An Intervention Plan for a Male Survivor of Interpersonal Violence

by

Yudhajit Roychowdhury

2037426

4 MPCL

CIA 2: Crisis and Trauma Counselling

Dr. Divya Ballal

Department of Psychology, CHRIST (Deemed to be University), Bengaluru

 Introduction to the Case

The client is a 27-years-old man currently employed in an IT firm in Bangalore. He had

been in a romantic relationship over the past five years, and they started to live together over

the last year. Although things were good in the beginning, the last six months or so had been

extremely difficult. He had been physically beaten by his partner causing bruising. He informed

that she tried to isolate him from his family and friends, his biggest support systems. There had

been times when verbal disagreements led to the client being locked up in a room and not

being provided with the opportunity to eat. The client also reported being raped. There were

times when he tried to confront his partner about her abusive behaviour, but got gaslit instead.

The client was extremely distressed about the ordeal. He had recently moved out to his aunt’s

place.

A Possible Intervention for the Case

Assessment

Danger to life

The first thing to be considered is the threat to the life of the client (Briere & Lanktree,

2011). Things to assess under threat to life include danger immediate threat to life or loss of

physical functioning, danger of incapacitation, presence of suicidal ideation or plans, and how

unsafe the immediate environment of the client is (Brier & Scott, 2014).

Psychological stability

Clients sometimes might be in a stress of acute crisis following traumatic exposure and

the therapist’s question regarding the events might only exacerbate the situation (Brier & Scott,

2014). If the therapist judges that talking about traumatic events might activate the client’s
trauma responses in a negative manner, it is beneficial to deter discussion of such materials to a

later time when the client would be in a better state of mind (Najavits, 2005).

Effects of trauma

Effects of the traumatic experience might include emotions, memories, or thoughts in

response to a certain triggering stimulus. The client might also show avoidance responses like

being overtly detached from the traumatic experience or actively avoiding any reminder of the

events. Emotional dysregulation and disturbance in interpersonal relationships might also arise

in response to trauma. The client might also be extremely vigilant of any signs of possible

trauma in the future. Trauma might also influence the client’s ability to form a proper working

relationship with the therapist. In extreme cases, symptoms of dissociation, PTSD, and psychosis

may appear (Brier & Scott, 2014). Since the effects of trauma are so varied, it is important to

assess the presence of them in order to design better interventions.

Assessment tools

There exist multiple standardised tools that might help the clinicians in assessing the

aftereffects of trauma in the client. These include The Structured Interview for Disorders of

Extreme Stress (Pelcovitz et al., 1997), Detailed Assessment of Posttraumatic Stress (Briere,

2001), Trauma and Attachment Belief Scale (Pearlman, 2003) among others.

Intervention

The intervention for the client might be long-term and might proceed in several stages.

An overview of the process of the intervention is being provided here.

Intervention of immediate concern: reducing any threat to the life

This stage is contingent on the existence of possible threats to the life of the client.

Prolonged starvation, as mentioned by the client, can indeed incapacitate the client or cause

serious health issues and even death. It is also important to assess whether the client has

suicidal ideation. This process needs to be approached with utmost caution, ensuring that the

questions are not intrusive or distressing to the client, but rather conveys a sense of support

and empathy.

The best course of action in the case of serious threat to life would be to arrange for the

provision of emergency medical or psychiatric services in case of serious threat to life. It is also

important to address the suicidal ideation through the use of effective therapeutic techniques.

Stage 1: Psychoeducation

Psychoeducation has been shown to be effective in reducing symptoms of trauma

(Ghafoori, Fisher, Korosteleva, & Hong, 2016). Psychoeducation can be focused on the nature of

trauma, the typical trauma responses, reframing the symptoms as trauma processing, and the

possible safety plans (Briere & Scott, 2014). The client might be prone to self-blame which is

often commonly found among trauma survivors and reduces psychological adjustment (Reich et

al., 2014). Being a man, the client might be prone to believing cultural myths surrounding

manhood and trauma which might negatively impact his recovery. Psychoeducation can be

appropriately used to bust such myths. Psychoeducation might be provided through handouts,

books, or through verbal instruction in sessions. The process of psychoeducation continues

throughout the course of therapy, being provided whenever the need arises.
Stage 2: Distress tolerance and affect regulation

Following a traumatic experience, the client might often face distressing emotions and

thoughts and feel overwhelmed. Thus it is important to train the client in distress tolerance and

affect regulation skills.

The easiest and also an effective way to deal with stress is grounding. During sessions,

the therapist can ground the client by requesting him to describe what he is feeling internally by

asking questions like:

“I feel that something is upsetting you. Would you like to describe what it is?”

Furthermore, the therapist might also attempt to orient the client to the immediate, external

environment, indicating the safe space of therapy and his existence in the presence. This should

be done using gentle, reassuring statements like:

“I understand that talking about those past experiences might be difficult for you. But

you are here with me, and you are safe here. No harm will befall you.”

Additionally, the client can also be taught certain commonly used grounding techniques like the

54321 technique which he can apply outside the therapeutic setting in his daily life to tolerate

distress.

Further distress tolerance skills can be borrowed from the skills used in DBT. This would

include reframing the situation in a different manner to change client’s perception, engaging in

mindfulness practices and relaxation techniques, using intense pleasurable physical stimuli like

taking a hot or cold shower, shutting out external sources of additional stress, thinking neutral

thoughts, or taking a break in general (Linehan, 1993a).

 Affect regulation starts with fostering awareness of discriminating between different

emotional states (Linehan, 1993b). The therapist can facilitate this by regularly encouraging the

client to explore and elaborate on his emotions. Direct feedback regarding emotional states

might also be helpful. The client also needs to be made aware of his triggers and then be taught

adaptive coping strategies to deal with them without being emotionally overwhelmed. The

strategies might include relaxation, distraction, positive self-talk, and support system (Briere &

Scott, 2014). Proper training in mindfulness can also reduce the client’s desire to act on the

triggers. This can also make the client more receptive towards experiencing the negative

emotions instead of trying to deliberately push them away, often with a paradoxical effect (van

Dijk, 2013).

Stage 3: Cognitive interventions

Cognitive interventions can help reduce self-blame, guilt, shame, low self-esteem,

hypervigilance, and other negative thought processes often associated with trauma survivors.

The process starts with the therapist helping the client relive the traumatic experience in

the safe environment of therapy. This can be done through a detailed verbal description of the

events or by writing about them. The idea is that by re-experiencing the events, the client

would become more aware that he has been internalising the rationalisations used by his

partner and how that is influencing his thoughts and feelings about himself. The therapist can

use techniques such as Socratic questioning to help the client explore the faulty assumptions he

has made about his experiences. Going further, the therapist can also the client to explore the

distorted beliefs he has formed about himself as a person, and then use questions to help the

client reality test these beliefs.

 As cognitive intervention proceeds, and the client learns to challenge his distorted

beliefs, it is expected that the client will begin forming a much more coherent, detailed, and

analytical narrative of his experiences. Such a comprehensive account would be beneficial in

deeper cognitive processing of the emotions, lead to reduction in symptoms (Amir, Stafford,

Freshman, & Foa, 1998), and have a positive effect on recovery (Pennebaker, 1993).

Stage 4: Trauma processing

To achieve any progress in trauma work, it is important to help the client process the

experience of trauma. Central to this process is the behavioural intervention of exposure, which

not only allows the exploration of the effects of trauma, but also allows the client to realise that

the fear associated with the traumatic experience is incongruent with the safe space of therapy.

Consequently, the activation that occurs and the disparity that arises within the client can be

worked through using counterconditioning which not only validates the client’s experience but

also reduces the fear associated with it (Abueg & Fairbank, 1992). This allows the client to think

about the events without being overwhelmed by them.

Stage 5: Strengthening identity and facilitating growth

It is important to also focus on and capitalise the strengths the clients already possess. It

is contingent upon the therapist to provide a safe environment where the client can explore and

use his strengths to work on the difficulties he is facing. As the client’s distorted beliefs about

himself decreases, the therapist should provide validation to the emerging sense of positive

identity, and should teach the client to validate how to validate his own feelings and emotions.

The therapist should also encourage and assist the client in forming and maintaining fulfilling

social relationships.
 Conclusion

Trauma work is a tiring experience for both the client and therapist. There are certain

nuances and precautions that the therapist needs to follow so that the client is nor harmed in

any manner. The intervention plan provided here is for a generic case of interpersonal abuse.

However, trauma can be caused by a multitude of experiences, and although the intervention

plan might look similar overall, certain additions and subtractions would need to be made based

on the nature of the trauma. It should also be noted that although the intervention has been

proposed as progressing through stages, these are not rigid structures but are rather flexible,

and the therapist should feel free to move across multiple stages as required.
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