Directed by Baltasar Kormakur in 2018, the survival drama Adrift illustrates the psychological impact of the natural disaster and the loss of a close one. The movie narrates the crisis experienced by the main character, Tami Oldham, 23 years old American female. Although not to the same extent as Tami, her fiance, Richard Sharp, a 34-year-old British sailor, also experiences a crisis and eventually loses his life.
The film depicts a survival crisis of primarily Tami amidst the natural disaster. Tami and Richard, who later dies, are left in the open Pacific ocean under Hurricane Raymond for 41 days. The category four storm significantly damages the yacht, forcing Tami to injure her head and lose consciousness. She also realizes that she lost her loved one as Richard was washed overboard during the storm.
The abovementioned circumstances have significantly affected Tami’s both mental and physical state. As she struggled to survive, she experienced hallucinations as if she had found Richard alive and continued to imagine his existence for several days. As such, the physical illness, added with the loss of her beloved one, presented her with a hard time accepting the reality of loss. Such an unpredictable course of events left Tami in a state of shock.
Crisis Intervention Model
Before discussing the potential intervention ideas, it is worth emphasizing the types of crises experienced by the client in this scenario. First, the patient has experienced a concern related to physical illness, driven by head injury, hunger, fatigue, among others. Natural disaster situations bring mental instability to individuals, which entails Post Traumatic Stress Disorder (PTSD), anxiety, and depression (Makwana et al., 2019). Secondly, and more significantly, the client has experienced a crisis of loss after the death of her fiance. These conditions led to the feeling of insecurity in the patient.
Cognitive-behavioral therapy (CBT) is one of the interventions that therapists can apply in this scenario. CBT includes several techniques that are found most commonly used, such as cognitive restructuring, guided discovery, journaling, stress reduction, among others. According to Monson & Shnaider (2014), CBTs can be particularly effective in treating PTSD patients. In addition, healthcare professionals should integrate psychological first aid (PFA) elements into treatment. Namely, PFA focuses on providing information, emotional care, safety, connectedness, and hope based on the specific needs of the victim (Shultz & Forbes, 2014).
Since the patient experienced severe mental trauma for several days, treating Tami’s mental condition would require additional financial and healthcare resources. First of all, before the therapies, she needs to feel secure physically since she overcame substantial physiological damage and the risk of death over more than a month. Hence, she needs to be provided with proper shelter, food, and medications to rehabilitate her physical health.
Coping
Tami attempted to cope with the crisis of loss by denying Richard’s death. As Makwana et al. (2019) stated, victims usually refuse the loss and try to escape reality. However, this coping mechanism is not practical for two reasons: firstly, the victim sooner or later discovers that the loss is realistic and will be much harder to accept it; secondly, more importantly, a state of denial posits patient in a condition where they are more vulnerable to stress, anxiety, and other cognitive-behavioral malfunctions (Makwana et al., 2019). Hence, denial is one of the most common coping strategies of patients suffering from grief.
Risk Assessment
Since the client did not attempt any suicide, the risk assessment model cannot be applied in this case. Instead, the patient had a strong desire to live and tried to survive for 41 days. Nevertheless, according to IS PATH WARM, the client has experienced some warning signs of suicide, including feeling trapped, loss of hope, rage, and uncontrolled anger (Green et al., 2016). Hence, counselors should reassess the client’s risk of suicide after she has survived the crisis.
Referral
The person needs to address several aspects in approaching counseling. First, the client has experienced a significant traumatic event that included the loss of the close one. Hence, the client needs to address the issue of accepting the loss. Secondly, for more than a month, the patient experienced the risk of dying, hence, causing depression and anxiety. Therefore, the client needs to address those issues with the counselor.
Diagnosis
The client meets the criteria for PTSD diagnosis, with depression and anxiety as comorbid disorders. According to the Diagnostic and Statistical Manual Of Mental Disorders [DSM-5] (2013), PTSD is the “development of characteristic symptoms following exposure to one or more traumatic events” (p. 274). The client meets criteria A since she directly experienced the traumatic event while also witnessing how this event occurred to her partner (DSM-5, 2013). The diagnosis is developmentally appropriate since individuals can have PTSD at any age, beginning within the first three months after the traumatic event (DSM-5, 2013). Thus, the person meets the criteria for a PTSD diagnosis.
Evidence-Based Practices
Several interventions have been identified and proven effective in treating PTSD. Specifically, the Veterans Health Administration and Department of Defense (VA/DoD), and the American Psychological Association (APA) published guidelines, including the set of recommendations for healthcare professionals treating PTSD patients (Watkins et al., 2018). Both institutions have particularly emphasized that Prolonged Exposure, Cognitive Processing Therapy (CPT), and trauma-oriented Cognitive Behavioral Therapy (CBT) indicate evidence-based efficiency in treating individuals with PTSD (Watkins et al., 2018). Hence, healthcare professionals might employ these practices to address the client’s condition.
References
American Psychiatric Publishing. (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5®).
Greene, C. A., Williams, A. E., Harris, P. N., Travis, S. P., & Kim, S. Y. (2016). Unfolding case-based practicum curriculum infusing crisis, trauma, and disaster preparation. Counselor Education and Supervision, 55(3), 216–232.
Makwana, N. (2019). Disaster and its impact on mental health: A Narrative Review. Journal of Family Medicine and Primary Care, 8(10), 3090–3095.
Monson, C. M., & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies: Interventions that work. American Psychological Association.
Shultz, J. M., & Forbes, D. (2013). Psychological first aid. Disaster Health, 2(1), 3–12.
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12.