Student notes
Case study
You are working as a psychotherapist in a community service that provides psychological interventions for people who have served sentences for criminal offences.
Arthur is 21 years old and has been referred, as part of a plan for his release from prison, for assessment for suitability for attachment theory-based psychotherapy intervention.
Arthur’s mother Kelly was 16 when she gave birth to Arthur, who was fathered by her 19-year-old boyfriend. Kelly was living with her boyfriend’s family when she became pregnant. She had to move out soon after the birth due to her boyfriend’s violence. Having approached the local domestic violence unit, she and Arthur were put into emergency accommodation. Close social service support enabled Arthur and his mother to stay together for the first two years of his life, but their living arrangements were chaotic and her own difficulties became too apparent as her drug use increased. Kelly then became involved with an older man who was aggressive and violent towards her. Arthur was taken into local authority care and placed with a foster family. This family consisted of two parents who already had two children of their own who were both older than Arthur. Arthur stayed with them until he was seven, and this was described as a relatively stable and happy period of his life. He enjoyed school and he had a particularly good relationship with one female teacher. Unfortunately, the placement had to end as the foster family moved abroad. He also had to move school. The next placement was not successful as the new foster family struggled to care for Arthur as his behaviour became aggressive both at home and in school. He was aggressive towards the foster parents and towards teachers. This family also had another child who had been fostered with them since she was a baby and there was real anxiety that Arthur was turning his aggression towards her. He was placed with another set of foster carers who had experience of coping with children whose behaviour could be quite disruptive. His local authority also agreed to fund a place at a specialist residential school. He did well at this school and at age eleven was able to live full-time with his foster family and attend the local secondary school. He had occasional contact with his mother throughout this time. By this time she had another two children, both of whom were considered by social services to be at risk of neglect.
Whilst his first year or so of secondary school was quite stable, his relationship with teachers became more strained as he approached his 13th birthday. He was often disruptive in the classroom, not able to concentrate and getting into arguments with fellow pupils and teachers. Overall, he did not do well in school, he was described as having few friends, but did find some companionship with some older boys who were known in the area to be involved in minor criminal activities. He had a girlfriend when he was 16, but her family stopped the relationship as they were concerned about his bullying behaviour towards her. There was another fostered boy in the household but they were often arguing and fighting. He had a number of temporary exclusions from school, but was never permanently excluded as the school worked hard to keep him there. He had not achieved any formal qualifications when he left school at age 16.
Arthur’s first contact with police was at age 14 when he was caught and cautioned with older friends vandalising and attempting to break into a local shop. His first conviction was at age 16 for theft and handling of stolen goods. Since then he had a number of convictions for crimes of violence and theft, culminating in a three-year sentence when he was 20. It was during this sentence that he was recommended for therapeutic intervention.
The report read:
A. finds the prison environment very challenging. He was often involved in fights in the early months. He was not seen as being the instigator of violence but would react strongly to any perceived insult. He responded well to the opportunity of literacy and numeracy classes, which went well until the teacher was changed after 4 months. He then stopped attending. With no qualifications and difficulties with relationships and problems with anger he will not cope well on release.
Focus of the assignment
TMA 04 is intended to particularly assess your skills in drawing on the concepts and ideas of a particular therapeutic approach to make sense of a client’s problems, and your knowledge of theory and practice in this approach. For this assignment you have been asked to consider the client information from the case study above and write a formulation report for this client drawing on the attachment-based approaches as covered in VLE Week 17.
The idea is for you to consider the information in the case study as though you were a therapist working with the client and apply your knowledge of attachment-based approaches to explain the presented problems and ways to work with them.
However, unlike a ‘real therapist’ you will obviously not have the opportunity to ask the client further questions, or gain further insights by observing their interaction in the therapy session. The task with this assignment is rather to use the limited information available in the case study and to construct the best formulation report you can, based on the information available.
You can interpret the information in the case study and infer assumptions.
It will generally be important to remember that there is not one ‘correct’ answer to this assignment but that your formulation report should provide a good fit between the client’s problems and the concepts and ideas you apply to them.
Structuring your report
As your formulation will provide a rationale for a psychotherapeutic intervention that is based on attachment theory, it is recommended that you should structure your report around the following themes:
1. The client’s current problems
You should start the formulation report by briefly summarising the client’s current problems, highlighting those that you think would be suitable for intervention. This section should be brief and not take more than 300 words.
2. Brief overview of attachment-based therapy
You should explain the rationale and aims of attachment-based therapy with reference to relevant literature.
3. The attachment style or styles that appear to be most relevant to this case
Here you are asked to make an assessment of what you imagine would best describe Arthur’s typical style of attachment and thus his typical ways of relating to others. There is no right or wrong answer here, but you must be able to justify your choice. You might want to consider ways that the attachment style could be assessed.
4. Outline a programme of treatment plan
You must outline a plan of treatment for Arthur including treatment goals. You should make reference to your previous discussion of attachment styles and of Arthur’s experiences.
5. Describe the issues that would be likely to arise
You need to discuss, from your understanding of attachment-based therapy and of how people with different styles of attachment might respond in therapy, what the expected issues and problems are that might arise during the process of therapy. In particular here, you will need to consider the importance of the relationship between the client and therapist (referring to issues of transference and counter-transference would be very likely to be helpful).