Physical abuse can bring immediate harm to a person and have long-lasting effects. People who have experienced physical abuse may likely struggle with emotional and psychological difficulties in their lives (Ho et al., 2016). These individuals require the intervention of mental health professionals to help them recover from the effects of physical abuse. In most cases, individuals who have experienced physical abuse struggle with emotional trauma. Therefore, it is necessary to deploy targeted psychotherapeutic treatment that is individualized to help achieve optimal patient outcomes (Ho et al., 2016). Catherine, a victim of physical and emotional abuse, has struggled with the emotional trauma associated with the abuse. She was attacked while from work and beaten severely. Additionally, she was threatened by the male assailant not to report the attack. Since then, she has struggled with accepting men. She hates men and blames herself for the attack.
The paper explores how to work with Catherine in therapy to help address her needs. Cognitive Processing Therapy (CPT) will be used as the ideal therapeutical intervention to help Catherine deal with interpersonal difficulties that resulted from the physical and emotional abuse she experienced. The paper will be organized into the assessment of the case through asking various questions, the conceptualization of the case, the treatment plan, and a discussion of therapist influence.
Assessment
The period before the beginning of therapy and the initial stages of therapy are the most crucial points in the therapeutic experience. They allow therapists to understand their clients better to determine the best therapy that fits these clients’ individual needs (Patterson et al., 2018). Moreover, therapists can express their hunches and ask clients various questions to help them understand these clients better. In this case, I had various hunches that played a significant role in informing questions that I asked Catherine to help understand her therapeutic needs.
First, most people who are victims of physical abuse who struggle with overcoming it may have been victims of childhood abuse and neglect. Most people who experienced childhood abuse and neglect often struggle with adult feelings and behaviors; particularly, when there was no intervention (Ho et al., 2016). Therefore, it is important to screen for child abuse and neglect histories during the assessment process. It will help identify if Catherine exhibits symptoms linked to child abuse and neglect, such as major depression, posttraumatic stress disorder, or mood disorders. Screening Catherine for child abuse and neglect histories may help determine if she will benefit from particular therapies. Also, it will determine the type of intervention to rely on to address Catherine’s needs. I believe that while a client may not show symptoms of child abuse and neglect during the initial phase, it is necessary to continue conducting the screenings during different times of the treatment process, as this will help elicit more information on the traumatic experiences a client presents (Patterson et al., 2018). Such screenings can be conducted after establishing trusting therapeutic relationships with a client.
Secondly, I believe that most victims of physical abuse or emotional abuse have their preferred coping mechanisms. The most common coping mechanisms include turning to drugs and drinking alcohol. I believe that while Catherine developed a feeling of hatred toward men, she identified a coping mechanism to help deal with the hatred. For instance, she may have started drinking alcohol to help cope with the physical and emotional abuse she experienced. Alternatively, Catherine may have turned to drug abuse to help her deal with the physical and emotional abuse. Therefore, it is important to ask questions to determine if Catherine has a coping mechanism that matches these described.
Thirdly, I believe that clients’ thoughts during physical abuse may have a significant impact on how they view it later in life. Clients who have thoughts of self-blame during abuse may have such feelings later in life. Clients with thoughts about the perpetrator being the wrong party will likely learn to cope with the abuse later in life. Therefore, understanding the client’s thoughts is vital to understanding how they perceive them.
Based on the hunches above, various questions exist that I will ask the client to understand the case better. For instance, “Did you experience childhood abuse and neglect?” The question will be vital in understanding the ripple effects of her childhood experiences and their capability of influencing her adulthood. Another question is, “What were your feelings toward men before the incident?” The question will help understand the impact of the incident on her feelings toward men. Also, it will help understand if the feelings toward men started before the incident. Another question that I will ask is, “Do you use drugs or alcohol to cope with the incident?” The question will help determine the ideal therapy to utilize based on a coping mechanism. Another question I will ask is, “What were you thinking during the incident?” The question will help understand the client’s perception of the incident to determine whether she blames herself or the assailant. Also, I will ask, “In a similar situation involving another victim, should the blame be on the victim or the assailant?” The question will help determine the client’s thoughts about the incident from a perspective different from a victim.
Clinical Conceptualization
Commonly, victims of physical abuse usually have psychological wounds that endure long after their physical wounds have healed (Patterson et al., 2018). These people suffer intense shock, fear, and terror in the victimization course in most cases. The incident that Catherine experienced made her feel terrified, so she attempted to scream for help. After victimization, most people struggle with anxiety, anger, social isolation, helplessness, and depression. For Catherine, the inability to get help despite her screams left her with feelings of anger. In this case, she developed anger toward men since the perpetrator was a man. It explains why she refused assistance from the males who came to her rescue, as she associated them with the perpetrator. Such feelings are understandable, and, in some cases, victims of abuse may develop feelings of helplessness and self-blame. In this case, Catherine started blaming herself for the attack. People who experience prolonged and repeated victimization are common to develop severe mental health problems (Ho et al., 2016). A review of the case demonstrates that the incident happened once, which means that the chances of Catherine developing severe mental health problems were low.
Importantly, not all physical abuse victims need or will benefit from mental health services to assist them in dealing with the victimization’s emotional and psychological aftermath. Physical abuse victims need specialized therapy benefit in that it helps them during the healing process (Patterson et al., 2018). In this case, Catherine can be categorized as a physical abuse victim who requires specialized mental health services to help her deal with the aftermath of the victimization. Based on her symptoms, which include hatred toward men and self-blame, she requires individualized therapy that meets her needs. Therapy will help her learn to cope with the victimization (Patterson et al., 2018). Therapy can help provide support, understanding, and counseling to the victim to overcome the physical abuse and learn to avoid blaming herself as a victim.
Memories of physical or emotional abuse can be intense, depending on the victim. For most victims, physical abuse can interfere with their ability to live fulfilling lives (Patterson et al., 2018). Others can attempt to forget the painful memories of physical abuse; however, this is not easy. Victims of physical abuse should examine and address their feelings of guilt, grief, anxiety, or anger by getting help from a mental health professional. Therefore, Catherine needs the intervention of a therapist to help her deal with her anger toward men and the guilt feelings she has regarding the abuse. Therapy will help Catherine let go of the painful memories regarding the physical abuse and learn to forgive the person who abused her. Without an intervention, Catherine will continue experiencing mental distress and difficulty throughout her life, and she may likely become a perpetrator. Therefore, therapy will help Catherine understand the situation and learn to live without blaming herself or hating men, as the perpetrator was of the same gender.
Treatment Plan
The treatment of Catherine will involve three stages, the beginning, middle, and end stages. It is necessary to have a goal for every stage and various objectives to help the client reach the identified goal. In the beginning stage, it will be important to establish a good relationship with the client, as this will determine the success of the therapy. The success of the stage requires engaging the client so that the issues surrounding the physical abuse she experienced can be explored. The key to successfully exploring the stage is winning over the client using strategic convincing communication skills (Tsai et al., 2009). Therefore, the goal for the beginning stage is to ensure that the client is comfortable enough to discuss the event. The achievement of the goal will involve two objectives. First, the client should detail the physical abuse with the therapist in detail. Secondly, the client should ask the therapist questions about the impact of physical abuse on victims. The rationale for the goal is that it will help the client better understand the therapeutic process. In particular, Catherine will understand the therapist’s role in overcoming the physical abuse. Additionally, she will learn what is expected of her in therapy and her role to make it successful. The stage will benefit the client by building a rapport with the therapist, which plays a significant role in a successful therapeutic relationship.
In the middle stage, it is necessary to detail the therapy to address the client’s needs. It allows therapists to constantly assess their clients’ coping strategies, insight, and improvement signs. Therapists must be cognizant of the role of external issues in affecting their client’s feelings and thoughts so that these clients can internalize their thoughts and feelings (Tsai et al., 2009). The stage allows clients to explore deeper feelings and negative thoughts associated with physical abuse. The stage allows for a better insight into the issue being covered in the therapy so that clients can utilize suggested techniques to overcome them. This stage aims to help the client identify and change unhelpful thoughts about the physical abuse. The goal will be attained with the help of two objectives. The first objective is for the client to think of the traumatic experience in more realistic ways that make it less upsetting. The second objective is for the client to work with the therapist to openly talk about the traumatic experience and suggest ways to reduce escape and avoidance behaviors. The rational for this stage is to help the client learn how to diffuse negative emotions associated with a traumatic experience (Tsai et al., 2009). The client will learn to avoid escape and avoidance behaviors associated with the traumatic experience when she is open to adjustments in her behavior as guided by the therapist. The therapist will rely on CPT to identify unrealistic and unhelpful thoughts Catherine has about the traumatic experience and its role in her beliefs and views about others and the world. The stage will allow the identification and change of these thoughts planned. Ultimately, the client will avoid being upset when she thinks about the traumatic experience. Additionally, she will learn to avoid hating other men or herself.
In the end stage, it is necessary to help the client understand the whole process, its closure, and the need to be well prepared to deal with similar issues in future. Reviewing the client’s progress is vital in this stage, as it allows them to understand what has been achieved (Tsai et al., 2009). An aftercare plan is necessary during this stage to equip clients with coping mechanisms for similar cases in the future. The goal of this stage is to help the client understand the intention of the therapeutic process. Meeting this goal will involve two objectives. The first objective is that the client should discuss how she can cope with a similar traumatic experience in the future. The second objective is that the client expresses anger productively without blaming herself or others. The rationale for the stage is to help the client understand the significance of therapy in addressing traumatic experiences (Tsai et al., 2009). Additionally, the stage allows clients to understand that some of these traumatic experiences are challenging to avoid, making them understand that the blame should not be on them.
Therapist Influence
Based on Catherine’s information, some parts of her experience may have allowed me to turn inwards. For instance, her narration of the traumatic experience; particularly, when she lashed out and attacked the emergency response team member, made me judgmental. Being judgmental is considered one of the ways how therapists can hinder the progress of their clients (Saxon, Firth, & Barkham, 2017). Navigating this pattern capable of stagnating the therapeutic process involves exhibiting unconditional positive regard and being sincere. As a therapist, I am expected to exhibit unconditional positive regard, be sincere with the client, and be nonjudgmental. Another possible way that I may have hindered the client’s progress is by being insensitive to the client’s cultural issues. The client informed me that she expected me to empathize with her situation, as it is culturally wrong for a man to attack a woman. Navigating this pattern if stagnating the therapeutic process involves researching a client’s culture to understand what is expected of a therapist. Understanding the client’s culture could have helped avert the client’s thoughts that I failed to understand her situation. Another possible way that I may have hindered the client’s progress during the therapy is the development of powerful feelings toward the client due to the magnitude of the traumatic experience. Addressing this involves focusing on empowering the client and understanding that being overinvolved can rob clients of the chance of drawing on their inner resources (Saxon, Firth, & Barkham, 2017).
In conclusion, an understanding of the therapeutic process is crucial to the successful intervention for a client who experienced physical abuse. In this instance, Catherine was beaten by an assailant, which had a long-lasting impact on her. She struggled with relating with men afterwards, as the perpetrator was a man. Additionally, she blamed herself for allowing the attack to happen and addressing this involved considering the major aspects of therapy, including assessing the case by presenting questions, conceptualizing it, providing a treatment plan, and understanding therapist influence. Cognitive Processing Therapy (CPT) was used to help Catherine deal with interpersonal difficulties that resulted from the physical and emotional abuse she experienced.
References
Ho, C. M., Lee, C. H., Wang, J. Y., Lee, P. H., Lai, H. S., Hu, R. H., & Chen, J. S. (2016). Abuse-related trauma forward medical care in a randomly sampled nationwide population. Medicine, 95(43), e5214. https://doi.org/10.1097/MD.0000000000005214
Patterson, J., Williams, L., Edwards, T., Chamow, L., & Grauf-Grounds, C. (2018). Essential skills in family therapy: From the first interview to termination (3rd eds.). The Guilford Press.
Saxon, D., Firth, N., & Barkham, M. (2017). The relationship between therapist effects and therapy delivery factors: Therapy modality, dosage, and non-completion. Administration and policy in mental health, 44(5), 705–715. https://doi.org/10.1007/s10488-016-0750-5
Tsai, M., Kanter, J.W., Landes, S.J., Newring, R.W., & Kohlenberg, R.J. (2009). The course of therapy: Beginning, middle and end phases of FAP. In Glen Callaghan, William C. Follette, Barbara Kohlenberg, Mavis Tsai, Robert J. Kohlenberg, & Jonathan W. Kanter. A guide to functional analytic psychotherapy: Awareness, courage, love, and behaviorism. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-09787-9_7
