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VCC CNSK 1503 Case Study Two

Assignment 2: Case Study Two
CNSK 1503
Instructor Peta Schur
What is the central problem or concern for the client?
Kevin is clearly dealing with concerning anger issues, which will need to be addressed.
However, I wonder whether the root cause of his anger is related to the traumatic experiences he
has endured lately. Kevin’s anger is new; we know this because he previously exhibited and
valued peaceful behaviour, and his girlfriend left him because she says he changed. Moreover,
Kevin has endured what is objectively a very challenging series of experiences: he was injured,
resulting in the loss of his career, passion, hobby, and relationship, all in one fell swoop. He also
reports suicidal ideation. It may well be that Kevin is experiencing depression or post-traumatic
stress disorder related to trauma. Research shows that anger can be a symptom of depression; for
example, anger attacks have been found to occur more often in depressed patients compared to
mentally well controls (Painuly et. al., 2004).
Kevin’s depression is a primary concern, given that he has thought about suicide and
wondered whether “there is any point in going on.” It must be addressed with urgency. Kevin’s
life has changed dramatically recently, in ways that he is unhappy with, and he needs help
processing his emotions, developing healthy coping skills, and rebuilding a life worth living.
Once Kevin’s depression has healed, his other issues may resolve, or become more manageable.
Which theory would you draw on when working with this problem?
I would first draw from trauma-focused therapy in working with Kevin. He was in an
accident that injured him badly enough that he can’t play sports or do any exercise—this itself
may have been a traumatizing event. Because of his injuries, Kevin then lost many of the things
that mattered most to him, including his career and girlfriend. We can guess that Kevin may feel
as though he has lost his entire personal identity: he wanted to be a horse trainer, but can no
longer do that; he values gentleness but has been feeling and acting aggressively; he loves to be
outdoors but is now employed at a desk job and isn’t even physically able to spend time in the
wilderness the way he used to love to do. Kevin may feel disconnected from his own self. This
traumatic experience appears to be at the root of Kevin’s depression and his uncharacteristic
emotional and behavioural response.
The first priority with Kevin is to establish a sense of relational safety. Following
traumatizing events, effort and energy go into self-preservation rather than connection; our
emotional brain is impaired, and with it, our ability to connect with others. Support and
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connection will be critical in helping Kevin digest and integrate the trauma he has experienced.
Utilizing empathy, congruence and positive regard will allow me as the therapist to co-regulate
Kevin’s agitated nervous system. With my calm, loving presence, I can help Kevin relax, which
will allow him to connect.
Ideally, I would then be able to work with Kevin on mindfulness, or examining his own
mind to understand his emotions and thoughts as they are occurring in the present. If Kevin can
learn to identify, understand, explore and express his feelings, he may begin to heal. Once Kevin
has a clearer understanding of how his mind is working, he will become more familiar with his
own triggers and mental patterns. Kevin appears to have little self-awareness of his own
emotional state, as evidenced by the fact that he reports feeling “anger” all the time; likely there
are other emotions that he hasn’t yet identified. We can guess that Kevin’s may be often thinking
about the past and future. By bringing his attention into the present moment, he will spend less
time and energy ruminating about the past and about what might have been.
Pick two other issues. Which theories would guide you with these problems?
Kevin reports having witnessed, as a child, his father abusing his mother. Adverse
childhood experiences like this are linked with mental illness later in life (Herzog & Schmahl,
2018). In order to grow and develop into their full potential, children need their caregivers to be
their leaders, and to at least appear to be largely calm and in control. It is terrifying for a child to
witness their parents exhibiting out-of-control behaviour like Kevin did, partly because their
developing minds perceive that they are not safe. Once again, I would utilize a trauma-informed
lens to help Kevin understand and explore how these early traumatic events have shaped him,
and how they continue to exert influence over his mind and behaviours.
I would also draw on feminist therapy to help Kevin make sense of and heal from his
childhood trauma. Feminist therapy emphasizes locating an individual within their social and
cultural context in order to understand their problems. Kevin’s mother endured abuse by Kevin’s
father; because of discrimination, she may not have had access to opportunities to leave the
abusive marriage in order to protect herself and her children. Witnessing and feeling the
helplessness and terror of this situation surely shaped Kevin’s perceptions of the world, of
himself, and of relationships. Kevin’s anger and depression cannot be treated without
understanding how they arise. In other words, Kevin’s anger and depression are the symptoms of
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much deeper wounding. Only by healing the underlying wounding can Kevin’s emotional
agitation be fully addressed.
Feminist therapy invites us to consider how Kevin’s gender identity and social
expectations may be shaping his personal experience. As a male, Kevin may never have learned
healthy emotional processing and expression. He reports that he “feels angry all the time,” which
is not a nuanced view that likely captures the true complexity of the range of emotions he is
feeling. Anger often follows feelings of fear, frustration, sadness, and so forth, and it sounds like
Kevin hasn’t identified any of these other emotions within him. He feels he cannot even take his
aggression out on a punching bag, indicating he is holding his emotions in his body and not
processing them.
I would want to utilize narrative therapy to help Kevin with both his identity loss and his
anger/violence issues. Narrative therapy invites people to author a new storyline about who they
are and what their life means. Kevin has lost his sense of self, and is suffering from this lack of
connection with himself and purposelessness he is feeling about his life. By intentionally telling
a new story about who he is and where he’s going, Kevin may begin to feel comfortable in his
own skin again and excited about his life. I suspect the anger and violence issues may
spontaneously resolve then, as they appear to be new issues that follow and are symptomatic of
his traumatic loss.
Narrative therapy recognizes that people have the skills and expertise to create change in
their own lives by objectifying or externalizing their issues. which in turn may lower their
defences. Kevin does seem to be closely identified with his issues, and defensive about letting
anyone get close to him. It will be helpful for him to allow himself to be vulnerable in order to
fully feel and process his emotions about his very difficult life experiences. Kevin reports
“feeling bad” about hurting his girlfriend; he may be feeling painful self-loathing, particularly
because he has failed in his own standards of never hitting anyone. Narrative therapy can help
him feel greater self-compassion as he externalizes his issues and comes to have empathy for the
person who has endured so much. Self-compassion may help Kevin feel more capable of change.
Which therapy techniques would you use to address their problems?
Kevin seems to lack insight into his own emotions, and his thinking patterns have him
feeling hopeless and depressed about his life. I would borrow from cognitive therapy to help
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Kevin explore his own mind and hopefully move him from a place of stuckness to one of
curiosity, openness, and possibility. When Kevin says he feels “angry all the time,” I would
probe him to explore in more detail where that comes from, how it feels, and how it is and isn’t
serving him. I would also invite him to consider whether there are other emotions co-occurring
with or preceding the anger, such as fear, sadness, grief, frustration, disappointment, loneliness,
helplessness, etc. And I would challenge his assertion that he feels angry all the time; are there
times when he doesn’t feel angry, and if so, when? What is different about those times?
From feminist therapy, I would utilize gender-role analysis by supporting Kevin in
examining how cultural norms about male behaviour have influenced his beliefs and behaviours.
For example, Kevin may have internalized the idea that men are strong and active, and that men
do not display emotions. Dismantling these false standards will help him to more fully embrace
and accept himself as he is now, and to identify and express his emotions. By exploring how his
ideas of maleness may have shaped him, he will begin to liberate himself from unquestioningly
fitting himself into the male role.
Narrative therapy invites clients to objectify or externalize their problems—by recasting
the problem as something outside of themselves—in order to help them take a stand against it.
The problem is sometimes given a name to emphasize it as an external object that is not the same
as the person. For example, Kevin may choose to label his problem as “Grief” or “Loss.” I could
then utilize questioning to help Kevin deconstruct his dominant story. In narrative therapy,
relative influence questioning helps clients explore both the influence of the problem in their life
and on their relationships, and their influence on the problem itself. I might ask Kevin questions
like, “How has Grief been shaping your life lately?” And then, “You’ve been through so much.
How have you prevented Grief from taking over your life entirely?”
From solution-focused therapy, I would be sure to normalize the problem for Kevin. As I
mentioned previously, I sense that Kevin is feeling disconnected from himself and privately selfloathing. I would gently help him to see that he has been through so much and that his immense
grief and indiscriminate anger are normal responses to a very challenging situation, and that
being largely alone in facing a major life event like he has would not be easy for anyone. I would
also utilize solution-focused therapy’s technique of complimenting the client. Kevin is very
down on himself and he has nobody to hold him in high esteem; therefore, I would want to point
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out all that he is doing well (e.g. refusing to be aggressive, continuing to work even though he
isn’t happy with his job). Kevin needs someone to see him as capable and worthy right now.
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Painuly, N., Sharan, P., & Mattoo, S. K. (2005). Relationship of anger and anger attacks with
depression. European Archives of Psychiatry and Clinical Neuroscience, 255, 215-222.
Herzog, J. I., & Schmahl, C. (2018). Adverse Childhood Experiences and the Consequences on
Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan. Frontiers in
psychiatry, 9, 420. https://doi.org/10.3389/fpsyt.2018.00420
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