Counselling Psychotherapeutic Intervention For Aggressive Behaviour In Offenders: A Case Study Essay.

Review the effectiveness (e.g., conducted in the real world/clinical settings) and efficacy (e.g., RCT studies) of one therapeutic intervention that targets the aggressive behaviour of perpetrators of physical violence within families. In your review you will also need to describe: the intervention;what it aims to achieve; and any limitations it may have. Make sure that you follow the marking criteria when reviewing the effectiveness of the intervention and include a description of the intervention (such as number of sessions and what is included in those sessions).Some suggested search terms: Violence, aggressive behaviour, anger management, child abuse, physical abuse, domestic violence, randomised controlled trials, treatment outcomes, and antisocial personality disorder. 

When it comes to abuse and assault, children and women are the most victimised ones in the families Frazier and Vela (2). In most cases both the male and female perpetrators abuse their children and physical violence is the ultimate result of their aggressive personalities. According to Franzini, Broggi, Cordella, Dones and Messina (1) family violence prevention has been one of the major health priorities in recent times and is being prioritised globally.  Domestic violence is the abuse by one person on the other in a domestic setting like marriage, family and co-habitation Franzini, Broggi, Cordella, Dones and Messina (1). Scientific evidence suggests that symptoms like anxiety, depression, chronic pain, substance abuse and post- traumatic stress disorder are all linked to family violence and efficacy and effectiveness play major roles in its intervention. Efficacy is the quality of being effective, here it is the ability of the intervention to produce the intended results. Effectiveness is a measure of the degree to which the targeted problems are solved Frazier and Vela (2).

In this paper the counselling psychotherapeutic treatment for aggressive intervention and its effectiveness is considered for the offender. Here necessary intervention of the male perpetrator for child-maltreatment is discussed. In this type of intervention, it is assumed that family violence is a result of personal dysfunction and target groups are independent of age and includes both men, women and children. Frazier and Vela (2) opined that psychotherapeutic treatments intervention are mainly derived from disciplines of psychiatry and human psychology. The randomised control trial (RCT) is used to test both efficacy and effectiveness of clinical interventions but here effectiveness of a real-world clinical setting is emphasised and cause-effect relationship is evaluated in consideration of the case. In RCT people in the trial process are randomly allocated to groups of either treatment under investigation or standard treatment groups. The psychotherapeutic intervention of counselling aims at treating the mental and emotional state of the offender. According to Hillis, Mercy and Saul (3) the counselling programs are ‘person-centred’ focusing on individual interaction between the perpetrator and the specialised trained psychologist. The ultimate goal is to rectify the aggressive behavioural approach of the offender in a slow and steady manner. 

The intervention is based on a real-world example in clinical setting where effectiveness of the intervention is focused upon. Mr. Jane is a financial consultant in ABS consultancy. He has been married for almost 7 years and has 5 years son. In recent times his wife has seen his behavioural changes and is surprised to notice that his aggression has increased tremendously. He rebukes his son for petty reasons and even bit him up. In extreme cases he throws objects on his son as well and has caused him several physical injuries. He is also an alcoholic. When his wife and mother try to stop him, he thrashes them as well. In these circumstances, the family physician recommended him to go for a counselling session and have psychotherapeutic interventions. Ideally, for preliminary mental issues, first, medications are prescribed by the psychotherapist and then the talk therapy or the positive activity intervention is provided afterwards. But when the medications have no long-term effect then counselling sessions is recommended. In this case a 4-week cognitive behavioural counselling therapy is recommended for Mr. Jane. The four phases of RCT namely enrolment, intervention allocation, follow-up and data analysis are used in the clinical trial process. Also, a contract agreement is being signed before the therapy session. 

Psychotherapeutic Treatment for Aggressive Intervention

In the first session of the cognitive behavioural counselling therapy, Mr. Jane was interacted with a general conversation. In recent times he is under tremendous work pressure and is suffering from depression. He is also been socially isolated. The unresolved and unconscious conflicts from within is causing him some unwanted behavioural changes and when he cannot control his stress and anxiety, he became aggressive. The psychotherapist also interacted with his family members and friends to know about his current behavioural patterns. Deeper research on the case provided the facts that he had childhood problem of stress management. The stress conditions remained suppressed for long because his work life was good and balanced. But after joining ABS Consultancy he again faced the stress burden and his behavioural changes were predominant. His childhood trauma is reflected back and his son has become the victim of his aggressive personality.

The process of de-escalating aggressive behaviour is focused upon in the next session. Four incident simulation elements for violence are arranged that includes the target (the client), a weapon (an object), a trigger (initiating stimuli) and an arousal state (the emotional and psychological state that precede violence). The escalation and de-escalation of the violent incident followed is tracked down by the physiotherapist and it is found that the track follows a bell-shaped curve where aggression increases from the baseline to peak state and then again descends to the state of lower aggressive arousal. Kraemer (4) opined that both verbal and non-verbal mode of communication should be encouraged at every stage of the arousal sequence. The arousal sequence is shown below.

Based on the result interview debriefing is to be suggested. Butchart, Mikton, Dahlberg and Krug (5) mentioned that the debriefing should include antecedents, behaviour, consequences, design and re-entry stages. The table below shows the characteristics of each stage.

In the next session both REBT (Rational emotive behaviour therapy) and DBT (Dialectical behaviour therapy) were provided to the patient to measure effectiveness of the intervention. The two therapies focus on the way emotions affect one’s thinking and actions. According to Rosell and Siever (6) the CBTs makes the client understand how the intensity of negative thinking and aggressive emotions can change the quality of thought process and how it results in overreaction and perspective loss. Actually, CBT evolves from REBT. Emotional balance maintenance is considered and a more realistic thought process is imbibed in the patient. DBT emphasis on moral boosting up of the patient and assures him that his behavioural outcomes are understandable. It also encourages the individual in understanding his own responsibility of changing those unhealthy and unwanted behaviour.

In the next session some activity participation is encouraged and the behaviour of the patient is noticed. The activities can be either recreational or pleasurable ones. Positive outcomes are noticed and the patient is appreciated for his positive reaction to the situations. He is suggested to stop alcoholism. It is true that withdrawal symptoms may lead to increased depression so he is advised to have healthy habits of drinking healthy beverages instead of alcohol. Though changing the moral behaviour of an adult person is very difficult but at times the results do favour positive outcomes.

The last session focuses on positive support and moral encouragement to uplift the moral behaviour of the Mr. Jane. His family and friends were advised to support him both emotionally and mentally. And in case, he is also advised to look for a job change. Along with it some additional medications for anxiety and depression are provided as well.

According to Smeets, Leeijen, van der Molen, Scheepers, Buitelaar and Rommelse (7) illness like depression and aggressive behaviour is not a quick fix but if the patient actively participates in the process then the effects are quick and long lasting than mere antidepressant drugs’ effects. In many cases positive results are noticed in the client and mental balance is regained. Compared to medications, it is safe to have counselling sessions that will help the patient to be back to normal life. According to Zarling, Lawrence and Marchman (8) there are a number of techniques where the patient is provided stress free environment once and again stressed environment to study the degree of aggressiveness and calmness as per stress and stress-free situations. A lot of unknown areas are discovered during the intervention sessions which may provide new dimensions for future treatment. Thus, therapeutic interventions like counselling is very effective for persons having psychological issues like stress, depression and aggressive personalities.

Therapies varies as per requirement and includes psychoanalysis, humanistic therapy and behavioural therapy. Other forms of psychotherapeutic intervention remained out of discussion as the psychologists are reluctant to categorise clients differently and assume that preceptor programs are based on the criminal justice contextual system. This is a major drawback of the intervention. Also, the research is carried out in a standard group clinical setting so the practical accuracy is somewhat affected. 

References

1. Franzini A, Broggi G, Cordella R, Dones I, Messina G. Deep-Brain Stimulation for Aggressive and Disruptive Behavior. World Neurosurgery. 2013;80(3-4):S29.e11-S29.e14.
2. Frazier S, Vela J. Dialectical behavior therapy for the treatment of anger and aggressive behavior: A review. Aggression and Violent Behavior. 2014;19(2):156-163.
3. Hillis S, Mercy J, Saul J. The enduring impact of violence against children. Psychology, Health & Medicine. 2016;22(4):393-405.
4. Kraemer H. Pitfalls of Multisite Randomized Clinical Trials of Efficacy and Effectiveness. Schizophrenia Bulletin. 2000;26(3):533-541.
5. Butchart A, Mikton C, Dahlberg L, Krug E. Global status report on violence prevention 2014. Injury Prevention. 2015;21(3):213-213.
6. Rosell D, Siever L. The neurobiology of aggression and violence. CNS Spectrums. 2015;20(03):254-279.
7. Smeets K, Leeijen A, van der Molen M, Scheepers F, Buitelaar J, Rommelse N. Treatment moderators of cognitive behavior therapy to reduce aggressive behavior: a meta-analysis. European Child & Adolescent Psychiatry. 2014;24(3):255-264.
8. Zarling A, Lawrence E, Marchman J. A randomized controlled trial of acceptance and commitment therapy for aggressive behavior. Journal of Consulting and Clinical Psychology. 2015;83(1):199-21