Introduction
Kyle is a twenty-five-year-old male from South Central, Los Angeles, California. He lives with his parents, who have been married for more than thirty years. His father volunteers at a community church from Wednesday to Sunday, while his mother is a waitress at a local diner. Before the age of seventeen years, he was friendly and close to all family members. However, this changed immediately after he witnessed his best friend killed by a member of law enforcement. He has never experienced any type of abuse from his family members, including physical or sexual and has not participated in drug abuse.
Kyle, who has been bullied before while in high school due to his sudden, sad and quiet nature, has never been involved in unwanted sexual experiences. However, since the incident when he was seventeen years old, he has had several issues with law enforcement. He once refused to stop when approached by a police car. After a five-minute chase by the police, he was caught crying inside his family car. The change in mood has made people remain away from him as they fail to understand his situation. Before, he used to be friendly with everyone and even attended school parties or other events that involved other people (Aron et al., 2019). He cannot even relate to his coworkers at McDonald’s when they try to share jokes with him.
In high school, before the traumatic incident, he was a bright student who had many aspirations of what he would desire to accomplish. For instance, he enjoyed science classes and claimed that he would become a doctor one day. He understood that education was a chance for him to get his family out of violence-infested South Central. He wanted to pass to the extent he would earn a scholarship to the University of California, Berkeley. However, after Norman, his best, died in the hands of the police, he changed and is no longer as inspired as in the past. He started missing school and redoing classes that he had not passed.
Apart from desire to reach greater heights in education diminishing, he could not maintain good eating habits. Since he was born, Kyle had a good appetite and even trained to participate in wrestling at one point due to his great physique. However, since the tragedy, he does not enjoy food as much. After a short while, he developed insomnia, which was observed by his mother as he let the lights remain on the majority of the night. Due to such events in his life, his weight has deteriorated as he is a skinny person now despite not abusing alcohol or any substance. His mother insists that he seek medical attention as he has even failed to attend a physical in ten years. Living in South Central, he does not know individuals who have undergone counseling in spite of the fact that this was his idea. He tried participating in self-help groups but discontinued because he thought they could not understand his issues.
Description of the Presenting Problem
In his visitation, Kyle has reported that he experiences recurrent and unwanted distressing images of the traumatic incident and has flashbacks. He attributes his trouble sleeping to the nightmares he has the past eight years. He claims that he has not passed through a specific street in his area for a long time since he fears being reminded of the event. He no longer feels as if he deserves anything good in life and this can be the main reason, he stopped having ambitions to pursue further studies. He developed anxiety that resulted in him being startled easily.
He reports that his thoughts, feelings, and perceptions have been impacted by the incident of a few years ago. He claims that he does not view the world in the same manner. He does not believe what people say of themselves since he feels that they could harm him when he least expects it. People’s suffering around him does not affect him as he appears numb to other people’s emotions. When addressed about something he has done wrong, he expresses extreme frustration and anger. He used to believe that he would influence the world positively, but this has changed as he thinks that everyone is only concerned about their own interests.
The trauma assessment began with data collection, the formation of a trauma team, and preparation of equipment. This was done before the patient arrived at the hospital. Upon his arrival, the team starts with a primary survey which consists of an assessment of their airway, circulation, breathing, exposure, and disability (Heywood et al., 2022). Once Kyle was stabilized, the secondary survey starts, which involved a detailed history as well as physical examination to avoid missing an injury. From this point, it is determined that the outcomes can be enhanced. Trauma and Injury Severity Score is used to determine the seriousness of the trauma.
Kyle reports that he first started experiencing the change in his general state emotionally, mentally, and physically two weeks after burial of his former best friend. During this time, he had a relationship with a girl at his school who left town and moved to Dallas, Texas to live with her mother. He felt as if the entire world had turned against him (Heywood et al., 2022). Initially, the emotions were not strong but as time progressed, his situation became worse. His trouble sleeping developed and was more intense when compared to others. He frequently could remain awake for long hours until recently he less cases of nightmare affect him. From the first time he noticed a change in his state, Kyle claims it is eight years.
Diagnosis (DSM-V)
Diagnosis of trauma needs the satisfaction of various criteria reflecting the elements of the disorder. For instance, the first criterion is exposure to a traumatic incident. Others include constant re-occurring of the incident, insistent escaping of reminders of the event, negative change of perception and mood associated with the happening, higher arousal, and indicators available for one month or more. The last two criteria consist of: symptoms result in clinical distress or impairment, and disturbance is not as a result of the influence of a substance or illness.
In the event, the dissociative signs can be seen and not as a result of a medication, criteria must be met for derealization or depersonalization. The condition can also have overdue expression, that is, the full criteria were not met until six months or a longer time after the incident. In my diagnosis, I can state that the patient is suffering from post-traumatic stress disorder (Aron et al., 2019). The reasons for stating this is that he qualifies for the above-mentioned criteria. For instance, he has experienced loss of his friend, who was killed in his presence. One’s case is only supported with this criterion if the exposure is direct or witnessed at firsthand, through hearing about the injury, or violent or accidental death of a close loved one.
Medically, it is invalid if the source of exposure was via media. The third criterion, avoidance, involves constant effort toward avoiding either thoughts or feelings associated with the event, the place, and other items linked to the incident. The patient has exhibited intrusion whereby he complains about nightmares that cause him trouble sleeping. Reminder of the traumatic event cause prolonged distress (Aron et al., 2019). When he experiences situations that appear similar to the past, he immediately starts sweating and panting without control.
In addition to this, he continually blames himself for the event, claiming it could not have happened if he had intervened. From the assessment, it was easy to establish that there is a marked decrease in interest in activities he used to enjoy doing (Aron et al., 2019). Since that time, he has not had meaningful social relationships either in school or work. His inability to show emotions the majority of the time has forced people away from him. All these show that Kyle has post-traumatic stress disorder.
Treatment Intervention Plan
Before codifying PTSD, characteristic indicators of the disorder had been identified and documented in the nineteenth century in civilians involved in traumatic events. Narrative therapy for this type of condition is referred to as narrative exposure therapy. This approach to counseling evaluates the stories an individual has created to define their life and identity (Bryant, 2019). A therapist can apply it to aid the client to modify narratives that are unhelpful. David Epston and Michael White developed the treatment or intervention as an empowering, nonpathologizing, and collaborative strategy.
The major assumptions by the idea of narrative therapy states that there is no truth but only several interpretations of reality. Thus, meaning is what is most essential and is created in cultural, social and political contexts. Through this approach, individuals can recognize alternative stories, widen people’s perspectives of self and challenge unhealthy beliefs (Bryant, 2019). A therapist helps the clients to express their narrative, usually via listening to them explain their stories and any problems that they desire to speak. This enables the patient to say what they think and explore incidents in their life and the meaning placed on the experiences.
It has been established that a therapeutic relationship is a crucial element and sign of effective treatment and healing. Some of the main aspects of this type of association include power, professional intimacy, empathy, trust and respect (Bryant, 2019). Such are connected with improvement in client satisfaction, quality of life, and reduced levels of anxiety. The narrative therapy approach seems to seek the achievement of three goals: placing aspects of the patient’s past into a narrative, aid clients in emotionally reconstruct the stories, and provide new meaning to the stories.
Similarly, to the majority of therapy approaches, the major ethical implication or issue by a therapist in this case is maintaining boundaries. Sometimes it can be hard to guarantee that one is not developing a personal connection with the client (Bryant, 2019). Other times, patients may blur the lines due to the development of the relationship. Lastly, apart from the therapist, the special education teacher can assist in such situations, especially during the time Kyle was still in school.
Conclusion
The findings prove that it is true Kyle suffers from post-traumatic stress disorder, which has changed how he lives. Analyzing data from his past and his present life, it is clear that the death of his friend in his presence affected him and how he now perceives life in general. The approach applied in this case is complementary rather than conflicting since it helps the patient to reconstruct his stories and give them a different meaning. When impacted with the incident, it is reported that he developed idea that he was insufficient in that situation and, thus, blames himself. Developing a different notion about himself and life allows him to be free from guilt that might be impacting him.
With time, the symptoms will start disappearing, especially after three or more therapy sessions. By telling his stories and mental health official listening it offers the client an opportunity to express how they feels. This ensures that a burden full of emotions such as anger, regret, blame, and guilt, to leave his life. Additionally, it gives him the courage to face his past without fear, which is the cause of why he avoids his past. In the diagnosing process, this was listed among the criteria for trauma. This case shows that it is important to find solutions that suit the needs of the clients. For instance, Kyle has been less friendly, which means he might have spoken less with anyone around him. Granting him a chance to vent and discuss his problems while someone else listens gives him peace and hope for healing.
References
Aron, C. M., Harvey, S., Hainline, B., Hitchcock, M. E., & Reardon, C. L. (2019). Post-traumatic stress disorder (PTSD) and other trauma-related mental disorders in elite athletes: a narrative review. British journal of sports medicine, 53(12), 779-784. Web.
Bryant, R. A. (2019). Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges. World psychiatry, 18(3), 259-269. Web.
Heywood, L., Conti, J., & Hay, P. (2022). Paper 1: a systematic synthesis of narrative therapy treatment components for the treatment of eating disorders. Journal of eating disorders, 10(1), 1-17. Web.