• Which of the above recovery factors were most prevalent in "Ellen's" case? • What could have been done to mitigate the long-term effects of her trauma? • What would you have done to support Ellen, were you her friend or confidant? • Was there anything surprising in the article(s) you selected to read? • What sorts of resources can you find online to help a victim of what she experienced?

Ciccarelli: Psychology_5 (5th Edition)
5th Edition
ISBN:9780134477961
Author:Saundra K. Ciccarelli, J. Noland White
Publisher:Saundra K. Ciccarelli, J. Noland White
Chapter1: The Science Of Psychology
Section: Chapter Questions
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Ellen, described as “challenging” by several therapists at a trauma program, was assigned a new therapist. The team of clinicians had struggled for many years with understanding and helping Ellen, a client with multiple diagnoses (bipolar disorder, major depressive disorder, post-traumatic disorder, and dissociative identity disorder) who was frequently admitted as an inpatient at various local hospitals. Both of Ellen’s prior therapists were interns. The intake coordinator concluded, quite wisely, that forming a therapeutic relationship with a staff person over a longer period of time might improve Ellen’s stabilization. When the therapist initially read her two-volume file, she learned a great deal of basic information about Ellen. It soon became apparent that it would be difficult, at best, to develop a clinical formulation that could be used as a road map for future therapy sessions.
Since Ellen began treatment in the program three years ago, she had developed a pattern of requiring inpatient treatment at least once every six months. There did not appear to be any definable triggering event to these recurrent admissions. Each time Ellen was discharged, some well-meaning psychiatrist would give her a slightly different diagnosis and several new medications to try.
Ellen attended therapy once a week for a period of six years. In the final two years of her therapeutic engagement, Ellen was not once admitted as an inpatient. Furthermore, she was employed part-time at a department store so she would not have to rely solely on her Federal Disability grant. After getting married, she considered relocating to another state so she could live closer to her daughter and granddaughter.
 
What factors contributed to Ellen achieving such an improved level of functioning? In describing the factors, the process of her treatment is described. First, it was important for Ellen to be psychologically tested in order to exclude concerns of neurological disorders and frontal lobe malfunctioning. Other personality and trauma screens, some of which are outlined later in this chapter, helped provide objective data on her functioning.
Second, the therapist attempted to understand Ellen’s perspective by exploring the role her hallucinations may have served and the underlying causes of her mood fluctuations. Often, new therapists are afraid to examine the inner workings of a client’s psychoses. As Ellen began to develop trust in the therapeutic relationship, she started to engage more fully. The recollection soon emerged that she had been sexually abused by her maternal uncle from the age of five until her teenage years. This trauma explained the origin of her mixed moods; her recollection also gave some clarity to her report of hearing negative internal voices. Ellen claimed that for the first time in her life, she felt heard and understood. Early in her treatment, when Ellen was hospitalized, the therapist attended Ellen’s discharge meetings so she could advocate for her. At these meetings, the health care providers involved in discharging Ellen were informed about treatments that had already been tried without success. By advocating for Ellen, the therapist served as the container that temporarily held Ellen’s world together.
Assessment Challenges
Assessing trauma survivors can be a challenge for many reasons. Trauma is seldom the presenting issue that brings clients to therapy. It is often not until much later in the therapeutic relationship that a therapist discovers an underlying history of trauma in a client’s life. Discovering this painful history illuminates a possible source for a client’s current difficulties. In Ellen’s case, treatment was sought for severe mood fluctuations; Ellen also wished “to get rid of the voices that tell me I am no good.” The client was correctly diagnosed with manic depressive disorder. Later, as her visual and auditory hallucinations became more debilitating, Ellen was given the diagnosis of schizoaffective disorder. However, merely assigning these diagnoses without understanding her symptoms at a deeper level failed because it neglected to fully address the underlying cause of her difficulties. For clients who may possess multiple psychiatric diagnoses, knowing the area on which to focus during a therapy session can be a challenge for the therapist. One possible strategy is to allow the client’s mood to dictate the focus of a particular session. This method of conducting therapy can also help the client maintain a sense of control and competency.
 
 
• Which of the above recovery factors
were most prevalent in "Ellen's"
case?
• What could have been done to
mitigate the long-term effects of her
trauma?
• What would you have done to
support Ellen, were you her friend or
confidant?
• Was there anything surprising in the
article(s) you selected to read?
• What sorts of resources can you find
online to help a victim of what she
experienced?
Transcribed Image Text:• Which of the above recovery factors were most prevalent in "Ellen's" case? • What could have been done to mitigate the long-term effects of her trauma? • What would you have done to support Ellen, were you her friend or confidant? • Was there anything surprising in the article(s) you selected to read? • What sorts of resources can you find online to help a victim of what she experienced?
disorder. The DSM-IV cited prevalence rates of PTSD between 3% and 58%
in 1994. More recent findings indicate that only about 25% of individuals who
experience trauma develop PTSD (Brady, 2001). Therefore, it is useful to
explore the factors that enable the other 75% of trauma victims to survive, and
even to psychologically recover, despite their traumatic experiences.
Resiliency is the term applied to those individuals exposed to severe risk
factors who nevertheless thrive and excel (Werner, 2001). It is an ability to
successfully overcome physical and psychological trauma that defines
resiliency.
In what is now considered a classic study on resiliency, Werner (2001) found
that in spite of extreme disadvantages and multiple risk factors, resilient
children manage to succeed and contribute to society. Werner followed 505
individuals from birth to adulthood, on the island of Kauai (Hawaii), to study the
impact of various biological and psychosocial risk factors, protective factors,
and stressful life events on their development. The group comprised
individuals from many different ethnic groups, including Japanese, Hawaiian,
and Filipino. Results of Werner's study indicated that one in three of these
high-risk children developed into confident, capable, and caring young adults.
Individual differences partly accounted for resiliency among some children.
The presence of grandparents or mentors who provided children with
consistent nurturing and support emerged as an additional factor that
ameliorated suffering and buffered responses to constitutional risks and
stressful life events (Werner, 2001). Besides innate and environmental
circumstances that support resiliency, several other factors also influence an
individual's ability to recover from trauma. By becoming familiar with these
factors and the intensity at which they are likely to occur, a practitioner is better
equipped to determine the direction of a therapeutic relationship.
Factors That Influence Recovery From Trauma
Intensity. Obviously, the more intense and chronic the trauma, the more
damaging are its effects.
Chronicity. Chronic PTSD, described as Type II trauma, is more difficult to treat
than acute, or Type I, trauma (Terr, 1991). Previous experiences of
victimization can severely compromise an individual's ability to recover. PTSD
symptoms of more than 16 to 18 months' duration tend to be classified as
chronic (Friedman & Rosenheck, 1996). Chronic PTSD is usually
characterized by fluctuations in symptom severity with periods of remission,
but rarely is more than partial recovery achieved (Ronis, Bates, Garfein, Buit,
Falcon, & Liberzon, 1996).
Pre-existing condition. A pre-existing mental illness, substance abuse, or
chronic medical condition decreases an individual's ability to recover from
trauma, leading to co-morbid disorders.
Personality. The personality, including a positive self-concept, high self-
esteem, high self-confidence, and an extraverted personality style, influences
resiliency and recovery from trauma (Werner, 2001). In a study conducted
among college students, those with trauma histories reported more trait
anxiety, lower self-esteem, higher neuroticism, more introversion, and reduced
emotional stability than non-traumatized subjects (Bunce, Larsen, & Peterson,
1995).
Cognitive style. The individual's cognitive style can also influence recovery.
Traumatized individuals reported more cognitive disturbances. They display
cognitive styles that are associated with an increased risk for depression
(Bunce et al., 1995). In contrast, resilient individuals tend to possess higher
cognitive ability which provides a protection against PTSD (Werner 2001)
Transcribed Image Text:disorder. The DSM-IV cited prevalence rates of PTSD between 3% and 58% in 1994. More recent findings indicate that only about 25% of individuals who experience trauma develop PTSD (Brady, 2001). Therefore, it is useful to explore the factors that enable the other 75% of trauma victims to survive, and even to psychologically recover, despite their traumatic experiences. Resiliency is the term applied to those individuals exposed to severe risk factors who nevertheless thrive and excel (Werner, 2001). It is an ability to successfully overcome physical and psychological trauma that defines resiliency. In what is now considered a classic study on resiliency, Werner (2001) found that in spite of extreme disadvantages and multiple risk factors, resilient children manage to succeed and contribute to society. Werner followed 505 individuals from birth to adulthood, on the island of Kauai (Hawaii), to study the impact of various biological and psychosocial risk factors, protective factors, and stressful life events on their development. The group comprised individuals from many different ethnic groups, including Japanese, Hawaiian, and Filipino. Results of Werner's study indicated that one in three of these high-risk children developed into confident, capable, and caring young adults. Individual differences partly accounted for resiliency among some children. The presence of grandparents or mentors who provided children with consistent nurturing and support emerged as an additional factor that ameliorated suffering and buffered responses to constitutional risks and stressful life events (Werner, 2001). Besides innate and environmental circumstances that support resiliency, several other factors also influence an individual's ability to recover from trauma. By becoming familiar with these factors and the intensity at which they are likely to occur, a practitioner is better equipped to determine the direction of a therapeutic relationship. Factors That Influence Recovery From Trauma Intensity. Obviously, the more intense and chronic the trauma, the more damaging are its effects. Chronicity. Chronic PTSD, described as Type II trauma, is more difficult to treat than acute, or Type I, trauma (Terr, 1991). Previous experiences of victimization can severely compromise an individual's ability to recover. PTSD symptoms of more than 16 to 18 months' duration tend to be classified as chronic (Friedman & Rosenheck, 1996). Chronic PTSD is usually characterized by fluctuations in symptom severity with periods of remission, but rarely is more than partial recovery achieved (Ronis, Bates, Garfein, Buit, Falcon, & Liberzon, 1996). Pre-existing condition. A pre-existing mental illness, substance abuse, or chronic medical condition decreases an individual's ability to recover from trauma, leading to co-morbid disorders. Personality. The personality, including a positive self-concept, high self- esteem, high self-confidence, and an extraverted personality style, influences resiliency and recovery from trauma (Werner, 2001). In a study conducted among college students, those with trauma histories reported more trait anxiety, lower self-esteem, higher neuroticism, more introversion, and reduced emotional stability than non-traumatized subjects (Bunce, Larsen, & Peterson, 1995). Cognitive style. The individual's cognitive style can also influence recovery. Traumatized individuals reported more cognitive disturbances. They display cognitive styles that are associated with an increased risk for depression (Bunce et al., 1995). In contrast, resilient individuals tend to possess higher cognitive ability which provides a protection against PTSD (Werner 2001)
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