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Isaac Ford Jr. Case Study Analysis

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Isaac Ford Jr. Case Study Analysis

Psychological Concerns

Isaac experienced emotional abuse as a child. He experienced parental substance use (alcoholism) and parental mental illness (depression). These conditions limited his mother’s ability to respond to Isaac’s emotional needs as a child. He also experienced the emotional trauma of being separated from his father when he was 7 years old (Ford, 2019).

Isaac also experienced physical abuse as a child. He survived a nearly fatal stab wound that punctured his lung. The experience was traumatic since he thought he was going to die (Ford, 2019).

Isaac was also significantly stressed as a child because of the pressure resulting from reversed parental roles since his mother was incapacitated by mental illness. According to Isaac, he did not get enough time to mature before he could assume these parental responsibilities (Ford, 2019).

Another psychological concern in the case is substance abuse. In college, Isaac started drinking as a way of numbing his pain (Ford, 2019). Similarly, there is a concern about high-risk behavior. As a college student, Isaac spent more time in the ladies’ dormitory than his own, indicating sexual-risk taking behaviors (Ford, 2019).

As an adult, Isaac’s combat experiences plunged him into post-traumatic stress disorder (PTSD), with recurrent distressing nightmares of these experiences alongside adverse childhood experiences. Isaac’s memories of adverse experiences during his childhood, combat, and experiences of racial injustice in his East Augusta neighborhood cause feelings of sadness and low mood.

Health-Related Illnesses (Biological) Concerns

An acute health-related illness, in this case, is penetrating chest trauma. Isaac sustained a penetrating chest injury after he was stabbed on the side by his mother, puncturing his lung and resulting in severe bleeding (Ford, 2019). Similarly, a chronic health-related illness is gastrointestinal problems that began after his traumatic combat experiences during deployment in Kuwait (Ford, 2019).

Social (Interpersonal and Environment) Concerns

A significant social concern in the case study is parent-child separation. Isaac was separated from his father and later from his mother as a child. He was separated from his father at the age of 7 years when his family moved in order to be closer to their maternal grandparents (Ford, 2019). He was subsequently separated from his mother at the age of 13 years after she physically abused him.

Additionally, he experienced parental substance use and mental illness. His mother was suffering from depression and alcoholism. This experience imaginably undermined the possibility of a positive mother-child relationship between Isaac and his mother. Another significant social concern is parentification. Isaac’s mother’s substance use and mental illness conceivably imperiled her ability to discharge her parental responsibility towards Isaac and his younger sister. According to Isaac, he was forced to “grow up really fast” (Ford, 2019). He was therefore compelled to assume parenting roles toward his family’s welfare. Similarly, there is a concern about Child Maltreatment. Isaac experiences physical and emotional abuse indicating a dysfunctional parent-child relationship.

There is a concern about racial injustice in Isaac’s neighborhood. Isaac’s family lives in a neighborhood in which members of his African American racial ingroup are undervalued, racially profiled, and targets of racial slurs by members of law enforcement. As a police officer, he is persecuted and fired arbitrarily for speaking up against police hostility toward African American suspects in police custody (Ford, 2019).

Spiritual Concerns

A significant spiritual concern in the case is spiritual distress. Isaac is a Christian. However, the multiple adversities he has experienced throughout his life, including the life-threatening penetrating chest injury he sustained as a teenager, have frequently driven him to question his faith and spirituality (Ford, 2019).

Problem List and Coping Mechanisms

Coping Mechanisms

Suppression: Isaac initially suppresses the memory of his adverse childhood experiences, including maltreatment and parentification.

Spirituality: As a Christian, Isaac relies on his faith in God for resilience during distressful experiences. His faith in God gives him the psychological stamina to endure episodes of stress and sadness.

High-risk health behaviors: Isaac drinks and gets involved with many girls in college to numb his psychological distress (Ford, 2019). This is a maladaptive coping mechanism.

Altruism: As an adult, he uses altruism to deal with unacceptable memories associated with his adverse experiences. Altruistic coping influences his decisions, such as advocating for fair treatment of African American suspects in police custody, engaging in social work and championing the welfare of members of his community.

Target symptoms and their impact on wellness (brain and body)

Nightmares involving previous traumatic experiences; recurrent nightmares result in insomnia and fatigue, impairing the ability to obtain adequate sleep and rest. Nightmares may also precipitate depression as the individual frequently relives their trauma through their nightmares (Shalev et al., 2017).

Alcohol use: alcohol use may culminate in an alcohol use disorder. Persistent alcohol use increases the risk of medical illnesses such as cardiovascular diseases, including cardiomyopathy and high blood pressure (Carvalho et al., 2019).

Persistent feelings of sadness; persistent sadness increases the risk of experiencing depression. This symptom may also precipitate biological symptoms such as reduced appetite and deranged bowel habits. Sadness may also increase the risk of medical conditions due to the dysfunctional chronic activation of the neurohormonal stress response system (Cho et al., 2019).

A Clinical Case Analysis

Isaac has a history of multiple adverse childhood experiences and negative life events that have predisposed him to significant mood disturbances. Experiences of maltreatment, including physical and emotional abuse, resulted in maladaptive coping strategies in young adulthood, particularly alcohol use. Coupled with the traumatic combat experiences during his military service, Isaac’s negative life events have precipitated mood disturbances, including nightmares involving his traumatic experiences and persistent feelings of sadness. Isaac is also a Christian who has a strong faith in God. However, some of the traumatic experiences in his life have driven him to question his faith, resulting in spiritual distress. These symptoms can potentially derail his quality of life.

Diagnosis

Post-traumatic stress disorder (PTSD): Isaac has nightmares in which he re-experiences some of the traumatic events in his life, including the near-death penetrating chest injury inflicted by his mother and some of the tragic combat encounters during his deployment in Kuwait. PTSD can cause nightmares in which an individual who has experienced a tragic life event relives the experiences in the form of flashbacks and nightmares. Similarly, Isaac’s drinking habit may be a symptom of PTSD as he tries to cope with the uncomfortable flashbacks. PTSD can precipitate alcohol dependency as a strategy for coping with the trauma in one’s memories (Shalev et al., 2017).

Psychological Test for PTSD

Clinician-Administered PTSD Scale for DSM-V (CAPS-5). CAPS-5 is an interview-based psychometric assessment instrument that can be used to assess symptoms of PTSD. The instrument contains 30 items that evaluate the presence of symptoms of PTSD during the previous week. Besides evaluating the clinical symptoms of PTSD and their duration and severity rating, CAPS-5 also assesses the client’s subjective feelings of distress due to the condition and the impact of PTSD symptoms on their functional status in the social and occupational aspects (Weathers et al., 2018). The instrument has been adapted to suit the criteria for the diagnosis of PTSD in the DSM-V. A sample item on the instrument is, “How much do these memories bother you?” CAPS-5 is administered by the clinician and is instrumental in making a definitive diagnosis of PTSD (Weathers et al., 2017). Additionally, the instrument can be used to establish a lifetime diagnosis of PTSD.

Impact Of Violence On Wellness And Mental Health

Violence has a dose-dependent relationship with poor health. Violence can either be psychological, occurring in the form of threats, or physical involving direct trauma such as a battery (Delara, 2016). Violence can impair wellness directly through the physical health effects of the injury inflicted on the victim. Specifically, pain or disability arising from a violent experience has a significant negative impact on the quality of life of the victim. Exposure to violence or witnessing another person experience violence can result in psychological trauma, which may precipitate mental illnesses and behavioral problems. PTSD can result from reliving the violent experience through one’s memories. Violence can also increase the risk of depression due to the persistence of negative thoughts and emotions related to the event, such as the guilt of being unable to intervene in witnessing violence. Violent experiences are also associated with anxiety disorders (Friborg et al., 2019). Negative emotions and memories of a violent experience can result in adverse coping behaviors, particularly substance use behaviors such as heavy alcohol drinking, which may precipitate chronic substance use disorders (Delara, 2016).

Integrated Treatment Plan

Isaac’s case should be managed through a comprehensive treatment program involving a multidisciplinary team, including a psychiatrist, a social caseworker, a physician, a chaplain, a nurse, a pharmacist, and Isaac’s significant other.

Following the assessment and diagnosis of PTSD and its severity, the client will be enrolled in a trauma-informed treatment program delivered by specialists, including pharmacological and cognitive behavior therapy. Cognitive behavior therapy (CBT) will be delivered in a dual intervention design that targets both PTSD and alcohol use and includes psychoeducation and coping strategies. Because of his strong spiritual background, Isaac will be referred to a chaplain who will address his spiritual needs and concerns as they relate to his psychological health.

Additionally, he will be referred to a community-based organization that assists community members or veterans with medication management in order to facilitate his access to PTSD medication during the treatment.

He will be referred to a physician who specializes in gastroenterology to assess and manage the associated gastrointestinal problems. Isaac will also be connected to a peer support group for veterans with PTSD to benefit from his peers’ treatment and recovery experiences.

Primary, Secondary And Tertiary Prevention

Primary prevention will involve the delivery of psychoeducational interventions before exposure to trauma or adversity. Pre-exposure psychoeducation prevents the development of post-traumatic stress and associated maladaptive behaviors such as substance use by building the individual’s resilience. Pre-exposure pharmacotherapy using sympatholytic agents such as beta-blockers may also be beneficial (Linares et al., 2017). This prevention level will not be feasible in this case since Isaac already has possible PTSD.

Secondary prevention involves the measures taken to encourage early detection of PTSD in individuals exposed to trauma and at risk of PTSD. These include early psychological assessment following exposure to trauma to identify risk factors for PTSD and psychosocial and emotional support for individuals exposed to trauma. Interventions to mitigate the experience, such as aggressive control of pain in the case of physical injury, brief CBT, and pharmacological interventions such as benzodiazepines, may also be beneficial (Linares et al., 2017). This prevention level may also be non-feasible in Isaac’s case.

Tertiary prevention involves the measures taken to prevent severe impairment following the diagnosis of PTSD. These measures include early initiation of pharmacotherapy and cognitive behavior therapy to prevent the development of disability and the effects of PTSD, such as depression and substance (Miao et al., 2018). This prevention level is the most applicable in the case study.

Ethical Issues

A potential ethical issue, in this case, is the effect of a dual relationship with the client. Since I have interacted with the client beyond the bounds of the therapeutic alliance, this non-professional relationship may potentially jeopardize my tenacity in exerting a therapeutic influence. Since the client is a veteran, confidential aspects of their combat experiences that present moral dilemmas may emerge, and I may be burdened with the responsibility of nursing these secrets as the caseworker.

Counter-Transference

As an individual who empathizes with the negative experiences of racism and injustice experienced by African Americans, I may employ this understanding to forge a therapeutic bond with the client and potentially exert a greater therapeutic influence. Similarly, having witnessed my own friend struggle with alcohol abuse following the separation of his parents, I may be driven to sympathize rather than empathize with Isaac’s situation, which may impede the objectivity of the treatment process. Finally, being a Christian, I may be tempted to intervene in Isaac’s spiritual distress, potentially interfering with the therapeutic alliance between Isaac and the chaplain.

Summary and Conclusion

Isaac is a client who has possible PTSD following multiple adverse experiences that include maltreatment and parent-child separation during childhood, exposure to trauma as a military combatant, and poor socio-economic living conditions. He also has an associated history of drinking. Isaac also has gastrointestinal problems. His target symptoms include nightmares, alcohol use, and persistent feelings of sadness. He will potentially benefit from an integrated management program that includes a multidisciplinary team and involves both pharmacotherapy for PTSD and cognitive behavior therapy.

Isaac has significant strengths that may be beneficial in his management and recovery. He has a strong spiritual background that provides a positive coping strategy. Additionally, he has a supportive extended family that will be a crucial source of psychosocial support during treatment. Furthermore, Isaac is socio-occupationally functional and has a positive premorbid functional level, which presents a positive prognosis. Finally, he has excellent insight since he understands that psycho-interventions may be useful in improving his mental health. This predicts the likelihood of treatment adherence.

References

Carvalho, A. F., Heilig, M., Perez, A., Probst, C., & Rehm, J. (2019). Alcohol use disorders. The Lancet, 394(10200), 781-792.

Cho et al. (2019). Factors associated with quality of life in patients with depression: A nationwide population-based study. PloS One.

Delara, M. (2016). Mental health consequences and risk factors of physical intimate partner violence. Mental health in family medicine, 12(1), 119-125. Delara, M. (2016). Mental health consequences and risk factors of physical intimate partner violence. Mental health in family medicine, 12(1), 119-125.

Ford, I. (2019). Up from the Bottom: A Memoir. Isaac Ford Jr.& Associates, LLC.

Friborg, O., Emaus, N., Rosenvinge, J. H., Bilden, U., Olsen, J. A., & Pettersen, G. (2019). Correction: Violence affects physical and mental health differently: the general population based Tromsø study. PLoS one, 14(1), e0210822.

Linares, I. M., Corchs, F. D. A. F., Chagas, M. H. N., Zuardi, A. W., Martin-Santos, R., & Crippa, J. A. S. (2017). Early interventions for the prevention of PTSD in adults: a systematic literature review. Archives of Clinical Psychiatry (São Paulo), 44(1), 23-29.

Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32.

Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-traumatic stress disorder. New England Journal of Medicine, 376(25), 2459-2469.

Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., … Marx, B. P. (2017). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and Initial Evaluation in Military Veterans. Psychological Assessment, 30(3), 383-395.

Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., . . . & Marx, B. P. (2018). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military Veterans. Psychological Assessment, 30, 383-395. doi:10.1037/pas0000486

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Isaac Ford Jr. Case Study Analysis

Case 3 Outline: Isaac

This assignment is an integrated case analysis written in a report format that is due week 12. Students will complete a comprehensive assessment that will include background information on the client, problem list (identify acute vs. chronic), target symptoms, bio-psych-social analysis, identify what would be helpful from a prevention perspective and diagnosis (s) with an integrated treatment plan (integrated intervention approach). Students will identify appropriate psychological testing that will assist in the development of the diagnosis, possible health related illnesses and appropriate referrals. The treatment plan should also identify three levels of prevention needed in the case and end with an integrated treatment plan that would improve the quality of the client’s life (Isaac). This assessment should be six to eight pages in content (does not include cover page). Students are required to use at least 3 references to include book, APA guidelines and headings below should be used in the paper.

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