Final Paper

docx

School

Westfield State University *

*We aren’t endorsed by this school

Course

0621

Subject

Sociology

Date

Jan 9, 2024

Type

docx

Pages

Uploaded by CommodoreEel3892

Final Paper: Adjustment Disorder and Trauma Theory Jennifer McKennedy Department of Social Work, Westfield State University SOCW 0621 Mark Horwitz, PHD, LICSW, JD December 18, 2023

Section I: Attachment and Trauma I have never had the desire as a social worker to want to work with children for many reasons that are not relevant at this juncture. However, I realized that the adults we work with in therapy have a past and how that has manifested in the individuals we serve and support as adults. In addition to trauma in childhood, there is also attachment trauma. Attachment trauma arrives from a disruption in the bonding process between a child and their primary caregiver. This disruption can have lasting effects into adulthood. A combination of these two can result in a very emotionally dysregulated adult. A child’s early life experiences significantly shape their adult life. The relations with their primary caregiver are crucial for their development. If a child’s early relational needs are not met, they can manifest later in life through challenges in their mental health, relationships, and childhood neglect towards the next generation.

Attachment- development and presentation Attachment can be defined as a deep and enduring emotional bond between two people in which each seeks closeness and feels more secure when in the presence of the attachment figure. Attachment theory explains how the parent-child relationship emerges and influences subsequent development. How the theory developed British psychologist John Bowlby was the first attachment theorist, describing attachment as a "lasting psychological connectedness between human beings." Bowlby was interested in understanding the separation anxiety and distress that children experience when separated from their primary caregivers. Some of the earliest behavioral theories suggested that attachment was simply a learned behavior. These theories proposed that attachment was merely the result of the feeding relationship between the child and the caregiver. Because the caregiver feeds the child and provides nourishment, the child becomes attached. What Bowlby observed is that even feedings did not diminish the anxiety experienced by children when they were separated from their primary caregivers. Instead, he found that attachment was characterized by clear behavioral and motivation patterns. When children are frightened, they will seek proximity from their primary caregiver in order to receive both comfort and care. Attachment is an emotional bond with another person. Bowlby believed that the earliest bonds formed by children with their caregivers have a tremendous impact that continues throughout life. He suggested that attachment also serves to keep the infant close to the mother, thus improving the child's chances of survival.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Bowlby viewed attachment as a product of evolutionary processes. While the behavioral theories of attachment suggested that attachment was a learned process, Bowlby and others proposed that children are born with an innate drive to form attachments with caregivers. Throughout history, children who maintained proximity to an attachment figure were more likely to receive comfort and protection, and therefore more likely to survive to adulthood. Through the process of natural selection, a motivational system designed to regulate attachment emerged. So what determines successful attachment? Behaviorists suggest that it was food that led to forming this attachment behavior, but Bowlby and others demonstrated that nurturance and responsiveness were the primary determinants of attachment While this process may seem straightforward, there are some factors that can influence how and when attachments develop, including: Opportunity for attachment: Children who do not have a primary care figure, such as those raised in orphanages, may fail to develop the sense of trust needed to form an attachment. Quality caregiving: When caregivers respond quickly and consistently, children learn that they can depend on the people who are responsible for their care, which is the essential foundation for attachment. This is a vital factor. There are four patterns of attachment, including: Anxious attachment: These children become very distressed when a parent leaves. As a result of poor parental availability, these children cannot depend on their primary caregiver to be there when they need them.

Avoidant attachment: Children with an avoidant attachment tend to avoid parents or caregivers, showing no preference between a caregiver and a complete stranger. This attachment style might be a result of abusive or neglectful caregivers. Children who are punished for relying on a caregiver will learn to avoid seeking help in the future. Disorganized attachment: These children display a confusing mix of behavior, seeming disoriented, dazed, or confused. They may avoid or resist the parent. Lack of a clear attachment pattern is likely linked to inconsistent caregiver behavior. In such cases, parents may serve as both a source of comfort and fear, leading to disorganized behavior. Secure attachment: Children who can depend on their caregivers show distress when separated and joy when reunited. Although the child may be upset, they feel assured that the caregiver will return. When frightened, securely attached children are comfortable seeking reassurance from caregivers. Unfortunately, when attachment interruptions (such as abandonment) occur in infancy, abnormal associations may be created. Physiological state memories, motor vestibular memories, and emotional memories are stored, and they can be triggered in later life. These triggers can manifest as mistrust or fear of interpersonal attachment. Since the original template for how relationships work was formed in early childhood, all future relationships can be corrupted. The person may find themselves struggling with difficulties in relationships, particularly with respect to trust, bonding, and intimacy—the core elements of healthy attachment. Part of the problem may be the person having absolutely no cognitive awareness of the source of their fears or that they were betrayed in infancy. This can make treatment efforts difficult.

Research suggests that failure to form secure attachments early in life can have a negative impact on behavior in later childhood and throughout life. Children diagnosed with oppositional defiant disorder (ODD), conduct disorder (CD), or post- traumatic stress disorder (PTSD) frequently display attachment problems, possibly due to early abuse, neglect, or trauma. Clinicians suggest that children adopted after the age of 6 months have a higher risk of attachment problems. Children who are securely attached as infants tend to develop stronger self-esteem and better self-reliance as they grow older. These children also tend to be more independent, perform better in school, have successful social relationships, and experience less depression and anxiety.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Trauma development and presentation

Section II: Case Description Nicole is a 33-year-old single heterosexual, unemployed female mother of two. Nicole and one of her children live with her maternal grandparents, aunt, and nephew. Nicole and her 8-year-old daughter live in the modified dining room turned into a bedroom. Nicole’s oldest child lives with his dad in Rhode Island, and she sees him approximately once a month. Nicole has lived her entire life in Massachusetts. Nicole did not finish high school. Nicole attempted to complete a program in a trade school but was unsuccessful due to a car accident. Nicole is currently a client at Community Service Institute, and I am working with her as a student intern. Nicole has been diagnosed with a major depressive disorder, recurrent episodes, posttraumatic stress disorder, and Opioid use disorder in early or sustained remission and with a z code of housing or economic problems. I am using Nicole as my case study due to her traumatic childhood and the negative discourse that has her in her current situation. Nicole’s parents divorced when she was an infant. Her earliest memory of abuse is at four. Nicole’s mother’s boyfriend, a well-known drug dealer in the area, was not pleased with her

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

sneaking a snack into her bedroom. She vividly remembers him using his belt and beating her as her mother watched and did nothing to protect her. This episode's outcome led to her moving into her maternal grandparent's home and the involvement of DFS. This is just one of the several boyfriends that her mother would bring home and physically abuse her and her siblings. Eventually, she was permanently placed in the custody of her maternal grandparents. At age nine, Nicole was the victim of sexual abuse for approximately four years by a family member, her mother’s “favorite” cousin. When Nicole told her mother about the abuse, her mother was in denial and was furious with Nicole for making it public knowledge with the DCF involvement. The client was then moved to the Palmer area, as she describes it, and was put into vocational school due to her failing at the school in the Springfield area. Nicole was in a severe car accident and was prescribed opiates for the pain for many months. Nicole stated that after almost a year, the doctor stopped prescribing and that this was the start of her addiction. Nicole struggled with addiction for years. Nicole had her first child on a one-night stand. She was in a shelter for almost a year. She obtained housing and met her second child's father, who eventually was incarcerated for drug possession. Nicole lost the housing, and her son is in custody with his father. Nicole moved back in with her maternal grandparents with her daughter. Nicole continues to have a relationship with her biological father but, due to an unsteady relationship with her stepmother, has minimal contact. Nicole also continues to be in minimal contact with her mother, who lives a few blocks away, and her sister and step-brothers. In addition, she is in contact with the mother of her second child’s father, and he recently surfaced after being absent and is currently in substance abuse rehabilitation. Nicole has difficulties with setting boundaries and identifying healthy relationships. Nicole has very low self-esteem, which is reinforced by the family she lives with and associates with.

I am the fourth therapist that Nicole has had at this agency, in addition to numerous DCF workers and counselors. Nicole shared her story with me during our third session. She stated that she has not disclosed the details she shared with me for many years. I appreciated her ability to open up again to me, and in every session, I commend her for her reliance. Nicole is a survivor. She has a solid innate willingness to be a good mother. She identifies more with her obstacles instead of her accomplishments. Nicole is goal-oriented and driven to provide more for her children and wants to be that role model that she feels was never offered to her. Nicole is open to learning about patterns of her past that have shaped her current self and how she wants to develop a deeper understanding to improve her overall well-being and quality of life. Section III: Application of Materials Discuss how the mental health materials you presented earlier help us understand this person’s presentation, both developmentally and descriptively. How well do these materials help us account for this person’s strengths and needs? If you have discussed DSM 5 material in your opening section, discuss specifically whether/how criteria for the DSM category you discussed are met by this person’s presentation. Address any important things about the person’s presentation that these materials do not adequately address. (2-3 pages) Adults with these attachment styles differ in a number of significant ways: how they perceive and deal with closeness and emotional intimacy.

ability to communicate their emotions and needs and listen to and understand the emotions and needs of their partners. modes of responding to conflict. expectations about their partner and the relationship Those who have anxious attachment worry that those they care about will not be emotionally available to them when they need support. They then pursue support with a sense of hypervigilance as a way of regulating their distress. Low on avoidance, high on anxiety. Crave closeness and intimacy, very insecure about the relationship. “I want to be extremely emotionally close (merge) with others, but others are reluctant to get as close as I would like. I often worry that my partner doesn’t love or value me and will abandon me. My inordinate need for closeness scares people away. Dismissive They tend to numb out when stressed and disconnect. This disconnect from others, from themselves, and from the present moment increases symptoms of PTSD (anhedonia, avoidance of triggers that remind them of trauma). Lassri et al, 2018 concluded that childhood trauma tends to make people self-critical, which the causes them to have adult relationships that are dysfunctional, reinforcing their belief that others do not like them. Therapists, therefore, need to educate their clients about the effects of trauma. If clients can see their interactions as arising from trauma, they can then begin to make different choices in the present and perhaps be more motivated to face their traumas (stop avoiding).

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Adults with a disorganized attachment style lack a coherent approach towards relationships. On the one hand, they want to belong. They want to love and be loved. While on the other hand, they are afraid to let anyone in. They have a strong fear of getting hurt by the people who are closest to them. Adults with a disorganized attachment style fear intimacy and avoid proximity, similar to individuals with an avoidant attachment style. The main difference for disorganized adults is that they want relationships. These adults expect and are waiting for the rejection, disappointment, and hurt to come. In their perception, it is inevita As adults, those who are securely attached tend to have to trust, long-term relationships. Other key characteristics of securely attached individuals include having high self-esteem, enjoying intimate relationships, seeking out social support, and an ability to share feelings with other people. Low on avoidance, low on anxiety. Comfortable with intimacy; not worried about rejection or preoccupied with the relationship. “It is easy for me to get close to others, and I am comfortable depending on them and having them depend on me. I don’t worry about being abandoned or about someone getting too close to me.” Research suggests that failure to form secure attachments early in life can have a negative impact on behavior in later childhood and throughout life. Children diagnosed with oppositional defiant disorder (ODD), conduct disorder (CD), or post- traumatic stress disorder (PTSD) frequently display attachment problems, possibly due to early abuse, neglect, or trauma.

Clinicians suggest that children adopted after the age of 6 months have a higher risk of attachment problems. While attachment styles displayed in adulthood are not necessarily the same as those seen in infancy, early attachments can have a serious impact on later relationships. Those who are securely attached in childhood tend to have good self-esteem, strong romantic relationships, and the ability to self-disclose to others.

Section IV: Interventions and Strategies Discuss intervention strategies that build on strengths and address needs. Rely on at least two outside sources, which can be taken either from other courses you are enrolled in or from your own literature search. Apply these ideas to the person you discussed above, considering which might be most useful to this person, singly or in combination.(3-5 pages The most important takeaway from these materials is that people’s attachment styles are not set in stone. Instead, we maintain the ability to grow and develop new skills throughout our lives, and relationships can be the source of change. A therapeutic relationship can have a sense of instability. Many individuals have attachment wounds, but not necessarily diagnosable attachment disorders. When working with individuals clinically, a fundamental goal is to provide a secure base through the therapeutic relationship. By understanding someone’s attachment style, a therapist can assist people in identifying relational patterns and assist them in establishing new ways of relating to others, with the therapy being a safe location to explore, seek reassurance and support, and expect consistency and reliability.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Therapists can play a large role in helping clients establish a healing relationship that challenges their current cognitive schemas about relationships and about the world. Therapists can also help clients recover from trauma by helping the current adult relationships the client has. As current relationships enter therapy and embrace a balance of openness and boundaries, as well as a safe, trusting relationship, clients begin to allow new schemas into their world view. The greater the number of safe relationships a client has, the more they can have the courage to face past trauma. Ceasing to avoid thoughts and feelings of past trauma eliminates yet another symptom of PTSD. Attachment patterns are passed down from one generation to the next. Children learn how to connect from parents and caregivers, and they in turn teach the next generation. Your attachment history plays a crucial role in determining how you relate in adult romantic relationships, and how you relate to your children. However, it is not what happened to you as a child that matters most — it is how you deal with it. Many people go from victim to overcomer.

References American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders-5 TR. Washington, DC: American Psychiatric Association. (Desk Reference – spiral) Beauchaine, T.P. & Hinshaw, S.P., eds. (2017). Child and adolescent psychopathology. Hoboken, NJ: John Wiley and Sons. Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, N.Y.: Basic Books. Herman, J.L. (1992). Trauma and recovery. New York, NY: Basic Books. (n.d.). Https://Psychcentral.com/Health/Attachment-Trauma.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Final Paper

Related Documents