A Case Study Unit Three: Counseling Specializations and Multidisciplinary Teams
COUN5004
Survey of Research in Human Development for Professional Counselors

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“When the truth is fully recognized, survivors can begin their recovery. But far too often, secrecy prevails and the story of the traumatic event surfaces not as a verbal narrative but as a symptom (Herman, 1997).”
The history of trauma theory was first introduced by Sigmund Freud. Through his psychoanalytic theory and practice, Freud discovered what he described as a state of disillusion in women suffering from hysteria. After WII, psychiatrists noted the severity of psychological illness of soldiers who had been in combat; and would then theorize that some individuals were predisposed to trauma while others were resilient and could cope with the stress war related events. Throughout the 21st century more and more psychologists have found evidence to support that exposure to a traumatic event or several traumatic events causes profound changes in an individual’s psychological state and has today become an area of concentration and specialization.
According to Herman, traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition and memory. Moreover, traumatic events may sever these normally integrated functions from one another. A victim of trauma may cope with overloaded internal balancing mechanisms by displaying one or more of the three main elements of post-traumatic stress disorder; hyper-arousal, intrusion or constriction. In a state of hyper arousal, the system of self-preservation goes into permanent alert as if the danger could return at any moment. A person who has experienced traumatic events may display high levels of anxiety, due the constant arousal of the autonomic nervous system. Attempts to avoid reliving the trauma too often result in a narrowing of consciousness or withdrawal from engagement with others and an impoverished life.
Paul is experiencing the symptoms associated with psychological trauma. As described above, his anxiety could be described as a state of hyper- arousal while his absence from work illustrates constriction. In an attempt to crease some sense of safety, traumatized people restrict their lives. In avoiding any situation reminiscent of the past trauma or any initiative that might involve future planning and risk, traumatized people deprive themselves of those new opportunities for successful coping that might mitigate the effect of the traumatic experience.
Paul is using substance abuse as a way to dissociate and cope with the traumatic events he experienced. In trauma theory this is described as constricting or numbing. Because Paul was helpless during these traumatic events he is in a state of surrender where his self-esteem has been damaged. The helpless person escapes not by action, but by altering state of consciousness. Events continue to register in awareness but it’s as though these events have been disconnected from their ordinary meaning. Those who cannot dissociate may turn to drugs or alcohol for their numbing effects. Adaptive during the trauma, numbing becomes maladaptive once the danger is past (Herman, 2007). Counseling specialization in collaboration
Because Paul is drinking frequently he would benefit by seeing a counselor who is specialized in addiction or substance abuse. The prevalence of substance abuse is alarming and becoming an interest of treatment in a variety of settings. Addiction specialists help individuals transition from denial to acceptance. Once an individual accepts that they have an addictive behavior the counselor can then work with the individual to extinguish the behavior and treat the underlying causes. In the last twenty-five years funding for the treatment of those with addictive disorders and substance abuse has increased and this area of specialization has developed to meet the increasing needs of those struggling with addiction (Bailey, 1995).

Collaboration
The addiction counselor will help Paul identify and accept that his substance abuse is a maladaptive coping mechanism. After completing an initial intake, the substance abuse counselor will consider the factors that contribute to Paul’s alcoholism and encourage him to find healthier alternatives to control his anxiety. The trauma specialist can collaborate with the addiction counselor to help Paul and his wife find additional support groups, community resources, and if given consent, work together to develop a comprehensive treatment plan.
Communication between professionals
To ensure collaboration and communication between members of Paul’s professional support staff it would be important to have Paul’s consent to collaborate with other professionals. The professionals could help him develop an action plan to modify his behavior. They can also help Paul identify any changes that could trigger his maladaptive behaviors. The counseling team could help Paul with his employment issues by contacting an employee assistance program, or by writing a request for a leave of absence. There are many ways that professionals can collaborate to ensure the goals and needs of the client are met.

References
Bailey, P. (1995). Addictions Counseling Certification: An Emerging Counseling Specialty . Journal of Counseling & Development,volume 74, issue 2, pages 167–171.
Herman, J. (1997). Trauma and Recovery. New York: Perseus Book Group.