taught to be sincere when she apologizes. She believed that his apology was sincere. However, she found that he was telling his family and friends that she attacked him and she lost her teeth when she bit his shirt. They believed him and she was treated as a “crazy” girl-friend who lost her control. When she realized that he was telling the “lie”, she left him for good. She states that she feels ashamed that she believed him and gave him the second chance. Cindy saw a therapist soon after she broke up with him. However, she felt that she was not ready. She reported that she felt overwhelmed after talking with her previous therapist. Thus, she decided to concentrate on her work and dental treatment.
Current symptoms Now that 2 years has passed, Cindy says that she is ready to “deal with” her trauma. She states her wish to “feel better” and to live as a “normal” person. She presents with elevated anxiety, anger, irritability, and depressed mood. She reports having difficulty staying asleep, trusting people, and concentrate, as well as flashbacks. She also reported that she has been avoiding social activity unless she is with her friends who she trusts. She continues to receive dental treatments. She has not yet to get permanent teeth. Moreover, she is planning to sue her ex-boyfriend for medical expenses and damage. Although, she indicates that she is apprehensive about suing him, she speaks her wish to make him take responsibility for what he did to her. She also mentioned a wish for his friends and family to recognize that he is not innocent and that she is telling the truth.
Trauma and PTSD diagnosis Many people in the world, regardless of age, gender, race, or language have experienced a traumatic event including, death of family or friend, sexual abuse, natural disaster, emotional abuse, domestic violence, and …show more content…
war (Krippner, Pitchford, & Davies, 2012). When a person experiences an overwhelming sense of powerlessness and helplessness, it takes over his or her ordinary (coping) mechanism. In other words, the traumatic event diminishes the individual’s sense of “control, connection, and meaning.” (Herman, 1992, p. 33) Herman (1992) stated:
Traumatic reactions occur when action is of no avail. When neither resistance nor escape is possible, the human system of self-defense becomes overwhelmed and disorganized… Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory. Moreover, traumatic events may sever these normally integrated functions from one another. (p. 34)
The degree in which an individual experiences and is influenced by the traumatic event depends on his or her developmental history, temperament, personal meaning of the event, and the context of which the event occurred. Also, the manner of which a person experiences such event as well as his or her response to it varies. Therefore, the individual’s experience and response to the event is attributed to negative consequences of trauma rather than the content of the event (Krippner, et al., 2012). The latest Diagnostic and statistical manual of mental disorders (5th ed.) (DSM5) published by American Psychiatric Association (APA) (2013) describes the diagnostic class related to trauma in its separate section (i.e., the title under “Trauma- and stressor- related disorders”) (p.
265). The posttraumatic stress disorder (PTSD) is placed under this category. According to APA (2013), people would be diagnosed with PTSD when they experience intrusive symptoms such as flashback, recurring dream and/or memory of the event, psychological and/or physiological distress when being exposed to cues related to the event, after being exposed to actual or threatened harm, death and/or violence. People with PTSD characteristically avoid stimuli that remind them of the event, have negative cognition s and mood (e.g., low self-esteem, fear, guilt, depressed mood, and feelings of detachment), and experience hyper-reactivity and/or hyper-arousal (e.g., irritability, anger, hypervigilance, sleep disturbance, and difficulty concentrating) (APA, 2013; also see Herman, 1992). These physical as well as psychological symptoms interfere with social, occupational, and/or academic functions for individuals with PTSD (APA, 2013). It is important to note that those people who do not meet full criteria for PTSD after being exposed to a traumatic event may still experience significant difficulties in their lives (APA, 2013, Burstow, …show more content…
2005).
Case Presentation: Cindy In this section, I will present a case of Cindy (pseudonym), with whom I recently started to work. I have seen her for a few sessions only. To protect her identity, some facts have been altered.
Background and mental status
Cindy is a 26 year-old, Caucasian, single, heterosexual, female.
She comes from an intact family. She reported that she grew up in the west coast of the US. Her parents live approximately 1.5 hours away from her residence. She reported that she has a good relationship with them. Nevertheless, she stated that she has not told them about the traumatic event. . She currently lives by herself near her work. She is college educated and currently employed at a large corporation. She is driven and eager to advance her career. She indicated that she has some close female friends. She reported that she gets along well with her co-workers. She sought psychotherapy for anxiety and post-traumatic symptoms. She comes to the session dressed appropriately to the weather. She is oriented times 4. Her mood is anxious. Her affect is congruent. She makes eye contact throughout the session and she answers my questions without hesitation. She is engaging and appears to be curious about her experiences. Nevertheless, her insight on her symptoms is limited. She attributes the symptoms to the traumatic event. Yet, she struggles to make sense of her experience and symptoms.
Traumatic
event
Approximately 2 years ago, she was dating a man who physically assaulted her. On one evening, they attended a party, which he planned for his team at work. They were at a restaurant. According to her, he often ignored her whenever they attend a public function. This evening was no exception. He acted as if he did not know her. She decided to enjoy the evening anyway and she socialized with people at the party. Later the evening, she was acquainted with a female guest, who was a new to the town. After talking with the guest and finding out that she was ready to start dating, Cindy asked her if she would be interested in meeting a Cindy’s friend. The Guest agreed. Cindy then sent a text message to her friend. Unexpectedly, her friend came to the restaurant about an hour later. When Cindy’s boyfriend saw that Cindy was talking with her friend and the female guest across the room, he approached her. Cindy recalled that she knew that he was angry. He asked her “what he (Cindy’s friend) is doing here?” He then started yelling at her saying “who do you think you are?” and “how dare you bringing him here!” She apologized and asked him to take her home. He continued to yell at her all the way to their apartment, where she moved to a few weeks prior. When they arrived at the apartment, she immediately started packing her bag to leave. He yelled at her for a while. Then, when he realized that she was leaving, he took her keys and left the apartment. As soon as he left, she locked the apartment door. After a while, he returned and forcefully entered the room by breaking the lock. Cindy noted that her memory after he came in to the apartment is fragmented. However, she recalled that he started to throw her across the room and “body slamming” her against furniture. During the attack, she lost some of her front teeth. She said that she must have fought him as he had some scratches on his arms. After he broke her teeth, he left again. Cindy called her best friend, who advised her to call the police. So she did. The police came shortly after. Cindy later found out that her boyfriend met with the police in the front of their building. He told the police that Cindy became aggressive and attacked him. He also told them that her teeth came out when she bit his shirt. Cindy spoke to the police when they came up to the room, where they found her covered with bruises, teeth missing, and crying. The room was disarrayed with broken furniture. The police took her statement and sent her to a hospital in the area. According to Cindy, her boy-friend was charged with second degree domestic assault. However, he talked her to speak to the prosecutor and reduce the charge. Thus she did. He pled guilty to fourth degree domestic assault, which is a gross misdemeanor. He was fined but was not incarcerated; instead, he received work release. Cindy reported that she returned to him after he was convicted and apologized to her. She said that she believed him. She noted that she was taught to be sincere when she apologizes. She believed that his apology was sincere. However, she found that he was telling his family and friends that she attacked him and she lost her teeth when she bit his shirt. They believed him and she was treated as a “crazy” girl-friend who lost her control. When she realized that he was telling the “lie”, she left him for good. She states that she feels ashamed that she believed him and gave him the second chance. Cindy saw a therapist soon after she broke up with him. However, she felt that she was not ready. She reported that she felt overwhelmed after talking with her previous therapist. Thus, she decided to concentrate on her work and dental treatment.
Current symptoms Now that 2 years has passed, Cindy says that she is ready to “deal with” her trauma. She states her wish to “feel better” and to live as a “normal” person. She presents with elevated anxiety, anger, irritability, and depressed mood. She reports having difficulty staying asleep, trusting people, and concentrate, as well as flashbacks. She also reported that she has been avoiding social activity unless she is with her friends who she trusts. She continues to receive dental treatments. She has not yet to get permanent teeth. Moreover, she is planning to sue her ex-boyfriend for medical expenses and damage. Although, she indicates that she is apprehensive about suing him, she speaks her wish to make him take responsibility for what he did to her. She also mentioned a wish for his friends and family to recognize that he is not innocent and that she is telling the truth.