Running head: BENITA CASE SUMMARY 1

Benita Case Summary

Christopher J. Sims

Barry University
BENITA CASE SUMMARY 2

Benita Case Summary

Section 1

Benita as an individual. Benita St. Julian is a 12-year old female who has been referred

by her school counselor for behavioral problems. Benita was recently suspended from school for

setting a toilet seat on fire, but has been exhibiting varying disruptive behaviors in school since

she was in the third grade. Mental status examination and biopsychosociospiritual history

describe Benita as having experienced a life of tumult and adversity at varying times in her life.

Benita was born in Haiti to a young, uneducated, single mother named Rose. Benitas

father, Esmee, is an African-American male who met and impregnated Rose while visiting Haiti.

Esmee remained largely absent from Benitas life until the age of seven. It is presumed Rose

remained in Haiti throughout her pregnancy and after Benitas birth. Rose fell ill shortly after

Benitas birth, and was frequently sickly and debilitated. Rose suddenly died when Benita was

five years old. For a year after Roses death, Benita was passed between maternal relatives in

Haiti. At age six Benita was sent to live with a paternal relative in New York City. After a year

in New York City, Esmee reluctantly took custody of his daughter after being ordered by Child

Protective Services. Benita was sent to her father in South Florida at age seven, and became a

part of Esmees family, which includes his wife Alma, their son Alexander, and Almas son

Joseph. In the five years being with her biological father and his family, Benita has exhibited

various behaviors that her parents and educators feel are problematic. However, a detailed,

holistic, developmental examination of Benitas life describes Benitas demeanor and behaviors

as symptoms of a complex series of traumas experienced throughout her twelve years. From an

Eriksonian perspective Benita has experienced adversity through her developmental stages.

Benita is twelve years old chronologically, but closer inspection may articulate that she has
BENITA CASE SUMMARY 3

emotionally, cognitively, behaviorally, and socially developed into a younger person than other

same-age children. Some of Benitas developmental deficits emerged from infancy, and perhaps

even before she was born.

Infancy stage. This developmental stage from birth to approximately 12 months old

presents to the child the psychosocial challenge of trust versus mistrust (Kail & Cavanaugh,

2013), and to Erikson, the establishment of trust lies at the foundation of human development.

Children are completely vulnerable in utero and after being born, and after birth the childs

caregivers provide for the infants needs such as safety, care, and feeding, fostering trust in the

infant (Kail & Cavanaugh, 2013). If those needs arent consistently met, the infant learns

mistrust (Kail & Cavanaugh, 2013). Erikson posited that an unhealthy balance of mistrust and

trust can stifle the infants acquisition of hope, described as openness to experience balanced by

guardedness that uncomfortable or dangerous situations may arise (Kail & Cavanaugh, 2013).

Due to the conditions that her mother likely faced, Benita likely experienced malnutrition and

maternal stress in utero, and stress, neglect and malnutrition in infancy; these factors stifled her

acquisition of trust, and created developmental deficits. Her developmental deficits seem to

manifest more observably when Benita reached school age and pre-adolescence.

The case notes describe Rose as uneducated and selling produce for a living. Rose was

likely living at or near poverty, as approximately 67% of Haitians live in poverty (Edmond,

Randolph, & Richard, 2007). Rose did not receive prenatal care, and likely was not provided

prenatal vitamins. It is likely that, being uneducated and living in poverty, Rose did not have

access to adequate nutrition while pregnant with Benita, and was unable to provide sufficient

breast milk or food for Benita after she was born. Although Esmee believes Rose had a normal

pregnancy and delivery, little is known of Roses state of well-being prior to Benitas birth. It is
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presumed, based on limited information provided from the case, that Rose also experienced

anxiety either in the face of poverty and/or in anticipation of being a single mother with a child.

From a physical perspective, Lutter (Lutter & Lutter, 2012) describes the prenatal period and

first two years of life as a critical window in which adequate nutrition (including breastfeeding)

can improve infant health and trajectory health beyond infancy. As is described in the sections

below, Benitas gestation and first two years exposed her to nutritional factors, among others,

that profoundly and adversely affected her infant and childhood development.

Biological implications. Prado and Dewey (Prado & Dewey, 2014, p. 280), in studying

nutrition and brain development early in life, posits that a well-nourished child is better able to

interact with caregivers in a way that provides the experiences necessary for optimal

development. Benita was likely malnourished in utero and infancy. Neonatal malnutrition has

been known to cause dyslipidemia, which is linked to children being at greater risk of becoming

overweight or underweight (Fernandes, Cotta de Faria, Bellomo-Brandao, & Negrao Nogueira,

2011). Prado and Dewey (Prado & Dewey, 2014, p. 280) further commented on malnutrition,

enumerating that malnourished children are at risk for failing to reach their developmental

potential in cognitive, motor, and social abilities. Malnourishment and irregular provision of

food likely affected Benitas capacity to build trust in the infancy stage, and also predisposed her

to lipid abnormalities (dyslipidemia) (Fernandes et al., 2011) that could cause weight gain later

in life (discussed later).

Cognitive implications. Research indicates that fetuses or infants deficient in

micronutrients such as iodine or iron can be at risk for impaired neural development, and mental

and motor delays (Recame, 2013). It is unknown whether Benita was subjected to these specific

micronutrient deficiencies, but while being wet-nursed, deprived of food, or fed sugar water, she
BENITA CASE SUMMARY 5

was likely subjected to some other micronutrient deficiencies that may have adversely affected

her cognitive development in the infancy stage.

Social implications. Bowlby asserted that attachment is a critical infant developmental

process, and infants who form a secure attachment with a caregiver are more likely to survive

(Kail & Cavanaugh, 2013). According to Kail and Cavanaugh (Kail & Cavanaugh, 2013),

secure social attachments are built by parents responding to infants needs in an appropriate and

predicable manner. Based on the case notes, Benita was neither provided appropriate or

predictable caregiver responses from Rose, her primary caregiver. There is not enough

information presented in the case to estimate the exact type of insecure attachment (Kail &

Cavanaugh, 2013) Benita experienced, but she likely formed one of the three theorized types of

insecure attachments. Children who form insecure attachments are more likely to experience

difficulty in forming healthy social relationships later in life (Kail & Cavanaugh, 2013), and

Benitas social relationships will be discussed further in Benitas school age stage.

Emotional/social/cognitive implications. At 12-years old, Benita exhibits what could be

described as compulsive and addictive eating patterns, and numerous anxious behaviors. Gapp

and colleagues (Gapp, Von Ziegler, Tweedie-Cullen, & Mansuy, 2014) posit that epigenetic

processes can transmit traits from mother to offspring. Their assertions suggest that, in Benitas

case, it was epigenetically possible for Benita to have inherited anxious or addictive traits from

Rose before she was even born. Gapp and colleagues (Gapp et al., 2014) go on to state that

persistence and strength of inherited epigenetic changes depend on the childs developmental

stage and time of establishment. While Benita may have been genetically predisposed to some

of her behaviors before birth, the environment she experienced in infancy also likely exacerbated

her state of anxiety and desire for food in the face of undernourishment or malnourishment.
BENITA CASE SUMMARY 6

Neglect, often studied as psychosocial deprivation, also emotionally impacted Benita in her

infancy stage.

Benita was often left alone, whimpering and waiting, while Rose remained bedridden for

much of her daughters early life. This psychosocial deprivation occurred during the phase of

life where Benita needed consistent caregiving and security to build trust, and likely left her with

little of the hope that signifies progress in the infancy stage. This type of deprivation has also

been shown to later specifically affect childhood executive functions like inhibitory control and

response monitoring. Kumsta and colleagues (Kumsta et al., 2010), studying deprivation-

specific psychological patterns, discovered four patterns strongly associated with infant

deprivation: quasi-autism, disinhibited attachment, cognitive impairment, and

inattention/overactivity.

Resilience. From the perspective of infant resilience, Benita demonstrated at an innate

level the resilience to pass through her infant stage, even while unknowingly or unwilling facing

the hardships of infant neglect and undernourishment. Benita was able to survive her infant

hardships because of the positive balance achieved between her risk factors (neglect and

malnourishment) and her protective factors (maternal relatives) (Herrman et al., 2011).

Although the effects of neglect and malnourishment were likely still affecting Benita beyond

infancy, it is likely that with if she was exposed to a more healthful, regular diet, and provided

regular care by a parent figure, her deficits would be diminished.

Early childhood stage. Eriksons early childhood stage is characterized by the

psychosocial challenges of autonomy versus shame and doubt (Kail & Cavanaugh, 2013), and

typically occurs between the ages of one and three years old. This is typically the stage during

which children learn to walk, talk, potty train, and begin to autonomously control their own
BENITA CASE SUMMARY 7

actions (Kail & Cavanaugh, 2013). Shame and doubt emerge from failure and present as a

challenge to the childs first experiences with autonomy (Kail & Cavanaugh, 2013), and out of

this dynamic emerges the childhood stage virtue of will. Very little is mentioned in the case

notes about Benitas development during this stage, other than Benita did not speak until beyond

this stage (age four) and that no one knows when Benita was potty trained.

Biological implications. It is presumed that Benitas physical and motor development

occurred during the normal time in her early childhood, enabling her to walk around the age of

15 months old (Kail & Cavanaugh, 2013). This skill acquisition represents a stage

accomplishment that was tempered by inability to more thoroughly explore beyond the confines

of Roses home, as Benita spent most of her time at home with her mother. Although it is likely

that Benita developed the physical growth and skill necessary to control elimination, it is not

known when or if Benita learned to completely control the urge to eliminate her bladder or

bowels. Goodman (Goodman, 2013) believes that childhood elimination, especially under stress,

is related to insecure attachment factors that likely emerged during Benitas infant stage.

Cognitive implications. The cognitive and social deficits that emerged during Benitas

infancy stage may be related to her late acquisition of speech. The home and social environment

that Benita was raised in also likely contributed to a late speech acquisition.

Social implications. It was during this stage that Benitas mother was bedridden and ill.

Benita had little contact with anyone outside the home, unless it was a family member that came

to assist Rose. There is little research that links delayed speech and language development to

any specific factor. However, based on descriptions in the case notes it is unlikely that Benita

received the type of adequate interpersonal stimulation necessary to facilitate language, speech,

and social development during this stage.

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Emotional implications. It is presumed that during this stage Benita would start using

and recognizing others emotions, and regulating her own emotions. However, due to the

psychosocial deprivation that Benita experienced during infancy and its persistent effects, she

likely experienced abnormal development in this stage, as the deficits she acquired in infancy

likely followed her into early childhood and later stages.

Resilience. From the perspective of early childhood resilience, Benitas protective

factors (neglect, malnourishment) (Herrman et al., 2011) continued to play a supportive role in

ensuring her survival amidst her risk factors.

Play age stage. This stage is characterized by the psychosocial challenges of initiative

versus guilt, and occurs at approximately three to six years of age, with successful completion

facilitated by the stage virtue of purpose (Kail & Cavanaugh, 2013). It is in this stage that

children play with purpose, understand adult roles, explore their environment on their own, and

balance initiative with the guilt derived from being in occasional conflict with others initiatives

(Kail & Cavanaugh, 2013). Rose died while Benita was nearing the end of this stage, and Benita

was alone in the house with Rose for three days before discovery. Benita began to speak at age

four (discussed in the early childhood stage), and was still likely spending most of her days

inside her mothers house with little outside contact, excepting family members who came to

assist Rose. Roses sudden death, relocation from the home of her primary caregiver, and

relocation to New York City likely were tremendously traumatic experiences for five-year-old

Benita, and the complexity of Benitas trauma from those events and those of her infancy

(neglect, malnutrition) are likely the most adversely profound factors that influenced Benitas

childhood. Benitas eventual relocation from Haiti to New York, as well as getting hit by a truck

at age six, likely affected her ability to process and grow from her cumulative trauma. There is
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much research on the complex, complicated, and traumatic grief patterns that children like

Benita have experienced. Ford and colleagues (Ford, Wasser, & Connor, 2011, p. 216) also use

the term polyvictims to also describe children like Benita who have been exposed to multiple

forms of maltreatment.

Biological implications. Benita likely exhibited normal physical growth and maturation,

as evidenced by the case notes. However, there were likely biological or neurobiological

disturbances that remained unnoticed by either Rose or Benitas caretakers after Roses death.

Brosbe and colleagues assert that children who have experienced complex trauma have exhibit

impaired ability to experience, regulate, and express emotions, causing the child to selectively

attend to potentially threatening stimuli in the childs environment (Brosbe, Faust, & Gold,

2013, p. 99). Cook and colleagues (Cook et al., 2005) also describe a few of the biological

impairments that victims of complex trauma have experienced: analgesia, increased medical

problems across a wide span, sensorimotor problems, problems with coordination, balance, and

body tone, and somatization. Benitas case notes describe potential analgesia and medical

problems as evidenced by Benitas nail biting and her pelvic pain.

Cognitive implications. Cook and colleagues (Cook et al., 2005) describe the following

cognitive disruptions that manifest in victims of complex trauma: difficulties in attention

regulation and executive functioning, lack of sustained curiosity, problems processing novel

information, focusing problems, object constancy problems, difficulty planning and anticipating,

difficulty understanding responsibility, language development problems, dissociation, and

disorientation of time and space. Benita is later described as having problems with executive

functioning, difficulty understanding responsibility, late language development, disorientation,

and possible dissociation.

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Social and emotional implications. It was during this stage that Benita demonstrated

delayed speech acquisition, a previously stated factor present in many victims of complex trauma

(Cook et al., 2005). Cook and colleagues (2005) also highlight other behavioral/social factors

that describe Benita and other children who have experienced similarly complex trauma patterns:

lack of impulse control, self-destructive behavior, pathological self-soothing behaviors, sleep

disturbances, eating disorders, oppositional behaviors, affect dysregulation, and diminished self-

concept. As previously discussed, in this stage Benita likely was still affected by social

attachment issues stemming from her infant psychosocial deprivation. At this stage in her life,

Benita was still residing in Haiti, and being shuttled back and forth between maternal relatives;

this was likely not a stable social or emotional environment from which Benita could healthfully

process the grief arising from her mothers sudden death.

Resilience. From the perspective of play age resilience, Benitas risk factors (death,

physical trauma, relocation, malnutrition) were in a fluctuating equilibrium with her protective

factors (maternal relatives, biological resilience) (Herrman et al., 2011).

School age stage. This stage is characterized by the psychosocial challenges of industry

versus inferiority, occurs typically between ages six and twelve years old, and stage completion

is facilitated by the ability to learn new tasks and work with others (Kail & Cavanaugh, 2013). It

was in this stage that Benita moved from New York and into the St. Julian family, and began

experiencing new adversity, all in the aftermath of multiple traumas before the age of seven.

According to the case notes, Benita has visibly struggled throughout this stage of her

development. She exhibited nervous and anxious behaviors, social isolation, disruptive and

impulsive behaviors like fire-setting, aggressive behavior towards her classmates, temper

tantrums, fighting with her half-brother Alexander, and estrangement from her stepbrother
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Joseph, frustration with her father and stepmother, and expulsion from school. Many of Benitas

cognitive, emotional, social, or biological tendencies and resultant problem states were likely

realities for her due to the previously described developmental impairments and deficits that

researchers believe arise within children who have experienced complex trauma (Cook et al.,

2005).

Biological implications. During this stage, Benita exhibits rapid weight gain, due in part

perhaps to a previously discussed latent genetic predisposition for obesity. Benita may also be

adversely affected by Almas eating and nutritional habits. Benita described sleep issues during

this stage, potentially influenced by her lack of domestic stability, interpersonal problems at

school, and family problems at home. Benita has to deal with the bleeding associated with her

constant nail-biting, along with pelvic pain from an unknown origin.

Cognitive implications. A number of the cognitive deficits described in Benitas play

stage began to manifest themselves during this stage, perhaps prompting an unsuspecting Alma

to describe Benita as autistic and schizophrenic, while Benitas exasperated teachers describe

her demeanors as acting as though she was in another world. Benita demonstrates the

diminished executive function, memory deficits and possible cognitive dissociations indicative

of a child affected by complex trauma (Cook et al., 2005).

Social and emotional implications. Although initially appearing to adjust to her new

environment in Florida, Benita seems to have struggled during this stage to healthfully

participate in familial and social relations with family and classmates. From an Eriksonian

perspective, Benita is struggling to achieve social and educational competence, while trying to

overcome feelings of inferiority (Kail & Cavanaugh, 2013). Her social systems appear to be

either wholly unaware of the nature of Benitas complex trauma patterns, functioning as
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unsupportive or unsuspecting detractors from her well-being; Alma berates Benita; Benitas

classmates antagonize her; she fights with Alexander.

Resilience. From the perspective of school age resilience, Benita has access to more

potential resiliency or risk factors, such as Esmee, Alma, Benitas teachers, and her mental health

counselors (Herrman et al., 2011). Resilience during Benitas school age years may be greatly

influenced by whether or not Benita, her family, educators, and counselors all work individually

and collaboratively to promote Benitas well-being.

Section 2

As was posited before, Benita is chronologically twelve years old, but developmentally

quite younger than other same-age children. From an Eriksonian perspective, Benita is at the

beginning of the adolescent stage of development, but still struggles with impairments that first

manifest after traumas experienced during her infancy, early childhood, and play ages. With her

current family support network and developmental impairments, Benita likely will face difficulty

progressing through adolescence.

Biological challenges. Biologically, Benita is likely at or near menarche, and will

experience pubertal changes in her body. She may have to learn how to deal with her changing

female body, fertility, and other physical and hormonal changes associated with female puberty.

Benita will also likely have to deal with the physical and psychological effects of her weight

(Cook & Kavey, 2011), which may continue to draw scrutiny and attention from her peers and

family.

Cognitive challenges. Benita will likely struggle with the familiar cognitive deficits that

began in her infancy. In her current cognitive state, with her family situation remaining

unchanged, Benita will likely face great difficulty in cultivating or reshaping faulty or distorted
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cognitions. Ideally, Benitas family and educational system will learn more about the nature of

her traumas and the effect the traumas have had on her growth and development. As is stated in

the intervention section of this paper, Benita may greatly benefit from any of the evidence-based

cognitive behavioral interventions that have helped victims of complex grief or complex trauma

(Kerig, Sink, Cuellar, Vanderzee, & Elfstrom, 2010).

Social and emotional challenges. Benita must learn how to better control her

aggressive, anxious, impulsive, and expulsive tendencies in the face of unsupportive or

unsuspecting people. In her current family and emotional state, Benita may continue through

adolescence struggling to learn how to interact with people, express her feelings, and feel better

about herself in a personal and societal context. Benita, impaired in cognition and emotion

regulation, may struggle to interact with boys or girls who express a social or sexual interest in

her emerging young womanhood. If Benita is better able to regulate her emotions, articulate her

thoughts, and make better decisions, she may be able to enhance the effect of the intervention

strategies recommended for complex traumatized adolescents.

Career development challenges. Although she is not at an age or developmental level to

work, Benita may benefit from some exposure to career development ideas and concepts. Benita

may benefit from experiencing a career day at school, or a visit to her fathers work. According

to the case, she enjoys math and science; Benita may benefit from participating in a science or

math camp, workshop, or club. As Benita prepares for high school, she may later benefit from

meetings with school representatives from local magnet school, who may be able to help Benita

find an area of academic or professional interest towards which she could direct her intellectual

efforts.

Section 3
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The St. Julian family is a culturally mixed household; Alma is an African-American

woman and Esmee is a Haitian man. The case describes Alma as having different values than

Esmee that are reflective of her African-American upbringing. This differs from Esmee, whom

Alma describes as not really caring much about worldly affairs or African-American culture.

Alma and Esmee likely utilize parenting styles that are reflective of their differing cultures.

African-American parenting roles. According to the case, Benitas stepmother Alma

plays a prominent role in Benitas life. After initially opposing the idea of Benita joining the St.

Julian household, Alma decided to bring her into the St. Julian household as essentially a

domestic aid and babysitter for her half-brother Alexander. Almas motherly interaction with

Benita is a reflection of her African-American culture and values, and an authoritative (Kail &

Cavanaugh, 2013) parenting style. Alma values cleanliness, education, and African American

culture. Almas authoritative (Kail & Cavanaugh, 2013) parenting style is exemplified by her

stern, cold demeanor towards Benita. According to the case, Alma describes Benita as

schizophrenic and autistic, believes she has lost her sense of reality, blames Benita for doing

things that she has not done, berates Benita about various things, and (according to Benita)

stepped on her while putting on her shoes. These parenting behaviors are supportive of the (Kail

& Cavanaugh, 2013) style.

Haitian parenting roles. When Rose became ill, and even after her death, Benita was

taken care of by various maternal relatives. This utilization of the extended female family

support in times of distress or hardship is indicative of the types of the lakou (Edmond et al.,

2007) system of support that extended family members provide children who are in need of care

and feeding. This system is thought to mitigate parental stresses, especially in impoverished,

rural areas of Haiti (approximately 67% of Haiti lives below the poverty line) (Edmond et al.,
BENITA CASE SUMMARY 15

2007). The lakou system also serves to diminish or downplay paternal inadequacies, in efforts to

protect the pride of the fathers of the struggling household (Edmond et al., 2007).

Esmee, according to the case, has limited contact with his kids, in part due to his work

schedule, but also because has a proclivity for playing dominoes and hanging out with his friends

at a neighborhood bar. Esmees fatherly interaction with his children may best reflect the role

that men play in the Haitian lakou system (Edmond et al., 2007), the female-dominated system of

family support. After Benitas birth, this supportive female behavior seems to have been

exhibited by Roses family in Haiti and eventually Esmees aunt in New York. In contrast to the

Haitian lakou system of extended child support and caregiving, Esmee and Alma raise their kids,

including Benita, in relative isolation from any peripheral family or auxiliary support units.

Esmee uses a primarily uninvolved parenting style; uninvolved parents generally lack

warmness and exhibit a low level of parental control (Kail & Cavanaugh, 2013). As described in

the case, Esmee seems uninvolved in matters of global, local, or familial culture or climate, and

his primary concern is in being the monetary provider for the household. The case notes

describe Esmee as caring most about his kids accomplishing their chores and how they are doing

in school. However, Esmees caring about his kids performance in school appears limited.

Esmee seems unresponsive to the school administrations requests for meetings related to

Benitas behavior.

Impact on Benita. Since becoming a part of the St. Julian household, Benitas

relationship with her father and stepmother is an amalgamation of culturally mixed parenting

(Haitian-American biological father and African-American stepmother) a young girl who arrived

into their household having already experienced a series of traumatic events. Esmee, Alma, and

Benita fit into the greater family unit that also includes Joseph and Alexander, each of which
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impact family dynamics. As parents, Esmee and Alma do not appear to be understanding of the

complicated nature of the traumas that Benita had experienced prior to her arrival into the

household. In order for Benita and her family to experience a greater degree of wellness, the

entire family and Benitas educators will have to take part in therapeutic or educational change

processes designed to help Benitas entire ecosystem.

Section 4

Classroom development. Because of her disruptive behavior, Benitas school has

barred her from attending regular school pending individual and family evaluation. Upon

reinstatement into her regular school or another school, Benitas educators should better

understand her from the scope of her traumas, and support therapeutic techniques that Benita

may acquire outside of the classroom environment. Cohen (Cohen & Mannarino, 2011)

recommends that educators contribute to traumatized childrens education by the following:

recognize symptoms in school settings; refer children for mental health evaluations when

appropriate; recognize traumatic triggers and manage triggered responses; support the students

learned stress-management techniques; respect confidentiality; respect cultural issues; and

maintain good communication with parents and other helping professionals. Educators,

guidance counselors, and school administrators should become as thoroughly aware of Benitas

condition without compromising her or her familys confidentiality, and supportive of evidence-

based therapies like Trauma-Focused Cognitive Behavioral Therapy (Cohen & Mannarino,

2011) that may be employed to promote Benitas wellness.

Therapeutic interventions Benita. Benita has experienced multiple traumas in her

lifetime: malnutrition, neglect, the death of a parent, bone fractures, torn ligaments, domestic

relocations, and personal and interpersonal discord among other realized or suspected traumas.
BENITA CASE SUMMARY 17

The nature of Benitas case warrants a broad, systematic, multi-modal approach to facilitating

positive change for Benita and her family. Common treatment for victims of such complex

trauma occurrences involve the parents, treatment tailored to the childs developmental stage,

and developing a narrative of the trauma to provide meaning to the child and place it into a

broader perspective (Lieberman & Knorr, 2007). Cook and colleagues (2005) articulated a

system of interventions for children and adolescents who experienced complex, multiple

traumas. The interventions form six core components and include: safety, self-regulation, self-

reflective information processing, traumatic experience integration, relational management, and

positive affect enhancement (Cook et al., 2005).

Safety. This goal of this stage is to provide internal and environmental safety for the

client (Cook et al., 2005). Benita needs to experience enhanced physical and emotional safety.

For the St. Julian family, this could include working with the school to prevent the bullying shes

experienced and ensuring that Benita is not antagonized or berated by Alma, Esmee, Joseph, or

Alexander.

Self-regulation. Self-regulation entails enhancing capacity for arousal control and

emotional regulation (Cook et al., 2005). Benita has demonstrated difficulty maintain her

arousal and emotional dysregulation, as evidenced by her loss of bladder and bowel control, nail

biting, temper tantrums, lighting fires, acting out towards others, and erratic behavior. The goal

of this phase is for Benita to better control her impulses and regulate her emotions.

Self-reflective information processing. Key features of this component include

enhancing executive functioning and attentional processes (Cook et al., 2005). Executive

functioning and attentional process refer to cognitive domains like visual attention and memory,

and planning/working memory (Bos, Zeanah, & Nelson III, 2009) Benita has demonstrated some
BENITA CASE SUMMARY 18

deficiencies in these domains, as evidenced by her not remembering things she did, not being

able to explain what bothered her meant, and being unable to remember why she set fire in her

living room during her first year with her new family. During this phase, Benita may work on

enhancing positive inner dialogue, self-talk practices, her ability to find connections between

past, present, or future events, and better understand the concept of choice and consequence, and

why she makes or made certain decisions or exhibits certain behaviors.

Traumatic experiences integration. The most important aspects of this component

center on the resolution, incorporation, or transformation of traumatic memories or triggers

(Cook et al., 2005). Benita experienced a number of traumas at a young age. It is unknown to

what degree Benita remembers or has stored her bevy of traumas, a lot of which occurred before

she was six years old. A therapeutic goal for Benita during this therapeutic component may be to

increase coping skills (Cook et al., 2005).

Relational engagement. Relational engagement refers to the creation, repair, or

restoration of working attachment models (Cook et al., 2005). As evidenced by problematic

relationships with her educators, parents, and siblings, Benita can benefit from increasing her

ability to relate to others in a more healthful fashion. This may include increasing interpersonal

skills such as cooperation, boundaries, limit-setting, social empathy, ability to see perspectives,

and building emotional and physical intimacy (Cook et al., 2005).

Positive affect enhancement. The last of the six recommended components of complex

trauma intervention includes enhancing positive affect (Cook et al., 2005). According to the

case, Benita often feels nervous, upset, ridiculed, berated, and angry. Benitas self-worth and

esteem would be enhanced in this phase (Cook et al., 2005), enabling Benita to feel better about

herself.
BENITA CASE SUMMARY 19

Holistic interventions Benita. Eating healthy food and participation in regular physical

activity has been shown to increase well-being, reduce risk of chronic disease, and maintain

healthy body weight (Clark, Lucett, & Corn, 2008). Since arriving to Florida, Benita has

struggled with her eating behaviors and weight. She lives in a home environment where her

stepmother Alma is riddled with illness and struggles with obesity. Benita expressed an interest

in swimming and bike riding; she may benefit from participation in swim lessons, or going for

neighborhood bike rides with Alexander. In addition to the previously described therapeutic

interventions, Benita may also benefit greatly from participation in supervised nutritional

planning and a supervised exercise program.

Therapeutic interventions Esmee and Alma. Esmee and Alma may benefit from

couples therapy for their own interpersonal needs, but also therapy as it relates to better

understanding Benitas problems. Based on how Esmee and Alma relate to Benita, it appears

that neither parent understands the depth, scope, and complexity of Benitas problems, even

though they regularly deal with behavioral disturbances related to her problems. Lieberman and

Knorr (Lieberman & Knorr, 2007) posit that it is essential to enhance the empathic response

within parents of traumatized children. Further, Lieberman and Knorr (Lieberman & Knorr,

2007) posit that helping parents understand their childs symptoms from a trauma perspective

will lower the likelihood of the parents berating the traumatized child or making negative

attributions about the childs behavior. The more that Esmee and Alma understand Benita from

the perspective of trauma, the more they may treat her less like a perpetrator or adversary, and

more like a survivor of multiple traumas.

Therapeutic interventions St. Julian Family. The entire St. Julian family, like Esmee

and Alma, may benefit from better understanding the impact of Benitas trauma on family
BENITA CASE SUMMARY 20

dynamics. A number of evidence-based family therapy modalities exist for families dealing with

a traumatized child. Kerig and Alexander (Kerig & Alexander, 2012) advocates for evidence-

based family therapies like Functional Family Therapy for families dealing with a traumatized

youth family member. Kerig and Alexander also advocate for the evidence-based Trauma-

Focused Cognitive Behavioral Therapy (Kerig & Alexander, 2012), which is a particularly

effective treatment modality for families of varying ethnic or cultural backgrounds. The St.

Julian family may consider one of the aforementioned family therapy modalities to enhance their

family wellness.

Section 5

There are ethical concerns specifically related to working with Benita and her family.

The primary ethical concern is promoting Benitas welfare (American Counseling Association,

2014). Benita has experienced a number of traumatic events in her life, and her counselor should

always treat Benita with dignity and respect (American Counseling Association, 2014). The

informed consent process is an ethical concern for Benita and her counselor because of her age.

Since Benita is a minor, she is unable to give voluntary consent to counseling services; instead,

Benita must assent to counseling services (American Counseling Association, 2014). Benitas

counselor must, during the initial informed consent process and throughout the counseling

relationship, explain the roles and responsibilities of client and counselor (American Counseling

Association, 2014). From the case description, it does not appear that Benita was legally

mandated to receive counseling. However, Benitas readmission to school is contingent upon

receiving a counseling evaluation and recommendations. Because of the schools stance against

Benitas behavior, part of her counselors informed consent process is explaining the potential
BENITA CASE SUMMARY 21

consequences of refusing counseling services (American Counseling Association, 2014). There

are also ethical concerns regarding the multicultural nature of Benitas case.

It is ethically imperative that Benitas counselor act to avoid harming Benita in any

manner during the counseling relationship (citation). Benitas counselor also must recognize and

respect the multicultural aspects of the case, and not impose belief systems or values (American

Counseling Association, 2014) that are different from or contrary to the beliefs or values of

Benita or her family. Protection of confidentiality is also an ethical concern for Benitas

counselor.

Benitas counselor must respect her right to privacy and protect her confidential

information and disclosures (American Counseling Association, 2014). Due to her age, there are

specific exceptions to Benitas right to confidentiality. Benita does not have unlimited right to

confidentiality; her counselor may be required to break confidentiality to protect Benita from

being harmed or harming others (American Counseling Association, 2014). Her counselor may

also have to refer to applicable federal or state laws, written policies, or other codes of ethics

pertaining to releasing Benitas confidential information (American Counseling Association,

2014). Benitas counselor must also be prepared for the ethical concerns that may arise if Benita

participates in a counseling group or family counseling.

It is imperative that Benitas counselor prepare her for a possible group or family

intervention, and explain to her and applicable family members the nature of the group

counseling process and individually working with members of the same family (American

Counseling Association, 2014)

BENITA CASE SUMMARY 22

Barry University
Adrian Dominican School of Education
Counseling Department

Course Title and Number:

Title of Assignment: Benita Paper

Instructor: Dr Roseman

Student: Christopher J. Sims

Certification of Authorship

I certify that I am the author of this paper and any assistance I received in its preparation is fully
acknowledged and disclosed in the paper. In addition, any sources from which I used ideas or
words, either quoted directly or paraphrased, have been cited in the paper. I also certify that this
paper was prepared by me specifically for use in this course and was not used in another course
and will not be used in any future courses I take at Barry University.

Christopher J. Sims 14 July 2014

_________________________________ _______________
Signature Date
BENITA CASE SUMMARY 23

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