Assignment Two: TheoreticalApplication Paper
Zoe is a 17-year-old Native American femalefrom the Ojibwe tribe. She lived on the Mille Lacs reservation withher parents until she was 13 years old (2012) then, social servicestook custody of her. The state through the social service can takecustody of a child if the parents cannot provide for the child fully(Kempe et al., 2013). Zoe’s parents lose custody in court, forcingtheir daughter to live in a residential living facility until July2016 when she transitioned to foster care and currently lives withher Caucasian foster parents. Because of poor upbringing from herbiological parents, Zoe has a bad childhood that negatively affectsher behavior.
Zoe’s biological parents never married. Shehad 2 older biological siblings and 3 half-siblings until July 2016when her biological brother decided to commit suicide at the age of24. Around the time of his death, Zoe lost two other members of herfamily through suicide. Zoe’s parents used illegal drugs and drankalcohol regularly influencing her do the same at just 6 years ofage. Zoe’s drug use progressed to marijuana and methamphetamines.Her mother suffered physical health issues and was hospitalized attimes. She physically abused Zoe and was unable to care for herduring her illness. When Zoe was eleven years old, the mother tookher to an uncle’s place for care. However, things did not getbetter for Zoe, as her was physically abusive. Zoe’s uncle alsoexploited her sexually by allowing other adult men to have sex withher at a fee. Her uncle would give Zoe some money for the serviceswhich she used to buy methamphetamines. It might be the reason whyZoe never reported this abuse.
Zoe is successful as a junior in high schooland attains a 3.4 grade point average. She also becomes sociallyactive: participating in Art club, church, Native American culturalactivities, and playing basketball for fun. She had previouslypracticed traditional Native American spirituality, but now shepractices Christianity and is involved with the church that herfoster parents attend. She was recently baptized and continues toactively participate in the church youth group.
Zoe experiences the desire to use drugs andalcohol whenever the trauma events from her life replay themselves inher mind and become intrusive. Subsequently, Zoe reacts to thesethoughts by behaving in an impulsive, anxious, and self-destructivemanner. The eco-map displays positive relationships among Zoe, herOjibwe culture and spirituality, and the church. Additionally, Zoehas positive outlets at school and in art club.
Zoe’s primary diagnosis is Post Traumatic Stress Disorder (PTSD).According to Christiansen et al, survivors of childhood sexual abusehave a higher occurrence of PTSD, the potential to experience moretraumatic events, and are insecurely attached with a fearfulattachment style being the most prevalent. She re-experiences theabuse from her past, avoids how she feels, displays negativecognitions and moods, and can be reactive (APA, 2013, p. 271). Zoeexperiences distress when she is re-exposed to her family,particularly her uncle. Zoe’s use of drugs and alcohol is also ofconcern. For Zoe to receive help, she must be sober and notself-medicating since she has a poor concept of herself in thatstate. Although PTSD is common with sleep disorders, Zoe has notverbally acknowledged a problem with sleep prompting furtherinvestigation in that area.
The second leading cause of death among persons aged 15-34 issuicide. (Center for Disease Control website, 2015, p. 2). Sincethree members of Zoe’s family recently committed suicide, she mayalso be tempted to take her own life. She feels helpless andpowerless after all she went through which makes it easy for her tobe suicidal (Panagioti et al., 2012). The clinician think Zoe maycommit suicide because of the trauma and they suggest therapy forher.
Trauma-focusedCognitive Behavioral Therapy
According to Gehart, trauma-focused cognitive behavioral therapy(TF-CBT) is the best approach for working with adolescents who haveexperienced sexual abuse or other traumatic events. With this model,the clinician deals with the trauma as well as helping the child andfamily to grow in their belief that they can attain their goals.TF-CBT is generally a short-term form of therapy and usually consistsof either 12 ninety minute sessions or 16-20 sixty minute sessions. It is comprised of 10 components: namely, psychoeducation on TF-CBT,parenting skills, relaxation, affective expression and modulation,cognitive coping and processing I, trauma narrative, cognitive copingand processing II, in vivo mastery, conjoint child-parentsessions, and enhancing future safety and development. Each componentbuilds upon the component that preceded it. Through the therapyprocess, the child is encouraged to discuss the trauma with thetherapist. This activity is done so that the child can come to termswith the trauma and move past it(Getz, 2012). One of the ultimategoals of TF-CBT is to increase the child’s ability to function inall areas of life: including, friends, family, physical, andemotional well-being. Other possible goals can includereducing/removing negative thinking and various acting out behaviors.A key aspect to the overall treatment process is that the counseloris able to establish an honest and trusting relationship with thepatient. With most survivors of abuse, there is a loss of a sense ofsafety and trust. It is paramount that the counselor works hard toestablish a relationship with the child where safety and trust arepresent.
Parents also receive some training during the TF-CBT process in thehopes that it will help in the recovery of the child who hasexperienced the trauma. This training is meant to help the parentslearn skills that they can use to help the child to experience a safeand trusting environment at home, school, and in society. Relaxationtechniques are taught to the child as well as the parents in aneffort to show the child that they truly have control over their ownbodies and thoughts and for the parents to help them deal with theirown issues and act as teachers to the child. One of the keeptechniques used in TF-CBT is changing the way the child cognitivelythinks about the trauma. A child may begin with a negative thoughtabout the trauma and this can lead to negative feelings andbehaviors. With help from the counselor, the child’s cognitionsregarding the trauma can be altered so that the negative thought ischanged to something that is more empowering to the child. With thenew empowering context to the trauma, the child can then formulatemore positive feelings and behaviors as they relate to theexperience. It is also very important for the child to understandthat the trauma was not the victim’s fault (Getz, 2012).
Practical Application ofTF-CBT
Surveying a youthwith a deeply distressing experience is a challenge because ofreasons that cannot be fully explained in this application focusedassignment. To summarize the therapy process: first, the therapistendeavors to not only assemble fundamental data on Zoe`s traumaticencounters but also discuss auxiliary difficulties that subsequentlyhappen as a result of those bad experiences. These experiencesinclude expulsion or dismissal from family, disposition in child careor a private treatment office, legitimate, therapeutic or differentmethods that may be likewise considered as traumatic (Cary &McMillen, 2012). It is important for the therapist to discusssecondary adversities with Zoe because youths who have suffered frompast experiences frequently under-report traumatic encounters andinjury related issues. This reasoning might be based on the groundsthat recalling some experiences may be too painful for the victimconnection related wounds may have made Zoe avoid the issue in priorsessions Zoe may also have concluded that incessant injury andcontrol issues are part of life and there is no need to talk aboutthem. Evaluation is generally a continuous procedure which needs datafrom guardians or parental figures, if accessible, and differentgrown-ups who had been in contact with Zoe when she was going throughthese tortures.
A complex disturbingexperience like the one that Zoe has faced impacts various areasincluding connection, biology, conduct, insight and observation,mental self portrait, scholarly workings, and standard Post-traumaticStress Disorder (PTSD) side effects (Cary & McMillen, 2012).Physiotherapists must lead continuous appraisals on these areas. Theyshould assemble data from the adolescent, foster parents, school, anddifferent assets while likewise comprehending the basic significanceof building up a trusting association with the victim who may viewsuch data collection with doubt. Because of rehashed interpersonalinjury encounters, Zoe sees most connections as possibly undermining.Each TF-CBT segment ordinarily incorporates slow presentation so asto help the young victim gather control over bad memories from thepast (Cary & McMillen, 2012). Because building a therapeuticrelationship involves recalling past encounters for the victim, thetherapist needs to slowly expose Zoe to the possibility of aprotected and friendly connection with them.
Underage people withpast complex experiences best react to stage based treatment that hasan underlying adjustment period to give adapting aptitudes, an traumapreparation phase to comprehend individual negative encounters, andan incorporation juncture to combine and sum up security and trust.Extent and balance are vital when giving TF-CBT. Therapists normallydevote a similar number of treatment sessions to each of the 3 TF-CBTstages – 1/3 of sessions for adapting aptitudes 1/3 for injury storyand preparation 1/3 for treatment union and conclusion (Cohen etal., 2012). However, an adolescent like Zoe, who had previous drugaddictions, has huge control issues which are usually aggravated bydifficulties in creating a predictable and productive therapeuticbond, therefore, the division of treatment is altered so as to devotemore time to the first phase of TF-CBT treatment. Likewise, thelength of TF-CBT treatment should be stretched out, from the common8-16 sessions to 25 sessions with periodical variations of 28-30sessions each with a 50 minute term.
In the firstadaptation stage, Zoe starts building a trusting association with thetherapist and develops more secure and compelling self-controlabilities (Cohen et al., 2012). Under ideal conditions, fosterparents engaged in the therapy also figure out the best way to dealwith Zoe when she acts out due to PTSD. In any case, since this stagemay force Zoe to change her longstanding reactions due to extremeanxiety, the behavioral switch is not easy. Regardless of the dangersposed by such behaviors, they appear to have helped the Zoe tosurvive, so surrendering them might frighten her. Subsequently, Zoeneeds more time practicing her new self-control abilities in variouscircumstances before she starts utilizing them successfully. Duringthe sessions, Zoe may continuously test the therapist fordependability – for example, she might mention another unknownencounter from her past towards the end of a session so as to see ifher `guardian` will extend the period just to hear more about herproblems. The therapist must preserve individual control in such acircumstance in order to show Zoe the importance of emotionalauthority in any situation. As a result, Zoe gains self-directionwhile figuring out how to endure sensible levels of dissatisfactioninside the setting of a continuous steady relationship.
In the second phase,the therapist encourages Zoe to speak and consider her intricatetrauma encounters which pose new difficulties for her after she hasgained control capacities (Cohen et al., 2012). In any case,recalling and remembering her past enables Zoe to comprehendthemselves, their connections, and past encounters in new and morepositive ways it additionally gives her the chance to upgradeself-direction authority. Through the trauma portrayal and handlingstage, Zoe comprehends and incorporates her traumatic encounters in amore noteworthy profundity.
Once Zoe finishesthe second stage, it marks the start of the last period of TF-CBTwhich supports the progressive exchange of communication about thetrauma from the therapist to the foster parents sums up the capacityto set up constructive, trusting connections from the adviser toother critical individuals in the Zoe`s surroundings and summarizesZoe`s capacity to maintain her health in everyday life (Cohen et al.,2012). This phase is frequently elongated for youths with casessimilar to Zoe`s as they try to remember what they learned in theprevious chapters while endeavoring to set up security and createsuitable connections and circumstances.
The reasoning behind choosing this theory forZoe’s case is based on the fact that the majority of issuesaffecting her are related to the various forms of trauma she hasexperienced. Whether it was her sexual abuse or the recent tragicdeath of several family members, the TF-CBT approach seems to be thebest choice. While this therapy method may be the best choice, it isalso important to highlight ethical issues related to the case.
There are variouscontemplations that are considered in TF-CBT with youngsters. Forexample, the treatment must take a formatively proper social approachto deal with treatment when working with children (DePrince et al.,2012). So as to act in a moral way, the therapist has to make surethat the treatment is formatively proper for Zoe`s age and that theprocedures utilized are aware of any social qualities and standardsthat may be connected to the victim`s culture. When the therapistperforms such activities, it increases the chances of the fosterparents allowing Zoe to go on with her therapy.
Another relatedmoral and political issue that exists in numerous treatments,including TF-CBT, is the recognizable absence of healing systems thatare adjusted and accessible to minority populaces. For example, Zoeis more likely to get TF-CBT in juvenile detention than when she isat home with her foster parents. Because most minority familiessuffer from family breakdowns, there is a tendency to sidelinevictims from these communities by offering therapy sessions that aredifferent from others. Other ethical considerations include theunwarranted medicalization of anguish and retraumatization ofvictims.
The utilization ofrestorative terminologies and constructs in some psychiatric issuesinvolves a wrong augmentation of the well-being calling andundermines acknowledgment of the sociopolitical way of these marvels.To translate such issues, due to the real figures of speech that mostof the time goes with them, exclusively as a disease is to medicalizetheir essential nature. The element of PTSD embodies some of theseissues. In this case, the therapist diagnoses Zoe with PTSD based onthe ordinariness of post-traumatic anxiety reactions these are insome ways standard reactions to remarkable occasions. But otherresearch contends that the finding of PTSD is simply themedicalization of a sociopolitical field. It means that people whohave suffered painful experiences do not necessarily have PTSD. So asto avoid a misdiagnosis, the therapist should analyze Zoe further.
As part of the threestages of TF-CBT, the therapist encourages Zoe to remember and learnhow to manage past traumatic experiences. However, some experts arguethat this method may be quite harmful since it results in theretraumatization of a victim (Cerulli et al., 2012). Helpfulreprocessing of a traumatic encounter is more perplexing than justdiscussing past it there is likewise a requirement for therebuilding of passionate recollections and securing of new andversatile reactions. Essentially, declaration is seemingly powerfuljust inside specific settings discussing trauma may be helpful at aspecific time for a specific individual, and it might becounter-therapeutic to urge the damaged individual to relate withtheir story when time and setting are improper.
In conclusion, Zoe suffers from post traumaticstress as a result of poor upbringing from her parents. She has toundergo TF-CBT in order to gain self control and avoid irrationalbehavior that results from recalling such memories. The therapist hasto establish an ethical and friendly relationship with Zoe so as tobuild trust. As long as there is trust, Zoe can open up about heruncle and start the healing process. Although some sessions might belonger than others, they are worth it if they produce positiveresults. Finally, TF-CBT is a good alternative for Zoe because it isa slow and steady process that gives the victim enough time to heal.
American Psychiatric Association. (2013). Diagnostic andstatistical manual of mental disorders (5th ed.). Arlington, VA:American Psychiatric Publishing.
Cary,C. E., & McMillen, J. C. (2012). The data behind thedissemination: A systematic review of trauma-focused cognitivebehavioral therapy for use with children and youth. Childrenand Youth Services Review, 34(4),748-757. Retrieved from
Cerulli,C., Poleshuck, E., Raimondi, C., Veale, S., & Chin, N. (2012).“What fresh hell is this?” Victims of intimate partner violencedescribe their experiences of abuse, pain, and depression. Journalof Family Violence, 27(8),773-781. Retrieved from
Christiansen,D. M., Palic, S., Karsberg, S., & Eriksen, S. B. (2014, September25). Impact of traumatic events on posttraumatic stress disorderamong Danish survivors of sexual abuse in childhood. Journal ofChild Sexual Abuse, 23, 918-934. Retrieved fromhttp://dx.doi.org/10.1080/10538712.2014.964440
Cohen,J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012).Trauma-focused CBT for youth with complex trauma. Childabuse & neglect, 36(6),528-541. Retrieved from
DePrince,A. P., Brown, L. S., Cheit, R. E., Freyd, J. J., Gold, S. N., Pezdek,K., & Quina, K. (2012). Motivated forgetting and misremembering:Perspectives from betrayal trauma theory. In Trueand false recovered memories (pp.193-242). New York: Springer. Retrieved from
Gehart,D. (2016). Theory and treatment planning in counseling andpsychotherapy (2nd ed.). Boston, MA: Cengage Learning.
Getz,L. (2012). Trauma-focused cognitive behavioral therapy – Hope forabused children. Social Work Today, 12(3), 22.Retrieved from http://www.socialworktoday.com/archive/051412p22.shtml
Kempe,C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., &Silver, H. K. (2013). The battered-child syndrome. In C.Henry Kempe: A 50 Year Legacy to the Field of Child Abuse andNeglect (pp.23-38). Netherlands: Springer. Retrieved from
Panagioti,M., Gooding, P., Taylor, P. J., & Tarrier, N. (2012). Negativeself‐appraisalsand suicidal behavior among trauma victims experiencing PTSDsymptoms: The mediating role of defeat and entrapment. Depressionand Anxiety, 29(3),187-194. Retrieved from