Common Assignment Final
October 20, 2020
Often times in life, families suffer because of the addictions and behaviors of the parents. Unfortunately, somethings these addictions and behaviors can be generations. The ones that often suffer the most because of these behaviors and addictions are often times the children. This is because they are vulnerable and are often times subjected to the will of their parents. In homes of addicted parents, children are often times abused and neglected. Instead of the home being a place of refuge and peace, it is often a place of chaos and fear. In the most severe cases, professionals such as mental health councilors and child protective several have to get involved, and even law enforcement. The case study of Michael unfortunately has many of the aspects previously mentioned. In this paper we will conduct a detail analysis of Michael’s traumatic background and uncover the details of his current mental and emotional state. We will also provide a therapeutic intervention to assist him and his caregiver in their current situation.
Presenting Problems and Relevant History:
Michael is a 13-year-old year Caucasian boy, who is of Irish and German- American decent. He is from a blue-collar neighborhood outside of Boston. Michael is currently living with his Uncle Patrick, after being removed from his parental home by CPS. Before we move forward with Michael, since he is a minor, we must obtain permission from his legal guardian and make sure all of the proper forms are completed. We must also have all practices aligned with the NASW Code of Ethics, and make sure all consent forms and HIPAA forms are completed, prior to providing services. Michael was removed from the home by CPS because he was being physically abused by his father. Michael had been abused by his father for some time until he was finally at his wits ends. He stated that “I’ve had it” and revealed to his teacher that his father had recently beaten him with a miniature baseball bat. The assault resulted in him obtaining several deep bruises on his leg. Since the teacher was a mandated reporter, she did file a CPS report, which resulted in not only the removal of Michael, but also his two younger sisters. His sister are the ages of four and six. Michael’s father had also began to beat the two sisters as well and had caused them injuries. His father also regularly abused the mother, who was helpless to defend the children. Michael is currently with his Uncle;however, his sisters were placed into foster care.
Michaels Uncle has recently brought him into a county mental health clinic for evaluation. Per his school records, it is indicted that Michael has had mental health services steaming back to the age of about six years old. This was due to his teachers reporting that he had difficulties with his impulsive behavior and had issues concentrating. He was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). He was provided an unknown stimulant medication for a few weeks, however there were no change in his behavior and so the medication was discontinued. Michael’s parents were recommended to bring him to psychotherapy, however there is no evidence that they ever did. After that incident, there were no additional follow up. Michaels teachers suggested that his parents assess him for a learning disability.
Michaels Uncle Patrick provides us with details on Michaels parents, and their traumatic history. He explains that him and Michaels mother were victims of abusive at the hands of Michaels maternal grandfather. Michaels grandfather was an alcoholic and would enact violence towards his wife and his children. Uncle Patrick describes Michaels mother as someone that would often seem shut down and unable to protect her children. Perhaps this was because of her past traumatic events that triggered her current behavior. Uncle Patrick stated that CPS almost took him and his sister away as children, however he did not admit the abuse and the investigation was dismissed. This led to his father being more careful not to leave marks on the children. Uncle Patrick also hinted that there might have been some sexual abuse that was done towards Michaels mother by her father, however it was never confirmed.
Because of the pattern of abuse growing up, Patrick stated that Michaels mother Karen started to experiment with drugs and alcohol and would often run away. Patrick stated that Karen also might have had several abortions in her life and was even expelled from school. She eventually met Michaels father, Rick at the age of 17 and he was 24. They later were married and had Michael. Michaels father Rick also abuses drugs. He often times drinks heavily and uses marijuana and cocaine. Uncle Patrick believes that there was a great deal of violence in the home soon after his sisters’ marriage. He would often times see his sister with bruises and black eyes. When he would confront her about this, she would deny it and push him away.
This displays generational trauma in the family. Michaels mother went through trauma in her home as a child and was powerless to stop it and now, she and her children are going through it again and she is again powerless to stop it. The generational trauma is a reoccurring theme in the life of Michaels mother and therefore she has perhaps normalized it. In doing so, she has risked the lives of herself and her children. One of the reoccurring thoughts that Michael expresses is that he does not feel loved by his mother and that he feels that she does not want to protect him or his sisters. He feels resentment towards his mother because of this. Michael is also suffering from several different forms of mental instabilities because of his traumatic backgrounds and they are affecting his everyday life, including his sleeping patterns and his ability to focus during school.
Trauma- Informed Assessment
When speaking to the social worker about his father, Michael seems angry, as if the thought of his father upsets him. Michael expresses that his father would often times hit him on his back and leg, so that the bruises would not show. He also states that his father would push him hard and knock him down. He also states that his father was verbally abusive towards his sisters. He states incidents where he would attempt to hide his sisters, as a means to protect them from his father. He also stated that his fears and his thoughts of escaping the home increased when his father began to hit his sisters with the belt. He expresses his disappointment in his mother for not trying to stop his father from abusing them. He stated that it would upset him that his mother did not defend them, however his mother was defenseless as well because she too was being attacked and beaten and unable to defend herself. Michael describes his mother as having a bad temper and verbally abusive towards him as well including stating that “I wish you were never born”. Michael expressed that hurt him a great deal. Michael reports witnessing both of his parents doing drugs and explained how it affected their moods and behaviors negatively towards them. He relates his trauma to his parental home and has stated that he would be fine if he were to never return home.
Michaels father is of Irish and German descent. Uncle Patrick stated that “drinking is part of the social life in this community”. The Irish are unfortunately often associated with drinking and fighting. There is even a college football team called “The Fighting Irish”. This stigma is even continued because of St. Patrick’s Day, where many people who are of Irish decent come together to drink, which sometimes ends in big brawls. The issue with Michaels father is that he is described as an “ugly drunk”. Often times when he becomes drunk, he attacks the members of his family. This family also has two generations of abusive relationships, pertaining to Michaels mother who was abused by her father and her husband. She has also observed abuse in both households. This ultimately created a culture of drug and alcohol abuse and abuse of family members, particularly wives and children. This probably normalized drugs and alcohol. Michael stated that he would at times attempt to find out where his parents kept their drugs so that he could regulate their drug use in order to know when he should protect himself and his sisters.
In regard to Michaels abilities in school, he has stated that his parents never showed him any interest or acknowledgement, as if they thought the worst of him. He stated that when he did do good in school, his parents did not seem to care. He stated that they showed more love and attention towards his sister whenever she did good in school. He stated that he did not feel loved and would often cry about it. Michael mentioned that school was a waste of time, perhaps because of his parent’s failure to acknowledge him. He stated that he associated him not being noticed to perhaps not being abused and would attempt to keep him and his sisters “invisible”.
In Michaels old school he was a “C’ student and described as disruptive. He has also been previously diagnosed with ADHD. He states that he has trouble concentrating in school. He also does careless errors, often times is daydreaming in class, and does not complete homework. However, Michael gets along well with female staff persons at the school. Michael is described as a loner and does not sit with anyone at lunch, nor does he invite other children from school over to his home or plays with other children in his new neighborhood. Michael also has trouble sleeping at night. Michael seems to have a high level of anxiety, possibly caused by PTSD. He is also overly concerned about the wellbeing of his sisters. Michael also seems to be suffering from nightmares and his Uncle has reported to hearing him yell in his sleep and thrashing around. Michael states that he does not remember this behavior when he is sleeping. Michael reports waking up in the middle of the night in cold sweats and shaking. At times he is unable to return back to sleep.
Michael has very deep-rooted trauma from the abuse that he sustained from his father. He reports having a finger broken by his father, as well as being beaten to the point that he would become dizzy and throw up. He stated that on several occasions he thought that his dad would kill him. Michael stated that he thought his dad would break something inside him that could not be fixed. He stated that at times he felt guilty and would think that the beatings were because of his actions, however even when he was well behaved, his father would still abuse him. He would blame himself for the beatings. Michael stated that he started to mentally remove himself from the situation, even when he was being beaten. He stated that he became accustomed to the beatings and they would be a routine like going to school. His concern grew when his father started to abuse his sisters. He explained that his father would even attack them in their sleep. Perhaps this is why it is difficult for him to sleep at night. He probably suffering from PTSD and is often times waking up, believing that his father would come and attack him. He stated that the emotional abuse at times was worst then the physical abuse because it often times caused him great pain whenever he would think about his mother’s lack of love for him.
It would seem that Michaels relationship with his parents has caused a level of mistrust between him and other adults. He stated that whenever he would stand up to his father on behalf of his mother, she would never thank him or show him any love. He also stated several times that he hated his father and wished that he were strong enough to defeat him in combat. Because of his prior relationship with his parents, it is hard for him to communicate with his uncle and have conversations with him. His uncle expresses that it is difficult at times for Michael to even accept positive affirmations from him. Michael is also very reserved and vigilant when speaking to Dr, Andrews, the social worker at the country mental health clinic.
Use of Core Concepts:
The first core concept that we would like to apply is:
- Traumatic experiences are inherently complex.
- Every traumatic event—even events that are relatively circumscribed—is made up of different traumatic moments. These moments may include varying degrees of objective life threat, physical violation, and witnessing of injury or death. Trauma-exposed children experience subjective reactions to these different moments that include changes in feelings, thoughts, and physiological responses, and concerns for the safety of others.
Michael often felt like his father would beat him to death or cause him serious bodily injury. He would often times become dizzy and vomit because he was beaten so bad. He would also witness his mother and his sisters being beaten by his father. His concerns grew when his father would beat his sisters with belts for no reason. This made him hate his father and want to defend his mother and sister, even though he was not strong enough to do so. This caused his to create a plan to escape the home, even if it meant leaving the mother behind. He began to save money to do so but was unable to afford it and so he went to his teacher for help.
- Children may consider a range of possible protective actions during different moments, not all of which they can or do act on.
Michael had dreams of superheroes coming to save him and his family from his father. He had dreams that the superhero would beat up his father and bring his to prison. He also tried to figure out ways to knock his father out, or to poison him, or even kill him so that they could get away. He saved $300 for a hotel room but was unable to get enough and he was not big enough to fight his father.
- Children’s thoughts and actions (or inaction) during various moments may lead to feelings of conflict at the time, and to feelings of confusion, guilt, regret, and/or anger afterward.
The actions of his father led him to hate his father and describe him as “evil”. He would often times blame himself for the beatings and would do things around the house and things to try to make his father happy so that he would not be beaten. However, he realized that his father did not have a real reason for beating them.
- The nature of children’s moment-to-moment reactions is strongly influenced by their prior experience and developmental level.
As a child Michael had ADHD and problems concentrating. He also had issues focusing on school when he got older, and ultimately started to hate school. Because his father use to beat him in his sleep, he now has nightmares and problems sleeping.
- Events (both beneficial and adverse) that occur in the aftermath of the traumatic event introduce additional layers of complexity.
As a result of Michael informing his teacher of the abuse, he and his sisters were removed from the home. His sisters are now in foster care and he and his Uncle do not know their current status or have heard from them. Michaels Uncle Patrick is now caring for him but has no idea how to raise children and doe does not have a spouse to help. He wishes to be able to take all of his sister’s children but is unable to do so at this time. Michael is also living in a new neighborhood and is attending a new school where he is a loner and does not have any friends.
- The degree of complexity often increases in cases of multiple or recurrent trauma exposure, and in situations where a primary caregiver is a perpetrator of the trauma.
During therapy we are now uncovering many new details of what occurred in Michaels home when he was living with his parents. His Uncle had his speculations; however, Michael provided the horrible details of abuse that occurred in the home. There were also drugs in the home, which were around the children which might result in criminal prosecution (NCTSN Core Curriculum on Childhood Trauma Task Force (2012)).
Addressing Ambivalence/Resistance Effectively:
There are multiple levels of ambivalence/resistance in this case. The first that we would like to address is the relationship between Michael and his parents. Michaels parents were invited to attend Michaels evaluation with Dr. Jane Andrews, however under the direction of their attorney, they refused contact. We believe that eventually his parents will have to meet with the treatment sources. After further investigation by CPS, it was determined that the parents could not contact the children and they could not return to the home for safety reasons. It would be suggested that the parents attend some form of counseling, particularly for their drug and alcohol abuse. They should also attend parenting classes before they are even able to see the children. In the event that they are able to see the children, the visits should be supervised.
Michaels mother should make peace with her brother Patrick. Patrick did her a great favor by taking in her son, and he attempted to provide her with as much support as he was able to do. Patrick can also be helpful in helping her to remove herself from her abusive relationship. We should also work on the resistance that Michael is putting against his Uncle Patrick. Michael often times avoids Patrick, and we believe that both of them would benefit if they were to improve on their relationship and communication. Perhaps Uncle Patrick can take some parenting classes as well and him and Michael can attend therapy together. If possible, we should also attempt to find a way to reunite Michael and his sisters. Perhaps they could attend sessions together, talk over the phone, or even meet for lunch. Uncle Patrick might be able to advocate for this in therapy or in court, or with CPS.
Summarizing the Treatment to Date:
The trauma treatment framework that we will apply and have been applying is TF-CBT. We have touched on light on psychoeducation, by acknowledging that Michael has ADHD, Anxiety, slight depression, as well as PTSD. By Uncle Patrick attending the sessions and taking Michael to see a social worker, he is getting additional information on his nephews’ condition and is helping the therapist and CPS to create a record of what has been occurring in the home. Parenting skills was lightly mentions, in the sense that Uncle Patrick has expressed that he was never married or had children, but now all of a sudden, a parent. He is also a parent of a child that had gone through a traumatic situation and is in attempts to assist him in the best way possible. Conjoint Parent-Child Sessions occurred several times in which Uncle Patrick and Michael attend sessions together and discuss the details of their history. Enhance safety & future Development was mentioned in the sense that the court stated that it would not be in the best interest of the children for them to return home or have contact with their maternal parents at this time. Cognitive Coping with mentioned in the sense that Michael associated school in a negative way with his parents. He felt that his parents never congratulated him whenever he did good in school. To combat that, his uncle would often provide him with praises in regard to this schoolwork and enlisted him into a better school with smaller class sizes. He also allowed him to invite his friends from school over so that he could have better feelings and a better outlook in regard to school.
Trauma Treatment Framework Next Steps
We would first start with Psychoeducation because Uncle Patrick is still new to all of this. The more education that he has on Michaels condition and trauma, the better he will be equipped to help Michael through his current situation. If he is able to find Michaels “baseline”, then he will be able to find a point of conversation where they can communicate on at home. This will help improve their relationship and help ease Michaels anxiety. Since Michael has witnessed bother physical abuse and violence in the home, Uncle Patrick will have to find ways in which to help Michael to differentiate appropriate discipline and inappropriate parental discipline. Parenting Skills would also be especially important to continue to focus on. Uncle Patrick has never been a parent, and this would provide him with great insight. It would help him to contact Michaels behaviors with his trauma. It would also help him to provide Michael with healthy coping skills. It would also help him to manage disruptive, aggressive, and noncompliant behaviors that Michael might display(https://tfcbt2.musc.edu/en).
Cognitive Coping would be very effect for Michael because it would help him to better communicate with his Uncle. At times he might be comparing his Uncle to his father and therefore might have a negative outlook towards him which might result in him being guarded. It would be beneficial to attempt to change his feelings and behaviors by thinking differently. It would be best to speak to his uncle and ask how he feels, instead of assuming that he has negative thoughts towards him. An example of this would be when he would hide under his pillow to cry so his uncle would hear him and think that he is a wimp. He could have went to his uncle for comfort instead of hiding from him(https://tfcbt2.musc.edu/en).
We would apply Conjoint Parent-Child Sessions in order to strength the bond between Uncle Patrick and Michael. This would help them to better communicate at home about the traumatic events that they both have been through in their lives and make their living arrangements more comfortable for the both of them. The more comfortable Michael becomes with his Uncle, the more that he will share, which will provide Uncle Patrick with more insight on Michaels trauma. We would do Enhancing Safety & Future Development last. That is because we would first have to address all trauma and create a safe space and a point of strong communication. Once that is completed then we could create a safety plan. The safety plan would also be important in case Michael is ever around his parents again or if Uncle Patrick ever becomes abusive(https://tfcbt2.musc.edu/en).
In conclusion there are multiple levels of trauma that must be addressed that must be looked over several times with great patience. We must obey by the NASW Code of Ethics and ensure that we have HIPAA forms and all necessary documents in order to move forward. We must also be sensitive towards the victim, which is Michael and understand that he is going through a very traumatic time. We must also provide Uncle Patrick with the necessary tools needed to be successful and providing support. With the help of multiple social service staff, we believe that this family with be successful in resolving the issues and conflicts caused by the previous trauma.
- TF-CBT Web (A course for Trauma- Focused Cognitive Behavioral Therapy ((https://tfcbt2.musc.edu/en)
- NCTSN Core Curriculum on Childhood Trauma Task Force (2012). The 12 core concepts: Core curriculum on childhood trauma. Los Angeles, CA, and Durham, NC: UCLA-Duke University National Center for Child Traumatic Stress.