Wednesday, September 5, 2007

Case Conceptualization: Jesus

By Sudipa Sarkar
Identifying data

Jesus is a twenty two years old Latino male who lives with her wife Daniela, 21 years old. Jesus is married for two years and they have one three years old son and they are expecting their second child in approximately within five months. He has been physically and verbally abusive to his wife. While showing aggression in some situations resulting unpleasant consequences, Jesus reports about his controlling ability over his temperament. Jesus is now working in a fast food restaurant as a cook, where he used to take 4-5 beers per day with his co-employees. Jesus reports that he is more sexually oriented when he is in good mood and it is not initiated by aggression rather by the release of tension. Jesus reports of having sleeping disorder. However, Jesus previously considered about suicidal ideation, whereas, at the time of interview he asserts he does not possess this thought any longer. Jesus also reported about having a stressful childhood memories.

Presenting Problem

The probation officer referred Jesus for therapy while he came into attention of the court on a charge of a simple assault and was sentenced to 100 hours of community service as well as 100 hours of therapy. He is having no or little social skills and has a hard time fitting in the community to behave with people in a justified manner. According to the court case against Jesus, it is described that a fifty year old woman has been battered by Jesus for acquiring the parking space which Jesus desired for some time. Moreover, Jesus is not capable of understanding the level of infringement made by him whatsoever and is trying to minimize the scenario either by inflicting the fault on the woman in question or by minimizing the consequences of the violation occurred by him. The same thing happens in his home also, where he becomes very assertive while he reports about the condition of her wife after a domestic violence, that she does not need any medication or she herself is the problem.

Relevant History

Jesus reports of having a stressful childhood with verbal and physical abuse and emotional negligence. He used to having been criticized as idiot and lazy. He had been physically attacked and was a victim of severe child abuse by his parents. He was a witness of his parents’ interpersonal violence. Jesus reports about having his father drunk and used alcohol abusively. Jesus, in his adolescence phase, developed the idea of keeping her mom out of his business while listening to his dad. It is quite evident that Jesus’ parenting style is a distorted one, and the mother-child attachment was not up to the mark as well. As provided the childhood history of Jesus and the symptoms such as tension, aggression, worry, difficulty in sleeping, and past suicidal ideation lead to the probable diagnosis of mood and anxiety disorder.

Interpersonal Style

Jesus reports not being aggressive towards his son, while being very abusive with his own wife. His relationship with his parents in childhood was full of anxiety and tension, the point at which, he may develop emotional insecurity (Hirschfeld, R. M. A., Klerman, G. L., Gough, H. G., Barrett, J., Korchin, S. J., & Chodoff, P., 1977) which, eventually turned out into aggression as a form of self-defence mechanism (Bornstein, R. F., 2006). He used to socialize with his co-workers with whom he usually used to have 4-5 beers per day. However, Jesus admits that having beer does not necessarily lessen his tension. In the interview, Jesus has shown a tendency to blame his wife for every negative consequences happened in life such as being late for work and as a result the parking space being occupied by the old woman. However, Jesus disagreed of being physically aggressive apart from being with wife and reported a good control over the situation if things possibly happen this way in public area or with public audience.

During the interview session, Jesus admitted that he would not hit his wife or any one ever after as he is afraid of getting punishment from legal authorities.

Environmental factors

Jesus has many stressors in his life. Since he was a child, his interpersonal relationship with his parents has not reached to an optimum level. Having an alcoholic father and criticized parents, Jesus had always been into anxious condition in which his development as a child may get adversely affected. According to Ochberg (2006) child abuse is an unconscious process of traumatic bonding in which one child has been trained since infancy to love an abusive parent in order to get the necessities on the one hand as well as to receive ‘hit’ and ‘hurt’ from the same on the other hand (Dutton, D. G., 1995). The victims of this type of domestic violation show a craving for good times incorporated with love and care for their partners with an expectation of better times in near future. In this type of setting, the victim has been encrypted within a cycle of domestic violence entailed with tension, abuse, relief, tension, abuse, relief, etc. – hence, with a period of ‘hope’ as a reward, and, thus the victim is reinforced. As Jesus has shown intensely abusive with his wife (Rathus, J. H., & O’Leary, K. D., 1997), it has been assumed as a manifestation of his childhood traumatic experience of being emotionally dependent as a child on his parents and being abused by them (Browne, A., 1993; Griffing, S., Ragin, D. F., Morrison, S. M., Sage, R. E., Madry, L., & Primm, B. J., 2005). which, eventually contributes to an escalating cycle of coercive control regulated by changes in emotional distance (Murphy et al, 1994), hence resulting in engaging into more intense, frequent and diverse coercive behaviour as Jesus did to his wife.

Treatment Plan

According to Cognitive Behavioural Therapy (CBT), I would want to address the behavioural and cognitive aspects of Jesus’ situation. Jesus should learn how to get fitted into the community setting. From a cognitive behavioural approach I would like to teach Jesus how to identify and recognize his own body cues when he gets anxious, frustrated and losing her temperament. I would let him identify how his thinking pattern shifts, how he feels about the changes of his bodily organs, how he starts sweating or how his tone gets changed, so that by knowing the changes in his body, he would be able to recognize the moments. After the identification process, I would like to teach him a relaxation technique so that he would be able to cope up with the situation, release his aggression in a more sophisticated and rational way and avoid being involved into any physical or verbal aggression.
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1 comment:

aaron grey said...

hi what did you write about jesus do you think is it a joke for you becouse everyone praise to him for help and for his blessing so i don't think it is right to say something like this about jesus it is only a comment so take care and god bless you tony

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