Reference no: EM133220906
Angela has been a regular patient of yours at the clinic. She is a victim of ongoing physical abuse in her nuclear family, and, although she has safely moved on and become an accountant, she has never completely been able to distance herself from her abusive father. She has been in ongoing therapy with you for almost 5 months.
Tonight, however, her life has come crumbling down around her and Angela has been hospitalized for severe posttraumatic stress syndrome.
A colleague calls you at home: "You might want to get to the hospital," he says. "This is really bad. I think you'll want to see her."
As you get out of bed and get dressed, you quickly review Angela's history:
Throughout her life Angela has been her family's "emotional caretaker," even though she is the youngest sister. Her mother and older sister have lived with intimidation by Angela's father.
"My mother did try to leave him several times," Angela says. "She'd pack up my older sister and me and leave, but when she'd go to her mother, or her aunts, or her own sister, they'd say, 'At least he provides for your family. You always have your bills paid and good food on the table, and the girls have anything they need. He's a good provider; go back home.' So she felt like she had no support and no way of getting help to get out."
As Angela was growing up, then, her inner strength and maturity, studious nature, and calm demeanor made it easy for both her mother and her sister to come to her when they were emotionally overwrought over her father's increasingly violent behaviors. In fact, her calm attitude gained her father's begrudging respect-but only to a certain extent. She faced physical abuse much less often than her mother and sister, who both became hysterical easily at his first signs of threat. This backfired in one way: her father too tried to make Angela his confidante, complaining to her about work and about the other two women in the family. He suffered from significant paranoia and believed that the other men in the small construction company he worked for as a carpenter were all laughing at him behind his back.
When asked how she responded to his confidences, Angela says that she felt very uncomfortable with that, especially since she too was afraid of him. "But I mostly just nodded or tried to reassure him when he got paranoid. I spent a lot of my adolescence saying, 'Oh, I know they must appreciate you. You're a good carpenter.' That seemed to satisfy him, and he'd call me a 'good girl.' He'd tell me I was the only 'good person' in his life. I hated that, but I couldn't say anything. The last thing I wanted was for him to notice me at all. I wanted to just be invisible and get out of that house before he killed someone."
Unfortunately, he did.
Angela and her sister both grew up and eventually escaped their violent household. Her sister has totally ignored the family, but Angela has felt sorry for her mother, who remained helpless to extricate herself from a violent marriage. Unfortunately, it means that her father still calls her to settle what he calls "arguments." She says she gets phone calls and goes to her parents' house where, she says, "... the main goal has always been to try to defuse my dad enough so that he wouldn't beat my mother up."
This week things took a turn for the worse and Angela has been through a severe crisis.
"Yesterday my dad called," she starts to cry, "and he said, 'Angie, now I've really done it. She asked for it, though. She pushed me to it.'"
"I could tell something was wrong, so I just hung up and called 911, and sure enough, when they got there, he had killed my mother. He killed my mom!" Angela sobs and shakes uncontrollably. "He kills her and then he calls me to tell me about it? I am not his friend or counselor. I am not the one he should call after something like that! I hate him! I want to kill him! I knew this was going to happen sooner or later. I knew it, didn't I?"
- Describe the first couple of steps in interventions for Angela at this point.
- What is the usual goal of crisis intervention, and how does that apply to Angela's case?