Trauma Model of Care - Term Paper Example

 «Trauma Model of Care» Trauma Trauma is a severe public health issue. A traumatic injury can be intentional or accidental but it has appalling consequences on the lives of people and it can lead to death within the first four decades of one’s life. Trauma can be the cause of loss of function for the patients. According to O’Shea (2005, p. 55), “…the irony is that traumatic injury is only the truly preventable disease”. The effects of trauma are subtle in character as it may be responsible for the loss of productivity during the prime years of a person. The treatment of trauma has been on the rounds for quite a long time bur the traditional psychiatric system has not been able to keep pace with the development or rather the increasing concern over varieties of psychic disorders, which do not abide by a general and common approach in treatment. Traditional approach to trauma treatment and the need for improvements There have been several limitations in the traditional approach to psychiatric treatment. First, the practitioners have never linked the childhood experience to the adulthood disorder. Secondly, they did not attach any meaning to the other social conditions that influences a person. Thirdly, they have never accounted for the normal responses that a person uses to cope with abnormal events. The trauma model of therapy developed in the late twentieth century has sought to explore how “people who have survived abuse are best helped by therapy that works from an understanding of how abuse and neglect, especially in childhood, affect the way people think, feel, behave and relate to others” (A Trauma Model Therapy, 2009). This trauma model links the problems with other external factors like social inequality, poverty, racism and sexism. An effective model of treatment must consider that the ongoing social conditions and trends can make the problem worse. The social scenarios have distinct influence on the psychology that can intensify the patient’s severity. In case of women in particularly, the social inequality can reinforce their feeling of being unsafe, cheated and disempowered. Another distinct feature of this model is that it views a problem as a response to an event that is uncomfortable to the patient. Rather than seeing problems as an indication that something is wrong with the patient, the problem is seen as arising in a particular context, in which external forces are held responsible. Trauma model of care - the initiation The trauma model of care was developed out of the limitation of the dominant models of psychiatric care. Collin A. Ross writes that he tried to evolve a more compatible and effective model in order to deal with the patients of mental disorder or simply going through certain mental troubles. He writes that when he was in Canada, he noticed that patients of psychiatric disorders underwent many different diagnoses. For example, a patient with depression would be admitted at one occasion and diagnosed and if the patient has psychotic disorder, he or she would be admitted at another occasion and diagnosed separately. While the current diagnosis gives the right result at the moment, the diagnosis would prove to be incorrect at some point of time in future. Even in a single admission, the diagnosis was changed several times in order to developing a new rationale for the new medication that the patient needs at that point of time. The problem as perceived by Ross was that the patients did not fit into the model of psychiatric practice that was prevalent at that time the problem being “the patients were too polymorphous, variable, complicated and, often, uncooperative” (Lee Harvey Oswald and Other Plays, The Trauma Model: a solution to the problem of comorbidity in psychiatry). At that time patients were being admitted who had ‘pan-sexuality’, ‘pan-anxiety’ and ‘polymorphous perversity’ and they could not be given a particular treatment according to the conceptual framework of psychiatry. His model, which he calls the trauma model, challenged the dominant model arguing that hiss model was able to predict psychiatric conditions and treat them with thorough research. This model tried to figure out why some patients take more time in recovering than others. His basic assumption was that past trauma is as important for the treatment of patients with psychological disorder as germs are to general medicine treatment. He insisted that early childhood trauma is a great contributing factor in mental illness (Brenner, 2002). Further developments in the Trauma model Today psychiatrics and clinicians are increasingly using the implications of childhood sexual abuse in the trauma model in their treatment. This is because these consequences of CSA can give a clearer understanding of what effect of this kind of abuse has on the adult survivors apart from the effect on children. Sanderson (2006) observes that there is a common tendency to equate trauma with other comparatively explicit injury like accidents or disasters and argues that trauma is rather associated with stress. He defines trauma as a “psychic injury, especially that caused by emotional shock, for which the memory may be repressed or persistent, and that has a lasting psychic effect” (Sanderson, 2006, p.151). Trauma is a complex concept. It involves both actual and threatened wound to the physical self or to the emotional self and it also forces the recipient the response with fear, horror or sense of helplessness. In this way trauma refers to an objective event along with the patterns of response in the subsequent period. This peculiar pattern of response is noticeable not only in relation to the traumatic event but also to other moments in life. The symptoms of this phase are called post-traumatic stress disorder (PTSD). From this definition, traumatic experience encompasses two components—an objective event that is the source of emotional imbalance and a subjective response, which is determined by the objective event. A case study involving a group of participants The trauma model of care is based on this concept of stress that has an enduring adverse effect on physical and psychological health. Human beings have enormous capability to adapt diverse circumstances and the ability to live through different experiences, which are not always healthy to them. But these experiences have long-term effects on the minds of human beings. Connor & Higgins agree that “traumatic experiences can alter people’s psychological biological and social equilibrium to such a degree that the memory of one particular event comes to taint all other experiences” (Connor & Higgins, 2008, p.293). They also note that although the concept of post-traumatic stress disorder was first used to give psychiatric treatment to the veterans of the Vietnam War, later it was found that the same could be successfully used in the treatment of adult survivors of childhood sexual abuse. But some thinkers challenged the concept of PTSD as they found it inadequate to deal with all patients of sexual abuse. Herman pointed out three areas of disturbance that transcend the problems grossly collected under PSTD. They are complex symptom picture, personality changes and susceptibility to repeated harm. That is why CP (Complex PSTD) has been taken as it denotes a constellation of different symptoms that are often found in individual, “who have experienced long-tern and multiple trauma experiences—either in childhood or in adulthood” (Connor & Higgins, 2008, p.294). The patients with CP exhibit a number of ‘symptomatic and pathological behaviors’ rather than a dominant set of behaviors. These patients report of frequent shift in their consciousness, self-perception, and perception of perpetrator, their interpersonal relation and meaning to other things. Another important blow on the concept of PTSD was because of its insufficiency erect a supportive consciousness in them patient before the individual begins to articulate her traumatic experiences. In order to explain this attack Connor and Higgins refer to Chi who indicated, “…many survivors of childhood requires an initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning and establishing a positive self identity” (Connor & Higgins, 2008, p. 294). For their purpose of study, Connor and Higgins took ten participants selected after a screening process to ensure that the finally selected patients fit into three criteria previously set by them. These criteria were that they should have experience of multiple or long tern trauma in childhood or in adulthood, they should be displaying symptomatology related to CP and comorbidity condition and they should have been able the feel the need to take treatment recently. The chosen participants then participated in a rigorous treatment agenda that concerned about 24 sittings covering beyond six months’ periods. It also incorporated group-counseling sessions that were commenced about after ix to eight weeks and was held once in every two weeks. For quantitative analysis they used discourse analysis and observed the volunteers’ use of language in describing their behaviors in both the pre and post treatment periods. Their language used by the participants to describe their relationship in the post-treatment period was compared with their language tom describe the same in the pre-treatment period. For quantitative analysis, the researchers used certain theories to record the reduction in symptomatology. After a few weeks of intervention it was seen that there was a considerable improvement in the behaviors of the clients. The most frequent themes pertaining to ‘self’ in the discourse of the participants were empowerment, strength, more knowledge, optimism, stability self-assuredness etc (Connor & Higgins, 2008, p.296). The researchers think that this CP model is more effective than the PTSD because it caters to a variety of needs of the victims of multiple childhood traumas. The PSTD only emphasized on three stages used to reduce the symptoms—re-experiencing, avoiding and arousal. In their study they focused on six aspects that the participants were expected to adhere to. They were 1) having a supportive therapist 2) ensuring personal safety 3) assisting with daily functioning 4) learning to manage core PSTD symptoms 5) treating complex PSTD symptoms and 6) having patience and persistence to enable ‘ego strengthening’ (Connor & Higgins, 2008, p.297). Following these stages, then participants were taught to develop strategies to protect themselves from the destructive desires for suicide, self-mutilation and others drives like re-victimization of the self. The therapists also sought to give assist them min their functioning, in taking employment, leadership, initiatives and this was important because it is often seen that the victims of child abuse loose all their functioning spirits due to emotional inertia. After that they were introduced with some methods that could help them in moments of mental crisis. The use of self-regulation, relaxation and stress reduction helped them to cope with their symptoms. Inducing the desire to treat their own problem was a major focus and challenge to the participants. They could analyze their own problems, as they had to prioritize according to their necessity because they had a variety of symptoms. This stress on their need was the defining characteristic of this model of trauma care. Finally, they were required to build a strong ego through patience and analysis. The division of the treatment plan into six distinct stages was very beneficial as it allowed a greater opportunity of dealing with the complex and interrelated chain of problems. Moreover there are victims of long-term sexual abuse, who become very emotional and responsive. In order to treat them there need to be highly sensitive and skilled intervention. Single person case study Another case study carried out by Connor and Higgins was even more revealing than the above one. The client Maria has multiple childhood traumas, both sexual and asexual. Her mother had two boyfriends who sexually abused her. Her mother used to take drug and did not mind having sexual, intimacy in front of her daughter. Her boyfriend beat her. Her mother accused Maria for having broken her relationship. In the study carried out by Connor and Higgins, the client recovered considerably. Among the 15 symptoms detected before the treatment, 8 symptoms were cured which included suicidal impulses, amnesia, victimization of others etc. But what is more important is that during the sessions and assessment period, certain other symptoms emerged, like a sense of permanent damage, the sense of being understood by nobody and the inability to trust anybody. The trauma model thus proves to be elective not only in treating core PTSD symptoms but also in exploring and addressing certain latent symptoms that can have unnoticed effects on self-perception, interpersonal relation and belief system (Connor and Higgins, July, 2008, pp-401-410) Isobel Reilly’s contribution In Isobel Reilly’s theory and practice, the internalization of trauma arising from the conflict between ideology and reality becomes a source of unexpected attitude in the thinking process of the mass. In the same way that Connor and Higgins proposes the long-term effect of the traumatic experience, Reilly describes how the attempt to nullify the implications of certain experience can color future thought. The nationalists had a traumatic response to the landing of British Army in the riots of Northern Ireland, where Reilly is a family therapist in Queen’s University Belfast. She notices that there had been an attempt to keep one’s head down and minimize the stress. Referring to Smyth, a writer, Reilly suggests that people become culturally stoic and took up rules and practices that supported in psychological term an ‘acceptable level of violence’ (Reilly, 1999, p.231). But despite the localization of the ‘Troubles’, there was a possibility that the randomness of the violent events could overwhelm them at any point of time and land them in reality. The professionals and the working groups strove to ensure that there was nothing that could affect their professionalism. They became adept at curtailing the effect of the violence on them. “Indeed we were proud of this, acting as if the Troubles were no trouble, as if we had been educated out of and away from our primitive world of sectarian bigotry” (Reilly, 1999, p.235). But after a certain time the anti-racist and anti-discriminatory necessities of the social system created a new brand of sectarianism and discrimination within the framework of family therapy practice. There was a shift in the public feeling as people began to talk more about their prejudices and in the family therapy sessions the clients began to bring in the matters related to state troubles. They were talking about issues that were ‘taboo within their family’. In the therapy room the themes of colonization, exploitation and legitimacy of the state emerged. Reilly has given no solution of this problem but has suggested that it was a challenge to the practitioners of family therapy to find a way that can create a framework for releasing the voices that have been silenced by the trauma caused by the shift at the macro political level (Reilly, 1999, p.235). According to her “the mind shifts required to move from linear to systematic, from individual to more than one, to embrace multiplicity, difference and possibilities takes time to absorb” (Reilly, March, 2007, p.48) Application of the model on other cases of trauma It is necessary to mention that the use of trauma model of treatment is not restricted to the cases of child abuse and other long-term stress issues. In fact, the first instance of use of trauma model is found in the treatment of traumatized Vietnam War veterans. According to Michael J. Roy PSTD “became part of our lexicon in the aftermath of the Vietnam War, but the symptoms and associated functional impairment it represents have been known for centuries” (Roy, 2006, p.59). The key element of the trauma treatment is the confrontation to the situation in which the event occurred. In the previous studies also it is apparent that the necessity to expose the victims and the subsequent confrontation raised the need for elaborate professional approach. Some victims are unable to imagine the traumatic past event, some refuse to recall them and some have a detached recollection even when they recall it. For this reason, virtual reality ‘offers a promising alternative to imaginal exposure’ (Roy, 2006, p.175). The projection of the virtual environment can allow the victim to be present at the place where the incident took place. Rothbaum published his first case study using virtual reality in the treatment of PSTD of Vietnam War veteran. With the help of computerized environment he recreated a combat scenario of the Vietnam War where the victims could confront the thoughts and emotions associated with the war. The result showed definite reduction in the PTSD symptoms (Roy, 2006, p.175). Conclusion From the above discussion it is clear how PTSD can affect the future of children and individual. Not only the loss of consciousness, dissociative identity crisis, lack of interpersonal skills but also the loss in productivity of a person in his working career can be addressed. The loss in productivity can be the result of the inability to acquire proper education. Traumatic incidents in schools or in some other situation can impair the pupil’s learning ability. The deaths of relatives and frequent illness are responsible for the high rate of school drop out cases. But in addition to that, trauma caused by discrimination, stigma and sexual abuse can put hindrance to the child’s education (UNESCO, 1995). Therefore the use trauma therapy in these areas of psychology is of great help, especially if applied at an earlier stage though in most cases the application involved people who survived the period of abuse and were adults. If properly modified as per requirement and applied on children, this model of care or therapy can bring about an evolution in treatment of cognitive problems arising out of childhood sexual abuse and other related forms of oppression. This would also prevent the survivors from retaining some of the cognitive disorders from their childhood times of oppression. References Brenner I (2002), Review, The Trauma Model: A solution to the problem of combridity in psychiatry, available at http://psychservices.psychiatryonline.org/cgi/content/full/53/3/350 Accessed on August 17, 2010 A Trauma Model Therapy, (2009) Centre for Addiction and Mental Health available at http://www.camh.net/Care_Treatment/Resources_clients_families_friends/Women_abuse_trauma_therapy/women_trauma_model.html Accessed on August 17, 2010 Connor P. K. and D. J. Higgins (July 2008), The ‘HEALTH’ model – part 1: treatment program guidelines for complex PTSD, Sexual and Relationship Therapy, vol-23, no-4, Routledge Connor P. K. and D. J. Higgins, (July, 2008), The ‘HEALTH’ model – part 2: case study of a guideline based treatment program for Complex PSTD relating to childhood sexual abuse, Sexual and Relationship Therapy, vol-23, no-4, pp-401-410, Routledge O’Shea, R. A. (2005), Principles and Practice of Trauma Nursing, Elsevier Health Services Reilly I. (1999), Therapist Reflections: A view from Northern Ireland, Journal of Family Therapy, Vol-21, p-230-237, UK, Blackwell Publishers Reilly I. (March, 2007), Letter From Northern Ireland: Fog and Fire, ANZJFT, Voi-28, no-1 pp-47-48, UK Sanderson C. (2006), Counseling adult survivors of child sexual abuse, Jessica Kingsley Publisher Roy M. J. (2006), Novel approaches to the diagnosis and treatment of posttraumatic stress disorder, IOS Press UNESCO (1995), Final report on the Unesco regional seminar on HIV/ AIDS and.., Unesco, Education Sector Read More