Case Study

Case Study Purpose: The purpose of this case study is for students to demonstrate skills in choosing appropriate assessment tools and interventions and applying them to a character who has experienced crisis or trauma. Process: Develop a case study based on one of the characters depicted in a selected film. The film should be selected from the list provided and a segment depicting crisis or trauma should be identified. Provide a brief summary of the film segment. The case study is to include the assessment tools and evidence-based counselling interventions appropriate to the situation. Identify cultural and ethical considerations, and reflect on personal responses to the trauma, and your current level of expertise in crisis or trauma counselling. Films to choose from: (Writer can choose from one of the movie below) choose one ONLY * The Impossible (2012) – The story of a tourist family holidaying in Thailand during the 2004 tsunami. This is available for hire from Campus Library. * Reign over me (2007) – the story of a man who lost his family in the September 11 attack who rekindles a relationship with an old friend. This is available for hire from Campus Library. Your case study will need to address: • An overview of the selected film and segment of film chosen ? • A description of the character chosen, and a rationale for choosing the character ? • An outline of the potential psychological impacts of victims and survivors of the selected area of interest ? • Assessment tools appropriate to the character identified and a rationale given for the choice of tools ? • Evidence-based interventions appropriate to the character ? • Cultural considerations identified ? • Ethical considerations identified ? • A personal response to the trauma discussed ? • Reflection of current level of expertise in crisis and trauma ? Marking Criteria: Case Study 1. An overview of the selected film and segment of film chosen 2. A description of the character chosen, and a rationale for choosing the character 3. An outline of the potential psychological impacts of victims and survivors of the selected area of interest 4. Assessment tools appropriate to the character identified and a rationale given for the choice of tools 5. Evidence-based interventions appropriate to the character 6. Cultural considerations identified 7. Ethical considerations identified 8. A personal response to the trauma discussed 9. Reflection of current level of expertise in crisis and trauma Structure, Presentation and Referencing 1. Main ideas clearly and logically presented 2. Relevant research and scholarship literature used appropriately to support claims 3. Correct academic writing style used, including correct spelling, grammar and punctuation 4. Presentation guidelines followed as specified in the learning and first/ third person writing style is applied where relevant 5. In-text referencing and reference list follows APA referencing style (6th ed.) as set out in the APA website: http://www.apastyle.org/ Extra Note: Unit learning outcomes On completion of this unit, students will be able to: • a) identify a range of traumatic triggers, and individual, group and community responses to trauma ? • b) demonstrate understanding of indicators of crisis and trauma responses, and assessment tools for crisis and trauma responses ? • c) identify and apply a range of evidence-based approaches to crisis and trauma counselling? • d) compileappropriateresourcesandreferrallistforclientsincrisis,orexperiencing traumatic reactions ? • e) identify and respond to the limits of expertise ? • f) demonstrate understanding of positive and negative impacts of working with crisis and trauma on the self of the counsellor, such as post-traumatic growth, vicarious traumatisation, vicarious countertransference, compassion fatigue, and develop strategies for self-care ? Textbooks The textbooks for this unit are: Miller, G. (2012). Fundamentals of crisis counselling. Hoboken, NY: John Wiley. Australian Centre for Posttraumatic Mental Health. (2007). Australian guidelines for the treatment of adult and acute stress disorders and posttraumatic stress disorders: Practitioners’ guide. Retrieved online from http://www.acpmh.unimelb.edu.au/resources/resources-guidelines.html Recommended readings The twelve sections of unit curriculum direct students to readings in the online classroom for this unit. These readings are selected from journals and books that provide additional information or a different perspective on topics covered in each section. They are from a range of authorities and expand the content of this unit. SAMPLE CASE STUDY Assessment from another movie: Introduction This case study will review the domestic violence (DV) experienced by character Beth Heke in the motion picture titled Once Were Warriors (Scholes, 1994). The case study will highlight appropriate assessment tools that are used within a counselling context and the potential psychological impacts for Beth as a result of DV. Evidence-based interventions for DV will also be discussed along with cultural and ethical considerations identified. Lastly, a personal response to the trauma depicted and current level of Crisis and Trauma expertise will be provided. Overview of film Beth is married to Jake and has five children. Beth ran away from her tribal land because her relationship was disapproved by her elders so they moved to the city with intentions never to return. Jake appears to be a loving husband when he comes home with gifts for his family and tells Beth that he has lost his job. Beth is dissatisfied and concerned, as she feels the family will not be able to make ends meet. Jake is often at the local bar drinking excessive amounts of alcohol and frequently invites everyone back to party at his place. When intoxicated, Jake has a temper and is quick to anger which leads to being physically violent towards Beth. Beth and Jake’s five children are all affected by the violent environment, however only three of them play a significant part in the film. Nig is angry and rebellious and joins a gang. Mark nicknamed Boogie, is arrested for breaking the law and is required to attend court. Beth misses the court date due to her being badly beaten by Jake the night before. The court determines Boogie’s parents are not fit to raise him and he is sent to a boys group home where he learns the traditional ways of the tribe. Grace has taken on the maternal role of the family and cleans the house after parties and gets her younger siblings ready for school. She also attends Boogie’s court date for support. Grace has a homeless best friend she visits for comfort and to escape the violence. One night Jake’s best friend sneaks into Grace’s room and rapes her and he threatens Grace not to tell anyone. Traumatised by the event she shuts down and isolates herself. Grace is away from home for a few hours and returns home only to be disciplined by Jake for not being respectful to the same person who raped her. Grace walks to the backyard and hangs herself. Beth is aware that the violence in home killed Grace but she was not aware of the rape until later. Devastated, Beth takes Grace back to her tribal land to be traditionally buried and the funeral unites all the children and Beth’s family together. The film ends with Beth leaving Jake for good and returning home with the support of her children. Segment of film chosen At Jake and Beth’s house a drunken party is occurring when Nig walks into the kitchen to ask for money. Beth asks Nig why he needs money and believes he does not need any as Nig has everything he needs at home. Beth asks Nig to have a drink with her and she recalls times of when Nig and she used to talk and laugh. Nig says “you’re drunk” and Beth replies she is not drunk, she is happy. Nig says she is out of her mind and Beth slaps him in the face, pauses, and then says she is sorry and searches for money. Nig walks out of the house leaving Beth upset by what happened. Jake’s best friend enters the kitchen and asks Beth to cook some eggs and bacon. Beth yells at his friend to go away and Jake walks in to ask what is happening. His friend says he asked for some eggs and Jake tells Beth to cook some eggs. Beth gets the eggs out of the fridge and smashes them on the ground while yelling at Jake. He demands once more and she screams “Do it yourself Jake”; he responds with a punch to the face knocking her to the ground. Beth rises and spits blood in his face and Jake repeatedly punches Beth in the head. Beth his thrown and kicked around the house and pushes Beth into their bedroom where he rapes her. Character chosen and rationale The chosen character for this case study is Beth as she was the primary character subjected to the domestic violence. She is a strong willed woman even though she is beaten by her husband. Beth wants a happy family and a home that she owns. Beth has never forgotten her family heritage and her spirit stays strong with the close connection to traditional ways. This is evident at the end of the movie when Beth leaves Jake saying “Our people once were warriors. But unlike you Jake, they were people with power, pride; people with spirit. If my spirit can survive living with you for eighteen years, then I can survive anything”. Potential psychological impacts Beth sustained physical injuries such as cuts, bruising and severe swelling to her face. These injuries are some common examples of immediate impacts in DV survivors (Domestic Violence Prevention Centre Gold Coast Inc., 2015). The psychological impacts Beth could potentially develop include depression; especially with the loss of her daughter Grace, post-traumatic stress disorder (PTSD), phobias, panic disorders, anxiety and substance abuse disorders (Carbone-Lopez, Kruttschnitt& Macmillan, 2006; Pico-Alfonso, et al., 2006). Beth potentially increases her chances of developing psychological impacts as she is already a regular drinker of alcohol and if Beth’s consumption turns to alcohol abuse this further increases her chance (National Institute on Alcohol Abuse and Alcoholism, n.d). Keeling and Mason (2008) also found that abused women experience depression and PTSD as co-morbidities at a greater rate than non-abused women. Assessment tools When assessing a client who is experiencing DV it is important to assess their circumstances which are completed with screening tools together with professional judgement. The NSW Government’s has contributed to DV issues as they have developed a framework for reform called “It stops here: Standing together to end domestic and family violence” which sets out to improve how government and non-government agencies respond to DV (NSW Health, 2014). The key components include a Domestic Violence Safety Assessment Tool (DVSAT) to identify the level of DV threat to victims; a central referral point to manage and monitor referrals; a network of local coordination points that facilitate local responses; Safety Action Meetings to develop action plans for victims of high exposure and the ability for service providers to share information so victims do not have to re-tell their story multiple times (NSW Government, 2015). The DVSAT identifies the level of threat to victims and discusses the violence toward the client, relationship between client and partner, background of partner, children and sexual assault (NSW Government, 2015). It is important to assess all types of DV risks for the survivor and any children involved because it identifies the level of threat for future harm. Safety is of the utmost importance (NSW Health, 2014). The DVSAT is appropriate to use with Beth as she was living with Jake at the time of the violence, therefore the risk of future harm is high, especially with considerable amounts of alcohol being consumed. There are also underage children exposed to the DV therefore it is also a safety risk for the children. Evidence-based Interventions An integral part of community approaches to DV is to have programs in place to support survivors of DV. Domestic violence agencies generally provide services that include crisis hotline; counselling, emergency shelters and advocacy (Bennett, Riger, Schewe, Howard & Wasco, 2004). Of these services provided, shelter programs tend to be one of the most supportive and effective resources for women as they are free of charge, they offer support groups and encourage empowerment and respect for women (Sullivan, 2006; Bennett, et al., 2004). Within the counselling context, a counsellor can work with a client who has experienced DV in a number of ways. Motivational Interviewing (MI) in conjunction with Transtheoretical Model (TTM, or Stages of Change model) may be effective as TTM assesses the client’s readiness to change (Bliss, Ogley-Oliver, Jackson, Harp, &Kaslow, 2008) while MI uses levels of empathic listening, encourages autonomy and self-efficacy, minimises defensiveness and resistance and focus on positives (Corey, 2013; Murphy &Maiuro, 2009; NSW Department of Health, 2008). Another counselling approach is Cognitive Behaviour Therapy (CBT) where the counsellor and client work collaboratively to identify what issues require attention, establish goals and how the client plans to reach the goal (Beck, 1989). According to Warshaw, Sullivan & Rivera (2013), trauma focused treatments frequently use forms of CBT, as evidence supports that it is effective for treatment in mental health disorders; however these approaches may not suit all trauma survivors. In the case of Beth, one could argue that she would be more concerned with protecting her children and finding emergency accommodation at a woman’s shelter than focusing on counselling. Appropriate interventions for Beth would be primarily around the assessment of risk factors for potential future harm of herself and her children. As Beth and her children would still be living at home with Jake at the time of the incident, the counsellor has ethical and legal obligations to ensure the safety of the client and children come first. This means assessing whether the victim is at threat or severe threat using the DVSAT, and then consent-based referrals would be forwarded to domestic violence specialists or other services, or if the victim is at serious threat, they would be referred to Safety Action Meetings (SAM) (NSW, Government, 2015). Cultural and Ethical considerations Beth is intimately connected with her spiritual tribal land and her heritage. In the film it is represented that the males and females are separated in the social context. For example, one scene shows the women in the kitchen talking and drinking while the men are in the lounge room drinking and singing. As Beth is culturally strong, a counsellor would need to be mindful of this when assisting Beth. There are seven key principles for health providers to support Maori victims of DV that include; Victim safety and protection; Maori friendly environment, Culturally safe and competent interactions; Engagement of local Maori community and whanau (extended family); knowledge of the community; intersectorial collaboration; Monitoring and evaluation of family violence interventions with Maori women and children (West Coast District Health Board, n.d). The New Zealand Ministry of Justice (2002) believe programs that intervene in Maori family violence should be considered from a historical and cultural standpoint and could be more effective when delivered by Maoris, for Maoris, under Maori Kaupapa (community). Due to the nature of crisis and trauma counselling, it is vital that counsellors follow the ethical standards set out by the Psychotherapy and Counselling Federation of Australia (PACFA). This also ensures that the client and practitioner are protected from psychological harm (Mailloux, 2014); especially from re-traumatisation or vicarious trauma. The counsellor should work in the best interest of the client, work within one’s own capacity, keep informed with relevant knowledge, have regular supervision to ensure quality, and most importantly ensuring it is a safe, secure and confidential environment (PACFA, 2014). Reflection of personal response Including Crisis and Trauma expertise Watching the film I cried a number of times due to the violence depicted. As a woman I felt overly protective for Beth which left me feeling concerned that if I was to work with Crisis and Trauma, how would I effectively conduct a counselling session without hindering the therapeutic process. Being aware of this will ensure I seek supervision when I feel it is not within my capacity while adhering to ethical guidelines. The knowledge I have obtained from focusing primarily on DV has educated me with tools and resources to aid in crisis and trauma counselling, however at this present time I strongly believe further education specialising in this field will expand the skills required for higher quality of practice. Conclusion By looking at the character Beth in the film Once Were Warriors, this case study was able to provide potential psychological impacts individuals may develop when exposed to domestic violence. Most importantly, the case study highlighted the importance of assessment tools that identify risk factors for future harm. Once the assessment has been completed, it can be determined what referrals are required for victims at threat or severe threat. Interventions and counselling approaches discussed illustrated how they may facilitate a client within counselling, however due to high risk factors for Beth, the most appropriate intervention would be to refer her onto a specialist services to find emergency housing for safety. The case study briefly discussed cultural and ethical considerations by emphasising that is imperative to work in the best interest of the client while upholding ethical standards. Domestic violence awareness is growing as there are many initiatives and prevention strategies in place; however it is important to highlight when working with crisis and trauma, a therapist needs to take extra care to avoid psychological harm to either parties and to remember each experience is unique. References Beck, A. (1989). Principles of cognitive therapy. In Cognitive therapy and the emotional disorders (pp. 213-232). London, England: Penguin. Bennett, L., Riger, S., Schewe, P., Howard, A., & Wasco, S. (2004). Effectiveness of Hotline, Advocacy, Counseling, and shelter services for victims of domestic violence: A statewide evaluation. Journal of Interpersonal Violence, 19 (7), 815-829. Bliss, M., Ogley-Oliver, E., Jackson, E., Harp, S., & Kaslow, N. (2008). African American women’s readiness to change abusive relationships. Journal Of Family Violence, 23 (3), 161-171. Carbone-Lopez, K., Kruttschnitt, C., & Macmillan, R. (2006). Patterns of intimate partner violence and their associations with physical health, psychological distress, and substance use. Public Health Reports, 121 (4), 382-392. Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.). Belmont, CA: Brooks/Cole, Cengage Learning. Domestic Violence Prevention Centre Gold Coast Inc. (2015). The impact of domestic violence on women. Retrieved from http://www.domesticviolence.com.au/pages/impact-of-domestic-violence-on-women.php Keeling, J., & Mason, T. (2008). Domestic violence: A multi-professional approach for health professionals. Mailloux, S. (2014). The ethical imperative: Special considerations in the trauma counselling process. Traumatology: An International Journal, 20 (1), 50-56. Murphy, C., & Maiuro, R. (2009). Motivational interviewing and stanges of change in intimate partner violence. National Institute on Alcohol Abuse and Alcoholism. (n.d). Special populations & Co-occurring disorders: Other psychiatric disorders. Retrieved from http://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/other-psychiatric-disorders New Zealand Ministry of Justice . (2002). Evaluation of programmes for Maori adult protected persons under the Domestic Violence Act 1995 . Retrieved from http://www.justice.govt.nz/publications/publications-archived/2002/evaluation-of-programmes-for-maori-adult-protected-persons-under-the-domestic-violence-act-1995-june-2002/introduction#1.4 NSW Department of Health. (2008). 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Retrieved from http://www.pacfa.org.au/wp-content/uploads/2014/10/PACFA-Code-of-Ethics.pdf Pico-Alfonso, M., Garcia-Linares, M., Celda-Navarro, N., Blasco-Ros, C., Echeburúa, E., & Martinez, M. (2006). The impact of physical, psychological, and sexual intimate male partner violence on women's mental health: depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide. Journal of Women's Health, 15 (5), 599-611. Sullivan, C. (2006). Interventions to address intimate partner violence: The current state of the field. In J. Lutzker, & J. Lutzker (Eds.), Preventing violence: Research and evidence-based intervention strategies (pp. 195-212). Washington DC, US: American Psychological Association. Scholes, R. (Producer), & Tamahori, L. (Director). (1994). Once Were Warriors [Motion Picture]. Footprint Films. Warshaw, C., Sullivan, C., & Rivera, E. (2013). A systematic review of trauma-focused interventions for domestic violence survivors. National Center on Domestic Violence, Trauma and Mental Health. West Coast District Health Board. (n.d). Domestic violence management & screening procedure. Retrieved from http://www.westcoastdhb.org.nz/publications/policies_n_procedures/family_violence.asp