The term trauma is used to describe the painful and distressing situations experienced by a person. Most people do not express trauma explicitly. Identifying the traumatized individual, therefore, is a hectic process. This is even more difficult if there is a weak relationship between the traumatized individual and the physician. While in an internship, I had a chance to work with a family whom they had been exposed to traumatic conditions for several years. The family was composed of the grandmother, Sarah, who was aged 49 and mentally retarded, the mother, Jasmin, aged 23 and with low IQ, the father, John, aged 25 and addicted to drugs and to daughter, Kelly and Janie, who were both aged 15months and 2years old consecutively. During my first encounter with the family, I was doing my normal chores of assisting the family in medical applications, job hunting, and financial assistance.
After some serious look into the situations of the grandmother and the mother, I found out that they had both been exposed to sexual torture by the men in the family. The father, on the other hand, had been exposed to verbal abuse by the women, for several years. The grandmother confessed that the father was fond of asking every female in the house for sex. The mother and grandmother were, therefore, living in the fear of him molesting the children. Weeks later I kept visiting this family and learned more and more about them. I later learned about the brother to the sisters, who had been registered as a sex offender by the civil protective services.
It was initially hard for Jasmin, the mother of the two girls to open up to me completely. She accused of her fiancé and the terrible experience of searching for a job, without success. She confessed of a count of abuses by her fiancé. She also told me that she had been accused by her father, sexually when she was still young. Her mother had also been sexually and verbally abused by the family members. She told me that she had moved from country to country for greener pastures and for a better life for her children. She had some love for her daughters because she talked about them positively.
Clinical formulation for the case
Clinically, trauma is related to many clinical implications. A traumatized individual tends to have compromised immunity. Managing traumatized case requires many considerations. It is important to note that medication alone may not help much during the management process. Furthermore, counseling alone is bound to result in insignificant positive outcomes.
Concisely, management of a traumatized case entails multisectoral approach. It is upon the practitioner to identify all the sectors contributing to the trauma. Identification of these sectors would be followed by prioritization process. Health practitioner should prioritize the sectors identified from the most direct to the less direct sector. The most direct sector is that sector that contributes significantly and directly to the trauma (Wesson, 2005).
After prioritization of the sectors involved, the practitioner should then systematically manage the trauma according to the priorities. As a practicing intern, I had an opportunity to explain to Jasmin the importance of my job to her. I told her that I had been sent to assist her to find the way out of her problems. I told her if she gave me the chance, I would help her meet her goals. I discussed with her about an agency, which would help her improve her skills of reading. The agency would also help meet her goal of obtaining a driver’s license. She had been suffering from depression and as a result had developed low self-esteem. I recommended that we make an appointment with a therapist. The therapist exposed her to medications, which changed her mood completely.
According to this case, the most urgent problem that needed to be addressed was the social aspect. The client seems to have lost the sense of belonging. Consequently, helping the client regain the aspect of the sense of belonging was of prime importance as far as the management of the trauma was concerned. It was apparent that issuing of the therapeutic and supplemental feeds was of less importance to the client (Herman, 1997).
The client should be advised on the best way through which she could reconcile with her husband. The client had to approach an administrator who could take her home and talk to her husband. Solving the social aspects should be followed by guidance and counseling. The client should be counseled on how to forget about the past events. The client has to be advised on the importance of focusing on the future.
Counseling can be done alongside the clinical or rather, medical interventions. It is at this stage that needs to provide the client with the therapeutic and supplemental feeds become inevitable. It is apparent from the foregoing discussion that social and psychological aspects should support the clinical formulation of traumatized individuals. Unlike other condition, medication alone may not assist in the management of the trauma (Schwartz, 2002).
It is, therefore, a duty of health practitioner to involve the multisectoral approach while managing a trauma-based case. The health practitioner should also be keen to diagnose all the factors related to the trauma. It should be noted that the most common factors associated with trauma include the social factors, the psychological factors, mental factors, physiological factors.
Diagnosing these factors correctly would enable the health practitioner to design the best approach to managing the condition. Psychological and social factors can be diagnosed through the assessment of the subjective information catered from the client. On the other hand, the mental and physiological factors can be diagnosed through the objective information obtained through observation and measurement (Schwartz, 2002).
The course of treatment
After diagnosing the factors facilitating the trauma, the next line of action is the treatment. As mentioned above, the course of treatment to be adopted depends on the urgency and the magnitude of the factors diagnosed above. Counseling is the main form of intervention that must be carried out. However, the counseling process must take into consideration the fact some of these factors are more crucial.
Considering the living conditions of my client, contextual therapy and CBT would be very useful for them. Every member of the family had been going some form of trauma and this prevented them from experiencing the normal, happy and satisfied lives. Each of them kept sharing with me the bad experiences they had undergone in the past and how this had influenced their dreams. Jasmin’s fiancé was suffering from ADD and ADHD. He shared with me how this had affected and prevented him from getting a good job, going to college, and doing everything right. Both the mother and father had difficulties in developing trust over one another.
Based on my case, it is apparent that it is impossible to administer nutritional counseling to the client before addressing the social factors. The client could not concentrate on nutritional counseling because it was of less concern than the social and moral support. Consequently, the treatment should be commenced by addressing the social and moral issues. Nutritional counseling whereby the client is counseled would then follow.
The client should be advised on the best dietary practices necessary during the postnatal period. However, it should be noted that during the administration of nutritional counseling, the counselor must be keen to cover the relationship between stress associated with trauma and the utilization of food. Nutritional counseling should be accompanied by the administration of therapeutic and supplemental feeds. Administration of antidepressant constitutes the last line of action to be taken (Wainrib, 2006).
Based on this and many other trauma-based cases, it is clear that trauma is can greatly reduce the quality of life. A traumatized individual views life as meaningless and hence it is the prime role of the counselors and medical practitioners to assist the traumatized individuals to recover from stressful and painful situations. However, it is apparent that most people do not reveal their situation easily. This makes it difficult for practitioners to make a proper diagnosis. This leads to wrong intervention measures. The practitioner should, therefore, have the counseling techniques in order to win the attention and trust of the client (Ball, 2010).
From the case discussed above, it is apparent that some traumatized individuals might have no source of livelihood. It is important for the health facilities to have support programs that can be used to assist trauma-based cases like the one addressed above. Support programs are very important in that virtually most cases of traumas tend to limit the person affected from assessing basic needs such as food and shelter. The presence of support programs would help in addressing such needs. Another aspect that is apparent in trauma-based cases is that traumatized individuals need much of social and moral support than any other form of support (Wainrib, 2006).
This means that there must be caretaker whose role is to keep the client busy. Leaving the traumatized individuals alone would give them time to recall the past events. The memories of the past events are bound to worsen the case. Consequently, there must be a caretaker to make them busy and concentrate on the present and future events. Moreover, it should be noted that trauma weakens the immune system of an individual. This predisposes the traumatized person to health conditions such as the frequent occurrence of the common cold, tiredness. It is important for the practitioner to be keen while assessing the traumatized client (Wesson, 2005).
From the foregoing discussion, it is apparent that trauma is among the worst medical conditions. Trauma worsens the medical condition of a person. Management of trauma constitutes the crucial step that must be taken. Nevertheless, the health practitioner must be aware of the fact that different forms of traumas have different intervention measures. In other words, the course of treatment of traumas varies according to the contributing factors. This means that each individual must be attended to selectively based on the nature of the trauma.