Solution Code: 1EIEH
Question: Domestic Violence And Sexual Assault
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Tanisha, 43, has referred herself to your counselling service, after it was suggested by her Family Services Worker, Jen, due to concerns about her difficulty coping at present, where she has been increasingly tearful and stressed. You have had two sessions thus far, and have been trying to get to know her and understand her history during these sessions.
Tanisha has three children, Lucas (16), Molly (7), and Grace (5). Tanisha reports that Lucas’s father Tim, her first husband, was verbally violent, and they separated when Lucas was 6. Over the past three years, Lucas has become increasingly aggressive towards Tanisha, often physically, and has not responded well to her attempts to set boundaries and limits at home. Two months ago, he decided he wanted to live with his father, and since that time, has refused to see Tanisha or his sisters.
After separating from Tim, Tanisha was single for a year before meeting Brian, the father of Molly and Grace. This relationship ended almost a year ago after ongoing conflict, although Tanisha reports they never fought directly in front of the children. Based on what Molly and Grace have told her, she believes that Brian may also have used excessive physical discipline with them at times, but never witnessed this. She noted Brian is strict and controlling towards the children, while she is more lenient. While she and Brian are living separately, Tanisha acknowledges some desire to reconcile, and notes that they have had an “on and off” relationship since he left the home last year. She notes a fear of being alone, stating she sleeps with a knife under her pillow due to concerns that an intruder might enter the house while she sleeps.
Tanisha reports that she has been feeling “flat” and “numb” much of the time since separating from Brian. She reports she is exhausted with the demands of the children and work and feels like she “has no more to give.” When discussing her children, she reports that Molly can get angry “just like Lucas did,” and that Grace can be “clingy,” stating she is scared of being away from Tanisha.
While you have not yet been able to obtain a detailed family history, due to Tanisha’s tendency to discuss events in detail, she has told you that she is determined to ensure her children have a better childhood than she had. She notes her father, now deceased, was an alcoholic, and says she has few positive memories of growing up. She reports currently seeing her mother regularly, although she says, “She’s a much better grandmother than a mother.” Tanisha noted that her mother worked a lot while Tanisha was growing up. She has not mentioned any siblings or extended family.
Tanisha is a childcare assistant, and has recently moved into full-time work after working part-time for the past three years.
Tanisha reports that she has been feeling “flat” and “numb” much of the time since separating from Brian. She reports she is exhausted with the demands of the children and work and feels like she has “nothing more to give.” She notes she rarely goes out apart from going to work and taking the children to school, due to a combination of exhaustion and anxiety about going out.
During sessions, Tanisha becomes very emotional when discussing her children, their behavioural challenges, and the violence she has experienced in her relationships. She tends to recall these incidents in great detail, often taking most of a session to discuss one incident with her children or an ex-partner. You have observed that Tanisha is often tearful in sessions, and appears tense, sitting in a hunched manner and frequently fidgeting.
Tanisha indicates that she wants therapy to help her to feel happier, less anxious, and more confident in herself. She also wants to “stop overthinking about the past.”
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According to Roberts (2016) sexual assault and domestic violence are major issues affecting many women in the society. Jen, who is a Family Services Worker, advised Tanisha to seek counselling services. It was after Jen realised that she is becoming more stressed and tearful. In this regard, this is a case study analysis on the case of Tanisha. The analysis will present the primary issues facing Tanisha. It will investigate all the issues that led to stressed and tearful Tanisha. It will propose the recommended treatment plan and intervention strategy for her. Relevant therapeutic and theoretical approaches in regard to Tanisha case will be analysed and a 5 P approach for case conceptualization will be developed. The challenges from the treatment plan and management plan will also be discussed. Finally, a summary of the conclusion will be provided basing on the key issues discussed.
Primary presenting issues for Tanisha
Primary presenting issues refers to the signs and symptoms that show a person is in need of professional help from social care providers, psychiatrists, and therapists (Wang, 2015).It is important to note that a presenting problem is a clue based on presenting symptoms that health professionals and therapists use to diagnose the patient(Wang, 2015). In this regard, it is important we analyse the inventory of problems as presented by Tanisha to be able to identify the primary issues that could have affected her health. Tanisha primary presenting issues are that is always stressed, tearful, and she is getting incapable of coping with the present. From the above inventory of signs and symptoms, Tanisha current situation could be deep-rooted in her childhood and her transition to the adulthood. First, Tanisha childhood was not enjoyable, the father was a drunkard and the mother was not caring. Second, she is a product of sexual abuse at the age of 18 which was conceived and terminated. From the given symptoms Tanisha could be suffering from neglects and abuse. She grew without loving care and attention of the parents. The alcoholic father could have exposed her to emotional and physical violence. The neglects from her parents could be the reason she was sexually abused. The sexual abuse, conception and termination could be a dreadful experience to Tanisha which she has not recovered yet.
Information helpful in analysing Tanisha case effectively
Tanisha problem is rooted in her childhood upbringing, growth and the transition to the adulthood. To understand the case further it is important to gain more information regarding the maternal health records. The records are important in the analysis the maternal health conditions of Tanisha. As identified by Jen Tanisha suffered postpartum depression that can be available from the pregnancy health records. It is also recommended to get access to her normal health records. The records can be important in disclosing helpful information about diseases or conditions she might have suffered from since the onset of the signs and symptoms (Morrison, 2014). It will be paramount in deciding whether a medical treatment will be needed. The records can also disclose important information before and after sex abuse, the assistance was given and the termination process. In case the details are not sufficient it is advisable to provide an enabling environment for Tanisha to open up (Morrison, 2014). Moreover, it can be useful to get information from her two husbands. As disclosed by Jen, Brian expressed worries over Tanisha anxieties and exaggerations in addressing family and children issues. It can be a stepping stone in understanding the key issues of their misunderstandings and devising her treatment plan.
Services beneficial to Tanisha beyond the normal counselling
Tanisha has undergone a traumatizing childhood and family life. Hence, in the current situation, she needs help to understand and manage her children. The children need counselling sessions and advice of providing emotional and physical support to the mother. Tanisha expressed exhaustion from meeting the needs of the family and that of work. She needs a break and a time alone. A vacation or a rehabilitation period could mean more for her. She needs social care to manage the needs of her needs and that of the children. The children need to be assimilated in learning institutions. A boarding facility would be beneficial for the children and also for their mother. To understand her situation better it could mean listening to her two husbands and the children point of view.
External sources and ethical considerations
To reinforce the case, external information can be important. While upholding the ethical principle of non-maleficence, honesty, and integrity sourcing information from the children and the two ex-husbands can be important (Rubin, 2016). It is important to retrace the journey of Tanisha life as expressed by the close people to her. Basing on the findings a recommendation for a medical mental check-up can be necessary when the evidence supports some cases of depressions, excessive stress and trauma. Moreover, external sources are the medical records (Still, 2016). They should be handled with confidentiality and sincerity. It is also important to brief Tanisha on the needs for her medical records and access them on her consent. It is also recommended to address the issues in the records depending on her need to open up. It is important to give her a sufficient time to talk about the pressing situations in her life. Her work record can be also important in understanding her behaviour at work. The work records and performance appraisal should access based on her consent and privacy has to be maintained(Still, 2016). From the findings can be important in identifying whether her current symptoms are observable at work.A progressive appraisal can be helpful in understanding her journal with the anxiety, and depression(Still, 2016). It can be very informing in devising an appropriate invention plan.
Case conceptualisation using the 5P approach
Case conceptualization will apply the 5 P approach (Barber, 2015). They are important elements that are important in arriving at an understanding between Tanisha and the counsellor. The 1st P is the presenting issues as identified in the case (Barber, 2015). The presenting primary issues are she appears stressed, tearful and incapable of solving problems. The next P addresses predisposing factors which are the factors which facilitate her current situations of being stressed, tearful, and incapable of handling the present.
The 2nd P is the predisposing factors that have shaped the current status as expresses by Tanisha (Aiken et. 2013). Such factors are the childhood upbringing and the sexual assaults that happened to Tanisha in her transition to the adulthood. Tanisha was not able to recover from her childhood problems because of the traumatizing sexual assault that she faced in her transition to adulthood. Her fears, stress, insecurity and mental disturbance could be highly impacted by the two factors. Given that he childhood was not smooth and her adulthood was worsened by the traumatizing experience. Tanisha seems to suffer from postnatal depression since the birth of Lucas.
The 3rd P is the precipitating factors. It refers to the factors that trigger Tanisha current status and expressions (Aiken et. 2013). Tanisha separated from her first husband who is a father to her son Lucas at 6.The separation is as a result of persistent verbal assaults. Second, Lucas character is unbecoming. It seems difficult for Tanisha to control Lucas and help him set limits and boundaries at home. Lucus is not only defiant but also engages in a physical confrontation with the mother. Tanisha expressed that Lucas left her present family to live with the father and he has not visited yet. It took only one year after her separation with the Lucus father where Tanisha engaged in a relationship with Brian. The engagement bore Grace and Molly. Tanisha expresses that the relationship has numerous confrontations but the physical conflicts were not known to the children. Tanisha feels that Brian uses excessive physical discipline on the children. Tanisha still has the desire to reconcile with Brian. Apart from that, she is also scared of sleeping alone and she hides a knife under her pillow. She also expresses exhaustion from the work and the family life. She feels that Molly could be like Lucas and Grace is not independent. Tanisha was raised by an alcoholic father and unloving mother. She is also a case of sexual assault and 18 years which resulted in a pregnancy that was separated. Tanisha is always anxious which she transfers to the children and tend to make the family anxious. She also feels anxious about the fact that Lucus has never come to visit the family ever since he moved in with the family. It is a situation that can be draining her based on the father and child attachment.
The 4th P is the perpetuating factors are mechanisms that accelerate the problem (Derlaga and Berg, 2013). The unbecoming behaviour of her children; Lucus seems to be violet that reminds her of his father violence. Molly is slowly taking after Lucus a situation that is draining her emotionally and physically. Grace does not seem to become independent and always clings to the father. Tanisha expresses frustrations in trying to balance her work and family life. She seems drained and she cannot contain the situation anymore. The separation from Brian could also be a reason she feels stressed. She confesses that their relationship has been on and off expressions some form of bond between the two. Could be she is attached to Brian but the disagreements and fights could be draining her efforts to reconcile.
The 5th P is the protective factors Tanisha could be getting that are helpful to overcome her situation (Derlaga and Berg, 2013). First, she cares help from Family Protection Services where Jen seems to provide emotional and financial support. Another protective mechanism is the counselling services she is seeking as advised from Jen. The decision by Lucus to live with the father was another protective mechanism that helps in neutralizing Tanisha current problems.
Relevant theoretical and therapeutic approaches for this case
Psychotherapy theories and approaches are effective in providing a mechanism for counsellors and therapists to interpret clients’ feelings, thoughts, and behaviours(Gladding, 2014). Such mechanisms provide a treatment plant for the diagnosis of post-treatment.
Psychoanalysis theory is very applicable in the case (Galbraith et al. 2016). The theory as described by Sigmund Freud argues that behaviour is a product of unconscious forces (Galbraith et al. 2016). Therapists use techniques such as transference, dream analysis and free association to understand the situation (Galbraith et al. 2016). In this regard, the use of psychoanalysis theory will be efficient in the analysis the current behaviour as expressed by Tanisha. It is through understanding factors that trigger stress as described in the 5P approach and developing mechanism in the pathway to treatment (Still, 2016).
Cognitive theory as described by Aaron Beck analysis counselling cases in regard to their not thinking and the effect on behaviours and feelings (Gladding, 2014). In this regard, the focus on not on Tanisha childhood but the adults. The case will analyse the postnatal depression and how she can be assisted to overcome. The theory encourages on the look at the case of the children and how their behaviour can be rectified. Also, the social welfare intervention could be an idea for Tanisha treatment and recovery.
The application of Integrative and holistic therapy is also important (Gurman, 2014). The approach addresses psychotherapy tools and techniques that are important for the situation (Gurman, 2014). It refers to the application of the above theories in promoting wholeness and healing for Tanisha (Roberts, 2016). It means engaging Tanisha in a session that maximizes functioning and healing of her emotional, physical and mental health.
Discuss your treatment plan
Presenting problems are incapable of handling current situation, stress and tearful. She is more anxious and always exaggerates issues. The following is the recommended treatment plan and interventions (Lindsay and Norman, 2013).
Expected challenges in the treatment plan and their medicationSome of the expected challenges from the process include lack of enough finances to carry out the intervention. The presenting issues in Tanisha case could be a stumbling block to her recovery. In most cases patients suffer from presenting issues in their healing process (Howell, 2016). In this regard, a rehabilitative session needs to be developed for the children. The professional, personal, and counselling sessions could be overwhelming for Tanisha. For quick recovery, she should seek financial assistance from the welfare. She should also seek for leave with pay to have more time for herself and the recovery process.ConclusionIn conclusion, Tanisha is the main case in the study. She is always stressed, tearful and according to Jen a family service provider she is not capable of handling her current situation. The presenting issues could be due to the major challenges she has suffered in her childhood and adult life. She was raised in a stressful marriage. Her father was alcoholic and the mother was not caring. She can count the number of times she was happy in her childhood. Tanisha was sexually assaulted at the age of 18 where she was conceived and the pregnancy was terminated. She was married to an abusive husband with whom she conceived Lucus and suffered a postpartum. She engaged with Brian with who she bored two daughters. Molly is following her brothers footsteps a situation that happens to stress her more. She feels drained, stressed and she cannot avoid being tearful. Jen recommended her to seek counselling services. From her symptoms the use of psychoanalysis theory is very relevant to her case. The goal will understand the factors affecting her situation from the present and recommending a course of action. The cognitive theory will expound on the issues from her childhood and her transition to the adulthood. Finally, the use of integrative approach will be important in summing up all the approaches as identified above. The treatment plan developed will seek to restore her situations of the mind be alleviating stress and anxiety. The plan will apply activities and cognitive intervention strategies to heal Tanisha situations. The records from the hospital and work will be effective in analysis her journey and the effect her situation has on the employment. All these will be important in settling for the most influential approach. The recovery process could be affected by the work and pressure at home. A rehabilitative session for the children will be recommended. It will be also helpful for Tanisha to apply for leave with payment and also seek additional funding from the family care services. Finally, the therapy will help her open up by encouraging confrontational sessions with Brian. The aim will be for her to face and overcome her fear in life. At the end, she is expected to develop an improved wholesomely.
|Reduction of anxiety signs developed from postpartum depression||Exposure|
|Eliminate guilty and ideation of worthlessness from sexual assault and termination of pregnancy||Cognitive restructuring|
|Non-work related activities||Scheduling of activities|
|10% reduced belief and assumptions of wanting to be perfect||Cognitive restructuring and developmental analysis|
|Restoring the mental status to normality work functioning||Through exposure and cognitive restructuring|
|Elimination of depressive and anxiety functioning||Exposure and cognitive restructuring|
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