This paper will attempt to address a crisis intervention for Cassandra Smith, a 21-year-old black female by examination through Myer’s triage assessment, possible theories, and a recommended solution. Cassandra presents with a disheveled appearance and is talking to herself. She often smiles when talking about important negative information. She was not born within the United States, therefore cultural differences exist. She was arrested for fighting with her boyfriend and may have killed him although this has not yet been confirmed. Her face and body show evidence of bruising. She relates an abusive background and has been hospitalized in the past for suicide attempts. She also relates an urge to kill those who have harmed her, particularly family members. It is not uncommon for a person who is suicidal to also be homicidal. If there is a history of self destructive behavior it is likely there is also a history of violent behavior (James, 2008).
The first thing to do is to try to make a connection with her and calm her stress by the tone of my voice and body language which would be calm and friendly while getting as much information as possible about her present circumstances; family background, cultural background, medical background, and the environment from which she came. Privately ask the attending officers what makes them think she may have killed her boyfriend and if there is any evidence to support the claim. Question if there are drugs involved. Ask open ended questions that hopefully encourage her to respond with full statements. This would be accomplished while completing the TAF or triage assessment severity checklist (James, 2008).
The characteristics that should be employed would include an open-minded positive attitude, be nonjudgmental with good listening and observation skills, genuine supportiveness, and reflective responses. Ethically speaking, it will be difficult to maintain confidentiality with the client due to the fact that the guarding officers refuse to leave the room. Regardless, maintain professional conduct and a reasonable level of care. You should avoid confrontation, convey what you can and cannot do with honesty and fairness to the client, respect her views in a nonjudgmental fashion, and cause no harm (James, 2008). The safety of the client is insured due to the fact that she is in handcuffs and leg chains and accompanied by two armed police officers.
Cassandra’s indirect answers and behavior could suggest drug use or addiction as well as a great deal of psychological pain that has resulted in a possibly pre-diagnosed disorder such as PTSD, bi-polar depression, borderline personality disorder, dissociative disorder, or any number of drug related disorders. It could also indicate that she is not receiving or taking previously recommended medications for a preexisting disorder (James, 2008).
From the information I have been able to gather I have discovered that she comes from a very abusive home environment suggesting that she has been abused many times in the past. She relates rage toward her family, especially her father and those who have hurt her. When dreaming of her father she reverts to fear and terror which is indicative of severe childhood abuse and possibly molestation (James, 2008).
A history of violence within the family is often carried into other environments. Predisposing family histories of witnessing family violence, being abused, enduring excessive physical punishment, abandonment, deprivation, and neglect are all predisposing to adult aggression (Eddy, 1998).
Indications of childhood abuse and type II traumas (those who have experienced severe abuse) suggests that in adulthood, rage may be a foundation for unresolved emotions and carry over into violent aggression. Rage includes anger turned inward toward the self and outward toward others(James, 2008).
When the officers in the room told her she could not leave she became verbally abusive and clearly disapproved of their presence. In reaction to this behavior I would remain calm maintaining a relaxed atmosphere and allow her to vent. There are officers in the room so the assumption of violent actions if attempted would be readily controlled. When she has finished we would resume our conversation (James, 2008).
Research indicates adult survivors of childhood sexual abuse show symptoms that are correlated with depression, anxiety, shame, and humiliation (Briere & Conte, 1993; Briere & Runtz, 1988; Browne & Finkelhor, 2000). Survivors are prone to use alcohol and drugs to submerge bad memories and to engage in suicidal ideation and attempts. These symptoms are even more profound if women suffered both sexual and physical assaults during childhood (Briere & Runtz, 1988).
Since this client is already in crisis I would not explore incest or childhood sexual abuse at this time because of the likelihood of compounding the present crisis through the deterioration of psychological defenses in a patient already exhibiting pathological behavior, regression, or dissociation (James, 2008).
Recommended therapy for this malady would be an eclectic array of therapies including relationship-building strategies, family-of-origin techniques, role playing and psychodrama, behavioral and life-skills training and perhaps some form of dance-movement therapy would be options because they are cathartic and give solid structure to diffuse feelings and abstract thoughts (James, 2008).
Having visited a psychologist in her youth and having tried to commit suicide on three separate occasions, having been hospitalized a mere three months ago, and now a murder suspect would suggest that her level of dangerousness is in excess. By asking repeated questions of whether or not she can see her boyfriend and how he is doing suggests she is alluding to codependency which is characterized by preoccupation with and dependence on a person. However, considering the fact that she may have murdered him this would lead me to wonder if perhaps the preoccupation is feigned as a deception.
I would be further inclined to ask myself if perhaps she hurt or killed her boyfriend in self defense after recognizing the fact that she has suffered trauma by the bruising presented. This would indicate a modicum of domestic violence. I would inquire if perhaps some of bruising had occurred in this way. I would also ask her about her fears and if this occurs often in an effort to gain more insight into her present situation. Any number of theories can be applied to battered women syndrome such as attachment/traumatic bonding with each partner creating ways to control the other to avoid abandonment or the contributing factors surrounding cultural reinforcement of the patriarchal position that is posited in many countries (James, 2008).
The Freudian inward aggression theory best encapsulates her suicidal ideation. In the 1916 psychodynamic view, “suicide is triggered by an intrapsychic conflict that emerges when a person experiences severe psychological stress. It may emerge as regression to a more primitive ego state or as inhibition of one’s hostility toward other people or toward society so that one’s aggressive feelings are turned inward toward the self (Freud, 1916).
The learning theory approach best describe Cassandra’s homicidal ideation as it operates on the principle that both perpetration and acceptance of physical and psychological abuse are conditioned and learned behavior. Research indicates that a correlation exists between witnessing parental violence and being violent toward a partner as an adult (Astin et al., 1995; Barnett & Hamberger, 1992; Jouriles & Norwood, 1995).
After completing the TAF I can see that she has an overall rating of above 20 and this position on the scale would mean that some degree of lethality is involved and she is moving deeper into harm’s way (Myer, et. al, 1991).
On the affective scale I would rate her on the upper end of low impairment giving her a score of five as affect appropriate to situation but increasingly longer periods during which a negative mood is experienced slightly more intensely than the situation warrants and she perceives her emotions as being greatly under control (Myer, et. al, 1991).
On the behavioral scale she displays coping behaviors that are likely to exacerbate the crisis situation. Her ability to perform tasks necessary for daily functioning is markedly absent (Myer, et. al, 1991).
On the cognitive scale she is plagued by intrusiveness of thought regarding the crisis event. The appropriateness of the her problem solving and decision making abilities likely adversely affected by obsessiveness, self-doubt, and confusion. Her perception and interpretation of the crisis event may differ with the reality of the situation, which gives her a score of eight (Myer, et. al, 1991).
If I were to make a diagnosis it would be post traumatic stress disorder (PTSD) brought on by physical and emotional abuse and the end product of trying to cope with the repeated traumas cast upon her.
Without the convenience of having a comparison of precrisis functioning to work with, other than what information I can gather from the client it is difficult to gauge the normal degree of deviation from the client’s affective, behavioral, and cognitive operating levels. Therefore, I have no other recourse than to conclude that she has a degree of lethality that should be addressed decisively. I would also conclude that this person has a chronic, crisis-oriented life history and will require a greater length of time in therapy for a viable resolution. After consultation with a superior, I would recommend immediate hospitalization in an attempt to quell the depression and homicidal tendencies she alludes as well as further evaluation and therapy (James, 2008).
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