From panic disorder to complex traumatic stress disorder : retrospective reflections on the case of Tariq
- Authors: Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6234 , http://hdl.handle.net/10962/d1007784
- Description: This is a phenomenological-hermeneutic case study of Tariq who initially presented with panic disorder. It documents how, as therapy proceeded, the underlying meaning of his initial panic deepened as its roots in traumatic memories of childhood emerged. There were four spaced phases of treatment over four years. The first focused on anxiety management; the second was conceptualized within schema-focused therapy, and evoked and worked with childhood memories using inner child guided imagery; in the third and fourth phases insights gained led to an authentic re-engagement with family members in relationships that had been problematic. The panic attacks resolved and there were two dreams representing a reconfiguring of his relationship with his deceased father. The first two phases were the focus of an unpublished case study presented at a conference in 1995. This article incorporates material from that study and looks back at the case both in light of developments in phases two and three and also in light of theoretical developments in our understanding of complex trauma since the initial presentation.
- Full Text:
- Date Issued: 2013
- Authors: Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6234 , http://hdl.handle.net/10962/d1007784
- Description: This is a phenomenological-hermeneutic case study of Tariq who initially presented with panic disorder. It documents how, as therapy proceeded, the underlying meaning of his initial panic deepened as its roots in traumatic memories of childhood emerged. There were four spaced phases of treatment over four years. The first focused on anxiety management; the second was conceptualized within schema-focused therapy, and evoked and worked with childhood memories using inner child guided imagery; in the third and fourth phases insights gained led to an authentic re-engagement with family members in relationships that had been problematic. The panic attacks resolved and there were two dreams representing a reconfiguring of his relationship with his deceased father. The first two phases were the focus of an unpublished case study presented at a conference in 1995. This article incorporates material from that study and looks back at the case both in light of developments in phases two and three and also in light of theoretical developments in our understanding of complex trauma since the initial presentation.
- Full Text:
- Date Issued: 2013
Responsive integrative treatment of PTSD and trauma related disorders : an expanded evidence-based model
- Authors: Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6223 , http://hdl.handle.net/10962/d1007679
- Description: In this article a practitioner oriented review of the literature on the treatment of post-traumatic stress disorder is used to construct a phase-based model that can serve as a basis for case formulation and treatment planning. Treatments shown to be efficacious in randomized controlled trials are listed and two discourses about them are contrasted. One calls for therapists to implement treatments scrupulously according to the manual, the other calls for flexibility and responsiveness to contextual understanding of the situation and personality of individual clients. Evidence for the centrality of the principles of this latter discourse for professional practice is summarized from work on case formulation, standards for therapist competence, and the concept of evidence-based practice. This provides the foundation for a model for treatment of PTSD, both simple and complex, that has five levels which represent increasing degrees of depth of clinical work. In accordance with the phased approach, conditions at one level need to be satisfied before proceeding to work on a deeper level. At each level specific areas of clinical focus are highlighted including risk management (at level 1), building the therapeutic alliance (at level 2) and trauma-focused work (at level 3). The model serves as a broad structured summary of accumulated clinical knowledge about PTSD and its treatment that provides an evidence-based foundation for assessment and treatment planning.
- Full Text:
- Date Issued: 2013
- Authors: Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6223 , http://hdl.handle.net/10962/d1007679
- Description: In this article a practitioner oriented review of the literature on the treatment of post-traumatic stress disorder is used to construct a phase-based model that can serve as a basis for case formulation and treatment planning. Treatments shown to be efficacious in randomized controlled trials are listed and two discourses about them are contrasted. One calls for therapists to implement treatments scrupulously according to the manual, the other calls for flexibility and responsiveness to contextual understanding of the situation and personality of individual clients. Evidence for the centrality of the principles of this latter discourse for professional practice is summarized from work on case formulation, standards for therapist competence, and the concept of evidence-based practice. This provides the foundation for a model for treatment of PTSD, both simple and complex, that has five levels which represent increasing degrees of depth of clinical work. In accordance with the phased approach, conditions at one level need to be satisfied before proceeding to work on a deeper level. At each level specific areas of clinical focus are highlighted including risk management (at level 1), building the therapeutic alliance (at level 2) and trauma-focused work (at level 3). The model serves as a broad structured summary of accumulated clinical knowledge about PTSD and its treatment that provides an evidence-based foundation for assessment and treatment planning.
- Full Text:
- Date Issued: 2013
Treating the psychological sequelae of proactive drug-facilitated sexual assault : knowledge building through systematic case based research
- Padmanabhanunni, Anita, Edwards, David J A
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6235 , http://hdl.handle.net/10962/d1007785
- Description: Background: Drug-facilitated sexual assault (DFSA) has emerged as a distinct category of sexual victimization and precipitates posttraumatic stress disorder (PTSD). Few studies have examined the distinct psychological aspects of PTSD caused by DFSA. Gauntlett-Gilbert, Keegan and Petrak (2004) represent a notable exception and draw on cases, from their clinical experience, treated using Ehlers and Clarks’ (2000) cognitive therapy (CT). Aims: This paper aims to further develop and refine clinical knowledge on CT for PTSD arising from DFSA and advance the findings of Gauntlett-Gilbert et al. (2004). Method: Systematic case based research was used to investigate the applicability of CT for PTSD related to DFSA. Three survivors were treated with CT within the South African context. Results: The case series corroborated existing findings but also documented the presence of somatic and visual intrusions among survivors with partial or complete amnesia for rape and illustrated the utility of imagery interventions in targeting intrusions. The study highlighted the role of physical paralysis in DFSA in compounding helplessness/powerlessness and the necessity of enhancing physical agency and building social support. Conclusion: Distinctive aspects of PTSD related to DFSA can be effectively treated by adapting CT to suit this population group.
- Full Text:
- Date Issued: 2013
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6235 , http://hdl.handle.net/10962/d1007785
- Description: Background: Drug-facilitated sexual assault (DFSA) has emerged as a distinct category of sexual victimization and precipitates posttraumatic stress disorder (PTSD). Few studies have examined the distinct psychological aspects of PTSD caused by DFSA. Gauntlett-Gilbert, Keegan and Petrak (2004) represent a notable exception and draw on cases, from their clinical experience, treated using Ehlers and Clarks’ (2000) cognitive therapy (CT). Aims: This paper aims to further develop and refine clinical knowledge on CT for PTSD arising from DFSA and advance the findings of Gauntlett-Gilbert et al. (2004). Method: Systematic case based research was used to investigate the applicability of CT for PTSD related to DFSA. Three survivors were treated with CT within the South African context. Results: The case series corroborated existing findings but also documented the presence of somatic and visual intrusions among survivors with partial or complete amnesia for rape and illustrated the utility of imagery interventions in targeting intrusions. The study highlighted the role of physical paralysis in DFSA in compounding helplessness/powerlessness and the necessity of enhancing physical agency and building social support. Conclusion: Distinctive aspects of PTSD related to DFSA can be effectively treated by adapting CT to suit this population group.
- Full Text:
- Date Issued: 2013
Treating the psychological sequelae of proactive drug-facilitated sexual assault : knowledge building through systematic case based research : extended version of the article that was published as a brief report
- Padmanabhanunni, Anita, Edwards, David J A
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6236 , http://hdl.handle.net/10962/d1007786
- Description: From Introduction: Drug facilitated sexual assault (DFSA) -- on victims who are too intoxicated to be aware of their surroundings or exercise any control of the situation -- has emerged as a distinct category of sexual victimisation. DFSA has been identified as a significant public health concern, particularly among college students, with the majority of victims being women (McCauley, Ruggiero, Resnick, & Kilpatrick, 2010; Zinzow, Resnick, McCauley, Amstadter, Ruggiero, & Kilpatrick, 2010). Exact rates remain uncertain due to significant under-reporting (Du Mont, Macdonald, Rotbard, Asslanni, & Bainbridge, 2010; Lawyer, Resnick, Bakanic, Burkett, & Kilpatrick, 2010). Opportunistic DFSA, also called incapacitated rape (Lawyer et al., 2010; Zinzow at al., 2010), is the most common form and refers to assaults on women who have voluntarily consumed an excessive amount of alcohol (Lovett & Horvath, 2009). In proactive DFSA (called drug facilitated rape by Lawyer et al., 2010 and drug-alcohol facilitated rape by Zinzow et al., 2010), perpetrators deliberately incapacitate victims by plying them with alcohol or covertly administering an incapacitating drug such as Flunitrazepam (Rohypnol) or Gamma-hydroxybutyrate (GHB) to victims with the intention of sexually assaulting them (Hall & Moore, 2008).
- Full Text:
- Date Issued: 2013
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6236 , http://hdl.handle.net/10962/d1007786
- Description: From Introduction: Drug facilitated sexual assault (DFSA) -- on victims who are too intoxicated to be aware of their surroundings or exercise any control of the situation -- has emerged as a distinct category of sexual victimisation. DFSA has been identified as a significant public health concern, particularly among college students, with the majority of victims being women (McCauley, Ruggiero, Resnick, & Kilpatrick, 2010; Zinzow, Resnick, McCauley, Amstadter, Ruggiero, & Kilpatrick, 2010). Exact rates remain uncertain due to significant under-reporting (Du Mont, Macdonald, Rotbard, Asslanni, & Bainbridge, 2010; Lawyer, Resnick, Bakanic, Burkett, & Kilpatrick, 2010). Opportunistic DFSA, also called incapacitated rape (Lawyer et al., 2010; Zinzow at al., 2010), is the most common form and refers to assaults on women who have voluntarily consumed an excessive amount of alcohol (Lovett & Horvath, 2009). In proactive DFSA (called drug facilitated rape by Lawyer et al., 2010 and drug-alcohol facilitated rape by Zinzow et al., 2010), perpetrators deliberately incapacitate victims by plying them with alcohol or covertly administering an incapacitating drug such as Flunitrazepam (Rohypnol) or Gamma-hydroxybutyrate (GHB) to victims with the intention of sexually assaulting them (Hall & Moore, 2008).
- Full Text:
- Date Issued: 2013
Victimisation in the lives of lesbian-identified women in South Africa : implications for clinical assessment and treatment
- Padmanabhanunni, Anita, Edwards, David J A
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6237 , http://hdl.handle.net/10962/d1007787
- Description: Few clinical studies have examined victimisation in the lives of lesbian women in South Africa and whether there are distinct implications for psychological treatment. This paper presents the assessment and treatment of a lesbian-identified South African survivor of childhood sexual abuse who, as an adult, was raped and later gang raped. Her victimisation in adulthood represented ‘corrective rape’ motivated by the prejudiced assumption that the sexuality of lesbian women is pathological and should be ‘corrected’ through rape. This paper lends insights into the role of heterosexism in shaping vulnerability to victimisation and the process of recovery. It provides recommendations for work with sexual minority clients and highlights the implications when there is an absence of safety and support in the external environment.
- Full Text:
- Date Issued: 2013
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6237 , http://hdl.handle.net/10962/d1007787
- Description: Few clinical studies have examined victimisation in the lives of lesbian women in South Africa and whether there are distinct implications for psychological treatment. This paper presents the assessment and treatment of a lesbian-identified South African survivor of childhood sexual abuse who, as an adult, was raped and later gang raped. Her victimisation in adulthood represented ‘corrective rape’ motivated by the prejudiced assumption that the sexuality of lesbian women is pathological and should be ‘corrected’ through rape. This paper lends insights into the role of heterosexism in shaping vulnerability to victimisation and the process of recovery. It provides recommendations for work with sexual minority clients and highlights the implications when there is an absence of safety and support in the external environment.
- Full Text:
- Date Issued: 2013
“It’s like uprooting trees”: responsive treatment for a case of complex post-traumatic stress disorder following multiple rapes
- Van der Linde, Francois, Edwards, David J A
- Authors: Van der Linde, Francois , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6238 , http://hdl.handle.net/10962/d1007788
- Description: This systematic case study documents 27 sessions of assessment and treatment with cognitive therapy of Bongi (23)who presented with major depression, posttraumatic stress disorder and borderline traits. Bongi had been raised in a punitive environment, had been raped three times, the first time at age 9, and had been in a series of abusive relationships. The treatment illustrates the importance of therapist responsiveness in addressing this kind of complex presentation, the importance of drawing on case formulation to guide the course of treatment and the range of different interventions that need to be incorporated into an integrative treatment of a complex case. Self-report measures of depression, anxiety and posttraumatic stress indicators provided evidence that the therapy contributed to positive changes and the qualitative therapy narrative gives details of the nature of some of those changes. Although treatment was not complete when Bongi moved away, Bongi herself judged that the therapy had been a valuable experience which had resulted in her feeling more alive, more confident, and better able to take care of herself.
- Full Text:
- Date Issued: 2013
- Authors: Van der Linde, Francois , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6238 , http://hdl.handle.net/10962/d1007788
- Description: This systematic case study documents 27 sessions of assessment and treatment with cognitive therapy of Bongi (23)who presented with major depression, posttraumatic stress disorder and borderline traits. Bongi had been raised in a punitive environment, had been raped three times, the first time at age 9, and had been in a series of abusive relationships. The treatment illustrates the importance of therapist responsiveness in addressing this kind of complex presentation, the importance of drawing on case formulation to guide the course of treatment and the range of different interventions that need to be incorporated into an integrative treatment of a complex case. Self-report measures of depression, anxiety and posttraumatic stress indicators provided evidence that the therapy contributed to positive changes and the qualitative therapy narrative gives details of the nature of some of those changes. Although treatment was not complete when Bongi moved away, Bongi herself judged that the therapy had been a valuable experience which had resulted in her feeling more alive, more confident, and better able to take care of herself.
- Full Text:
- Date Issued: 2013
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