Psychological formulation of a case study.

| December 8, 2015

Psychological formulation of a case study.
Order Description
Construct a psychological formulation of the case study provided, using ONE major perspective only (cognitive-behavioural, social constructionist, social inequality or systemic).
PSYCHOLOGY OF MENTAL HEALTH AND DISTRESS – 2015-6
Course work question

Construct a psychological formulation of the case study provided, using ONE major perspective only (cognitive-behavioural, social constructionist, social inequality or systemic).

Please note you are NOT required to provide a treatment plan for this client. Any treatment plan will be overlooked by an assessor, and you will inevitably lose marks.
Guide: The coursework should be broken down as follows:
Introduction – to the perspective you are using to construct the formulation, which should include the key ideas underpinning the approach and supporting references (500 words).
Formulation – this is the main body of the text and should include references to further literature (e.g. if you make a claim that delusions are caused by systematic logical errors, then provide a reference to support this claim). Here you are making the argument for how the formulation approach you have adopted is supported by empirical evidence – so use journal articles from current issues to support your claims. Start with the literature cited in the Johnstone text and then follow up the references they use, and expand on them with up to date empirical findings (1500 words).
Integration – use this section toinclude any further information from any other perspectives that you think might be relevant to the client (e.g. even though you may have concentrated on CBT, you could include issues relating to social inequality if you think they are relevant) (300 words).
Conclusions – use this section to critically evaluate the observations you have made or the approach you have used more generally. You may also add further comments on any unresolved issues (200 words).
Zac

Zac is 20 and was referred to a clinical psychology department two months into his admission to an acute psychiatric inpatient unit because his medication did not lessen the voices he encountered and did not reduce his delusional beliefs.

Zac was born in Zimbabwe in Southern Africa and lived there with his mother, father, brother and three sisters, until he was nine. His mother and father came to England (inner city Birmingham) in the early nineties to start a better life for their children. In Zimbabwe, there was a great deal of civil unrest due to the actions of the Mugabe government and to make matters more difficult, Zac’s father was considered to be a dissenter and was being sought out by governmental officials for his involvement in anti-governmental protests. Growing fear for Zac’s father’s safety prompted the family to flee the country, with the hope of one day returning.

Zac’s family were deeply religious and heavily involved in the local Christian community. Zac’s father became a prominent figure in the local church, spending more time away from the family to attend to church duties. In public, his father was an upstanding member of the community, but Zac and his siblings found his presence in the home increasingly menacing, especially when he would verbally bully their mother. His mother was also working two part-time jobs now to support the family and would spend increasing amounts of time outside the home. Zac and his siblings got on very well and would spend long hours telling each other stories and watching films together in the evening. In spite of his extra duties, Zac was not doing very well at the prestigious local university he attended, as he found it very difficult to concentrate and felt isolated from his classmates. He was studying engineering, because his father felt that this would provide him with a secure future and would enable him to contribute to the family more generally. Zac, however, would have liked to study drama as he liked reading plays and watching films. His father believed this was a useless past time and made sure that any spare moment was taken with studying for his exams and producing good coursework grades. The university was predominantly middle class, with many students coming from backgrounds where they had never been required to work or support themselves.

Around the time that Zac was 13, his father began spending more time away from home when he wasn’t at work (a low paid job with no prospects). After attending church meetings where he would make a very public contrintion to church life, he would go out drinking and would often come home drunk. He was often verbally abusive after these drinking episodes, especially towards his wife but occasionally towards Zac. It was clear that the marriage was in serious trouble and Zac’s mother began then to spend more time away at work. On one particular night, when Zac’s mother was working a shift, Zac’s father came home very drunk and began hassling one of his sisters (who was 12) for sex. His father threatened to hurt her if she didn’t comply with his demands but Zac managed to fight his father off, but sustained a number of physical injuries. On another occasion, however, Zac’s father knocked him unconscious and sexually assaulted his younger sister. Zac felt overwhelming guilt at not being able to protect his sister from his father and felt a growing resentment towards the church who were always heralding his father as a vital member of the church community and a wonderful father. Two years after the sexual assault, his father became a church pastor and Zac hated him even more. Zac’s behaviour became more disruptive in family interactions, and after a long heated argument, Zac punched his father, leaving him grounded and bloody while he escaped from the family home and disappeared for five days, sleeping rough. Upon his return, he was met with silence,not just by his mother and father but his siblings. This lasted several days until his parents warned that if he did not attend church and publicly confess his awful crime, they would have no choice but to prevent him from ever going out. He was also required to publicly apologise to his father and admit satan had entered him and incited him to act in a violent manner towards a man (his father) who only did right by him. His younger sister pleaded with him to do what his parents asked of him, because she was terrified that if he left again, she would not be protected from a father who was again making increasingly sexual advances towards her. Zac’s intense guilt over the last episide of assault encouraged his compliance and he confessed and asked for forgiveness from all the church members. His father then claimed he forgave – in front of his entire congregation. His congregation members congratulated Zac’s father on his magnanimous approach to his son, who had shamed him and his family so badly.
After leaving school, Zac studied hard for his A-levels, even though his did not enjoy the subjects he had taken (which were subjects his father had advised him to take). He became more withdrawn and spent a great deal of time in his room, secretly watching films on his computer. He loved escaping his life and becoming embroiled in the characters on the screen. His attention was increasingly focussing on violent films, especially retribution type films where ‘justice’ was achieved by those who had been wronged. He also began to take a great deal of interest in politics, although his mother and father disapproved, because they believed that they had come to England to escape politics and did not wish to be reminded of anything back home. Zac’s father had continued to drink secretly, although Zac now suspected he was having a secret relationship with one of his congregation, as he seemed to come home in a slightly better mood. However, one night, Zac confronted his father about the affair and his mother overheard. Zac raged against his father, calling him a hypocrite and a liar, and his mother a weak willed idiot. He then physically attacked his father and claimed he was Satan, that he had the devil in him. He ranted and claimed to hear the voices of Gabriel speaking to him to take revenge on his evil father who he now believed was working on behalf of the Zimbabwean government. After this, Zac’s parents’ called for a public prayer meeting to rid Zac of his beliefs. After this didn’t work, a psychiatric team was called in and Zac was assessed more closely. The psychiatrist on call assessed Zac and came to a tentative conclusion that Zac was experiencing an acute psychotic episode. She recommended a medium sized dose of Olanzapine (an anti-psychotic) to calm his aggressive behaviour and continued to observe ‘levels of aggression’ and his ‘active symptoms’.
Zac was admitted to a local psychiatric ward at the general hospital. Pastors from the church were also informed of his condition and their visit to the hospital to offer spiritual healing sparked another violent reaction in Zac. The whole time, Zac’s mother and father were being comforted by family and friends and everyone was praying for Zac to recover from his mental illness.
Zac’s voices and beliefs do not improve on medication although he feels a lot calmer. He continues to believe his father is out to get him and his mother is his powerless conduit. He experiences his voices as omnipotent – they are like Gods inciting him to carry out their wishes. He believes he has no control over them and must follow their commands.

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