Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder

Presenting problem

oWhat is the client’s problem list?

oAre there any diagnoses?

Mr. Sage has previously been diagnosed as suffering from Anxiety Disorder, Conduct Disorder and “Unspecified” mental health disorder. A variety of antipsychotic medications has been used in the past for behaviour control, though Mr Sage reports he is currently not receiving any medication.

It is also notable that when Mr. Sage experiences anxiety he becomes disorganized and hard to understand. Mr. Sage has great difficulty with conflict, frustration and anger. He has also threatened to hurt himself or others.

DIAGNOSIS – rule out pyromania, rule out bipolar disorder; personality disorder

Predisposing factors provide

one reference for each factor

oOver the person’s lifetime, what factors contributed to the development of the problem?

Biological factors

van, WK 2004, Human Behavior and the Social Environment : Micro Level – Individuals and Families, Oxford University Press, Incorporated, Available from: ProQuest Ebook Central. [14 October 2019].

Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder

Psychological factors

Attachment dysregulation in infancy behaviours, it is theorized that the effect of poor-quality early care on long-term outcomes would be mediated by attachment disorganization. However, research to date has not supported this theory. The literature shows instead that infant disorganization and quality of early care each contribute independently to long term psychological adaptation, and that quality of early care has a more powerful influence overall on negative outcomes than infant attachment disorganization. For example, results from a longitudinal study by the US National Institute of Child Health and Human Development Early Child Care Research Network [46] indicates that quality of caregiver interaction provides greater prediction of later child adjustment than infant attachment behavior itself.

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In several recent longitudinal studies, quality of early care and maltreatment experiences were assessed prospectively (as well as by young adult selfreport) so that the contribution of quality of early care in infancy on later psychiatric morbidity could be examined separately from experiences of abuse. In the first investigation, Ogawa and colleagues [45] demonstrated that the occurrence of physical or sexual abuse during childhood was not associated with the extent of dissociation in young adulthood after controlling for parental psychological unavailability during the first 2 years of life. Instead, psychological unavailability of the parent in infancy and, to a lesser extent, infant disorganized attachment were the two strongest predictors of dissociation in young adulthood.

A more recent investigation [47] confirmed these findings and identified specific aspects of quality of care in infancy, including disrupted maternal communication, maternal flatness of affect and lack of maternal responsive involvement as significant predictors of young adult dissociation, independent of prediction from abuse experiences. Notably, this early care cluster accounted for half of the variance in dissociation after controlling for gender and demographic risk. In addition, with quality of early care controlled, only verbal abuse added to the prediction of dissociation in young adulthood, despite a high rate of sexual or physical abuse in the sample (29%). Infant disorganization was not a significant predictor of dissociative symptoms in this sample.

Other non prospective investigations separately assessing family environment by self-report have also found that history of physical abuse was associated with dissociation only in families characterized by low positive affect [48] or in individuals who perceived limited social support networks [49]. Quality of early care and infant disorganization have been similarly implicated in the development of depressive symptoms in childhood and young adulthood [9]. Maternal hostility assessed during infancy uniquely predicted depressive symptoms in both childhood and young adulthood, and low maternal involvement added to the prediction of such symptoms in young adulthood. Maternal depression during a child’s infancy was also a unique predictor of young adult depressive symptoms, as noted above.

Finally, disorganized attachment in infancy independently predicted depressive symptoms in childhood. Abuse experiences were not evaluated as possible contributors to depressive symptoms. Additional studies have shown that quality of parenting independently predicts depressive symptoms in offspring, rather than mediating the transmission of depressive symptomatology from depressed mother to child [50– 52]. Results from these investigations confirm the long term prediction possible from careful assessments of quality of early parent– infant interactions, and also indicate that different aspects of early parenting may contribute to different types of later psychiatric symptomatology.

A third prospective study [53] assessed the contributions of attachment, early care and childhood abuse to the extent of impulsive, self-damaging borderline features exhibited in young adulthood. In these analyses, both the caregiver’s withdrawal from the child’s attachment overtures in infancy and the young adult’s self-reported experiences of childhood maltreatment were independent, additive predictors of borderline features.

Maternal withdrawing behaviors in infancy were characterized by limited provision of dialogue and parental structuring within interactions, distanced interactions with the infant, highly limited physical contact and using toys rather than physical holding and interaction to soothe the infant. These findings converge with work by Hooley and Hiller [54], who found that relapse among patients with borderline personality disorder was associated with less parental expressed emotion (i.e., criticism and overinvolvement), in contrast to findings among other diagnostic groups where relapse is associated with more parental criticism and overinvolvement. Taken together, these findings suggest that parental withdrawal may be particularly problematic for those vulnerable to borderline personality disorder from a point early in development. 51
Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder.

The Impact of Early Life Trauma on Health and Disease : The Hidden Epidemic, edited by Ruth A. Lanius, et al., Cambridge University Press, 2010. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/acap/detail.action?docID=542784.
Created from acap on 2019-10-14 20:25:48.

Lanius, RA, Vermetten, E, & Pain, C (eds) 2010, The Impact of Early Life Trauma on Health and Disease : The Hidden Epidemic, Cambridge University

Press, Cambridge. Available from: ProQuest Ebook Central. [14 October 2019]. Created from acap on 2019-10-14 20:29:17.

Social factors

Stressful life events such as bereavement, moving house and changing jobs have repeatedly been implicated as risk factors for mental and physical ill health. Since the 1940s, researchers have demonstrated the negative effects of stressful life events, refined methods of recording such events and investigated the relative impact of different types of event. These investigations have generally not extended to include people with intellectual disabilities. We have identified two specific life event types where sufficient evidence has been published for use in this way. These events are sexual abuse and bereavement, and we provide a brief discussion of the evidence here before considering the central question of the review. to provide evidence that sexual abuse victimisation is associated with a range of psychological problems.

A retrospective analysis of psychological case notes (Beail & Warden 1995) has yielded evidence for an association between sexual abuse victimisation and challenging behaviour. One small case–control study has revealed increased levels of depression and anxiety in comparison to a control group (Matich‐Maroney 2003), while a larger case–control study reports increased rates of psychological disorder, behavioural problems and post‐traumatic stress (Sequeira et al. 2003).

This study aimed to examine the relationships between childhood sexual abuse (CSA) and other adverse development factors and a range of adverse adult psychological and socioeconomic outcomes. Postal questionnaires were sent to a random community sample of women with a screen included for CSA. Two hundred and fifty‐four women who reported CSA were interviewed as well as an equal‐sized control group with no CSA. A range of negative outcomes in adulthood were more likely to occur in women reporting CSA compared with controls. These outcomes included psychiatric disorder, lowered self‐esteem, deliberate self‐harm, increased sexual problems, adolescent pregnancy, difficulties in intimate relationships, decline in socioeconomic status and increased likelihood of separation or divorce. The results after logistic regression modelling demonstrated that a variety of childhood risk factors such as poor parental mental health, relationship to parents and being physically punished as well as CSA contributed to negative adult outcomes. The precise patterns varied for each negative outcome. It was concluded that CSA is best conceptualised as a non‐specific risk factor for a wide range of adverse psychological and social adult It is frequently found in families which have other risk factors for adverse outcomes.
Kerry Gibson and Mandy Morgan, Narrative Research on Child Sexual Abuse: Addressing Perennial Problems in Quantitative Research, Qualitative Research in Psychology, 1080/14780887.2011.606597, 10, 3, (298-317), (2013).
Shelly A. McGrath, Ashlyn Abbott Nilsen and Kent R. Kerley, Sexual victimization in childhood and the propensity for juvenile delinquency and adult criminal behavior: A systematic review, Aggression and Violent Behavior, 10.1016/j.avb.2011.03.008, 16, 6, (485-492), (2011).

Crossref

Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder.

Bruininks R. H., Woodcock R. W., Weatherman R. F. & Hill B. K. (1996) Scales of Independent Behavior‐Revised. Riverside Publishing, Itasca, IL.

Cohen S., Kessler R. C. & Gordon L. U. (1995b) Strategies for measuring stress in studies of psychiatric and physical disorders. In: Measuring Stress: A Guide for Health and Social Scientists (eds S. Cohen, R. C. Kessler & L. Underwood Gordon), pp. 3–26. Oxford University Press, New York.

Einfeld S. L., Tonge B. J. & Mohr C. (2002) The Developmental Behaviour Checklist for Adults (DBC‐A). School of Psychiatry, University of New South Wales, and Centre of Developmental Psychiatry and Psychology, Monash University, Sydney, NSW; Melbourne, Vic.

Beail N. & Warden S. (1995) Sexual abuse of adults with learning disabilities. Journal of Intellectual Disability Research 39, 382–7.

Mr. Sage was born in Melbourne in 1975. His natural father is not known. At the time he was born, his mother had been in a common-law relationship for six months, and Mr Sage took his last name.

Mother also had two daughters by a prior relationship and both older than Mr. Sage. She also had a son by a stepfather that is younger than the patient.

Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder

No family coherent Belended family

Stepfather was physically abusive toward the patient’s mother and the children. Mr. Sage believes he was sexually abused by either his nominal father or stepfather, and that the abuser went to jail. We not sure about it no document to prove it.

The children were taken from the home and were subsequently raised by the maternal grandmother.

no place to call home Mr. Sage went into foster care and became a permanent ward in 1978 when he was 3 years of age. Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder

Mother later remarried and reunited with the 3 children in her mother’s care and took a new last name. Mr. Sage stayed in foster care until he was an adult. There was little or no contact between Mr. Sage and the rest of the family during his childhood. The mother abandoned him while she reunion with other kids

In 1997 when Mr. Sage was 22, his Social Worker arranged a meeting between Mr. Sage, his mother, brother, and two sisters. One sister subsequently kept in touch with him. Haven’t seen his family no contact with his mum

The other family members have not, and apparently have no desire to do so. Mr. Sage’s sister with whom is in contact currently lives in Melbourne and is married with children.

From this time until he was 20, Mr Sage was in several foster care situations, temporary placements, respite homes, and training schools. He underwent several assessments and was on many regimes of treatment.

Mr. Sage has never been married nor engaged to be married. He did not date as a young adult, has no peer relationships with the same or opposite sex. It does not appear on any record that he ever had any such relationship.

Mr. Sage has always had multiple service providers working with him and he has referred to them as his friends. When his service providers have changed, Mr. Sage has had trouble adjusting to the new relationships and has historically acted out at these times.

Mr. Sage was sexually abused by an older male while he was in foster care. He also feels he was sexually abused by his stepfather when he was an infant.

Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder.

Precipitating factors

provide one refrence for each factor

oWhy now?

though Mr Sage reports he is currently not receiving any medication.

oWhat are triggers or

events that exacerbated the problem?

Mr. Sage’s history has consistently shown that he is a person who is very dependent on the direction of others and on a predictable, unchanging routine. His behaviour problems, which have most frequently occurred when there has been a change in his life, have been interpreted by his caregivers as his way of having external controls brought on him and making his life predicable again. he has had a lifelong history of disturbing behaviour which has challenged his caregivers to meet his needs safely. These behaviours have included outbursts during which he has yelled out inflammatory statements in public and engaged in other difficult behaviours, (e.g., tearing up books and pictures, breaking windows). At the time of his index offense, Mr Sage had been living in a share house, and in the weeks prior to his offense, described increasing conflict with his housemates and with Centrelink staff. Mr Sage’s housemates reported that he had uttered threats that he was going to burn the house down if his Centrelink payments were not increased (he wanted to move to a different location but could not afford it).

When he realised his demands were not going to be met, he piled clothing belonging to his housemates on the stove burners and started a fire

Perpetuating factors

provide one reference for each factor identified

o What factors are likely to maintain the problem? Strain theories view deviance as a result of the tensions or strain experienced by people because of their position in and relationship to the larger social structure.

Thompson, WE, & Gibbs, JC 2016, Deviance and Deviants : A Sociological Approach, John Wiley & Sons, Incorporated, Hoboken. Available from: ProQuest Ebook Central. [14 October 2019].

Created from acap on 2019-10-14 19:18:58.

His Social and environmental factor as well as his anxiety

O Are there issues that the problem will worsen, if not addressed

Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder

Protective factors

one reference for each factor identified

oWhat are client strengths that can be drawn upon?

oAre there any social supports or community resources?

The 5 P’s of Case Formulation

Case study: Mr Sage

Mr. Sage has been convicted of Uttering a Threat, Causing Damage by Fire, and Mischief. Mr. Sage has been sentenced to a 4-year community correction order with the condition that he:

undertake medical treatment or other rehabilitation
be supervised, monitored and managed by a corrections worker.

Mr. Sage was born in Melbourne in 1975. His natural father is not known. At the time he was born, his mother had been in a common-law relationship for six months, and Mr Sage took his last name.

Mother also had two daughters by a prior relationship and both older than Mr. Sage. She also had a son by a stepfather that is younger than the patient.

Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder

The children were taken from the home and were subsequently raised by the maternal grandmother.

no place to call home Mr. Sage went into foster care and became a permanent ward in 1978 when he was 3 years of age.

The other family members have not, and apparently have no desire to do so. Mr. Sage’s sister with whom is in contact currently lives in Melbourne and is married with children.

No specific diagnosis but few abnormal behaviour was noted :

His pattern of being a “victim of verbal and physical abuse due to (his) behaviour” was established and noted when he was 7. Bizarre behaviour such as barking like a dog or bringing tree branches on to the bus were noted since he was 14. Behaviours such as running away were noted since he was 18.

Subsequent to 1994, when Mr. Sage turned 19 and was no longer in foster care, DHHS continued to contract with proprietary care homes and other services under their mandate to provide services for Mr Sage. This was a discretionary service which Mr Sage accepted.

However, while he continued to be dependent on his caregivers, he did not accept the direction they gave him and would frequently run away from his placements or otherwise be so disruptive that they did not want to have him anymore.

From 1996 to 2000, Mr. Sage attempted to live on his own, supporting himself on welfare and living in hotel rooms in Melbourne. His housing broke down frequently and he became well known as an emergency client of shelters where he tended to stay for long periods as there were few available accommodations for him.

During this period, he also became a frequent user of other services in the area. He was noted to be frequently in crisis.

In 2003, Forensicare’s outpatient service became involved with Mr. Sage when he was referred during a six-month probation term. They continued to be involved with him on a voluntary basis after the Probation Order had expired, up until March 2006 when his treating psychiatrist retired.

Mr. Sage was sexually abused by an older male while he was in foster care. He also feels he was sexually abused by his stepfather when he was an infant.

Mr. Sage never had any problem with alcohol or any illegal drugs.

Mr. Sage was also charged with causing disturbance in Melbourne in early 2003. He pled guilty on February 05 2003 and was supervised through a brief period of probation.

Mr. Sage was also charged with Mischief under $5,000 in Melbourne, in May 2006. This stemmed from an incident during which he broke several windows at the home of a previous caregiver he had been visiting. It was noted at the time that Mr. Sage had broken windows on several previous occasions, but no charges had been laid. He was convicted on May 23 2006 and was given a 12-month term of probation.

During all of his terms of probation, Mr. Sage was noted to have reported as ordered, and to have taken his probation orders seriously.

Although Mr. Sage has not been convicted of other offenses, he has had a lifelong history of disturbing behaviour which has challenged his caregivers to meet his needs safely. These behaviours have included outbursts during which he has yelled out inflammatory statements in public and engaged in other difficult behaviours, (e.g., tearing up books and pictures, breaking windows).

At the time of his index offense, Mr Sage had been living in a share house, and in the weeks prior to his offense, described increasing conflict with his housemates and with Centrelink staff. Mr Sage’s housemates reported that he had uttered threats that he was going to burn the house down if his Centrelink payments were not increased (he wanted to move to a different location but could not afford it).

When he realised his demands were not going to be met, he piled clothing belonging to his housemates on the stove burners and started a fire. He then left the house. He believed that the house would burn down and Centrelink would be forced to assist him to find new accommodation.

After he left the house, he dialled 000 with a request to be arrested.

Fire setting has also been a problem in the past. Mr. Sage states he has started several fires, and it appears that this is a behaviour he uses when in crisis to help alleviate his anxiety or to get what he wants.

A fire he started in a dumpster in the entrance to an emergency shelter in Melbourne in 2006 was confirmed.

DIAGNOSIS – rule out pyromania, rule out bipolar disorder; personality disorder

Assignment

Predisposing factors

provide one reference for each factor

Over the person’s lifetime, what factors contributed to the development of the problem?

Biology, psychological, environmental factors

According to research available on early childhood theorized that the effect of poor-quality early care on long-term outcomes would be mediated by attachment disorganization. Also, quality of early care has a more powerful influence overall on negative outcomes. Clearly, Mr Sage childhood is not exception and have had a massive negative impact on his behaviour and his overall life experiences.

Other non-prospective investigations separately evaluating family environment by self-report have also discovered that history of physical abuse was associated with dissociation only in families characterized by low positive affect or in individuals who perceived limited social support networks. In fact, it’s important to evaluate the interlink affect of the biological and evolutionary basis of human behaviour with discussion of the emotions, the regulation of affect, models of stress and coping, attachment, psychological defence mechanisms, and brain growth and development.

However in the context of this research attachment is examined in brief. Rising focus is being given to the neurological, emotional, psychological and social development of children who have suffered abuse and neglect. And as the goal of attachment behaviour is protection and the regulation of anxiety, it has playing a significant part in these debates. By taking a multi-disciplinary perspective on development and attachment, it is possible to offer further improvements to the traditional ways of classifying child abuse and neglections. The function of attachment is to protect the young and vulnerable of the species from danger (and extinction).

When infants feel safe, they are free to explore, investigate and learn. The more secure children feel, the more time, energy and openness they have to seek understanding and make sense of their surrounding. ‘Whereas fear constricts, safety expands the range of exploration’ (Fosha 2003: 227). This is the reason to why the social, emotional and cognitive development of abused and neglected children is heavily compromised as a result of lack of care. They don’t feel safe and they hardly can relax. Fear for these children can be so endemic that evaluation of is compromised, anxious and irregular. Most maltreated children’s psychological effort are focussed on survival and safety. As Schore mentioned, ‘the child’s mind is the birthplace of the psychological self’.

In the words of Schore (2001a), ‘young minds form in the context of close relationships’. The self is copied as the young brain purposefully interact with others and begins to experience itself as a growing psychosocial being: ‘the development of the self is tantamount to the aggregation of experiences of the self in relationships’ (Fonagy et al. 2002: 40). Gerhardt (2004: 18) sum-up is very clear, ‘the baby is an interactive project not a self-powered one’. The infant’s brain is programmed to make sense of experiences around them. As important as it is to learning to see and learning to speak, it is also important of learning to recognize, to understand and make sense of the complex mind and the psychological nature of both the self and others (Fonagy et al. 2002). The major source of these psychological experience lays within in the interactions between babies and their carers.

Psychological experience is particularly increased at times of anxiety, fear and distress. simply put, the intensity of mental state experiences is utmost whenever the attachment system is activated and the child presents care seeking behaviour. ‘This is why the quality of caregiving is critical, not just to the child’s feelings of safety, but also to the quality and character of the mind and psychological self which form’( Howe 2005). Of course, there are many other factors that influence our personalities and the way our minds form. Genes and biology are some of those factors that make up our temperaments. Such as being shy or forceful, irritable or good-natured, optimistic or pessimistic, cautious or adventurous these temperaments are highly heritable

( Howe 2005).Temperament can also have a long-term impact on our development, including the development of antisocial behaviour if caregiving is poor quality (Saltaris 2002). Moreover, attachment is precisely one of the proximity-seeking behavioural systems including association, sexuality, caregiving, subordination and domination. Modern developmental sciences, including attachment theory and the neurosciences, are opening up a fascinating account of how minds grow, how psychological selves form in the context of close relationships, and how different social and cultural outsides get into the mental insides of human experience and understanding.

In human development, we see the wonderful interplay between nature and nurture. Riddley (2003) explains it as ‘nature via nurture’, identifying that ‘nature needs nurture’ and that ‘nature is designed for nurture’. Moreover, children become accustom to the world in which they happen to find themselves and they will have to survive and function. All of this is fine if that world is benevolent, but not very good if it is antagonistic, uncaring or chaotic.

Furthermore, the impact of social factors such as traumatic life events, bereavement, moving house and changing jobs have continually been linked as risk factors to mental and physical disorder. Researchers in this field identified two specific life event where sufficient evidence has been published. These events are sexual abuse and bereavement. Mr Sage has greatly experienced both of these during his life time. A brief discussion of the evidence is provided here to provide evidence that sexual abuse victimisation is associated with a range of psychological problems. A retrospective analysis of psychological case notes (Beail & Warden 1995) has yielded evidence for an association between sexual abuse victimisation and challenging behaviour. This study aimed to examine the relationships between childhood sexual abuse (CSA) and other adverse development factors and a range of adverse adult psychological and socioeconomic outcomes.

The results suggested psychiatric disorder, lowered self‐esteem, deliberate self‐harm, increased sexual problems, adolescent pregnancy, difficulties in intimate relationships, decline in socioeconomic status and increased likelihood of separation or divorce are likely be the outcomes for those that have such an experience in their childhood. The results after logistic regression modelling demonstrated that a variety of childhood risk factors such as poor parental mental health, relationship to parents and being physically punished as well as CSA contributed to negative adult outcomes. The precise patterns varied for each negative outcome. It was concluded that CSA is best conceptualised as a non‐specific risk factor for a wide range of adverse psychological and social adult outcomes(Shelly et al. 2011).

Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder

Precipitating factors

Why now? What are the triggers?

Reinforcement is a basic process in nature. Understanding the reinforcement process is one way to understand behaviour— why people do what they do. One of the most popular theories of criminal behaviour, especially among sociologists and social psychologists, is the notion that criminal behaviour is learned behaviour. Learning theory has revolved around the concept of conditioning, where in behaviour (responses) is related to the environment in which it occurs (stimuli). The Pavlovian type of classical conditioning is based upon a stimulus eliciting a response, the stimulus occurring before the response. The stimulus follows the response.

Examples of operant behaviour include verbal behaviour, sexual behaviour, driving a car, writing an article, wearing clothing, or living in a house. The concept of operant behaviour is important to sociologists because most social behavior is of an operant nature. Social interaction is maintained by the effect it has on other people. Homans has used the concept of operant behavior to discuss what he calls elementary forms of social behavior (4).

Stimuli, or environmental conditions, can be divided into several categories. Contingent stimuli are the environmental conditions which are pro- duced by and are contingent upon a given response of the actor. Such stimuli can be reinforcing or aversive. A reinforcing stimulus strengthens the response, that is, the response rate increases when a given stimulus is produced by a given response. This process is known as reinforcement. An aversive stimulus weakens a response rate, that is, the response rate decreases when a given stimulus is produced by a given response. This process is known as punishment. Reinforcement can be positive or negative. Positive reinforcement refers

to the process whereby the presentation of a stimulus increases the response rate; negative rein- forcement refers to the process whereby the elimi- nation of a stimulus increases the response rate. Likewise, punishment can be positive, wherein the presentation of a stimulus decreases the response rate, or negative, wherein the elimination of a stimulus decreases the response rate. Criminal behavior is operant behavior; that is, it is maintained by the changes it produces on the environment.

A criminal response can produce money, a car, a radio, sex gratification, or the removal of an enemy. A criminal act may lead to reinforcement, but it also may lead to punishment. The theory of differential reinforcement states that a criminal act occurs in an environment in which in the past the actor has been reinforced for behaving in this manner, and the aversive consequences attached to the behavior have been of such a nature that they do not control or prevent the response.

Criminal behavior is under the control of reinforcing stimuli. The theory assumes that (1) The reinforcing quality of different stimuli differ for different actors depending on the past conditioning history of each; (2) some individuals have been reinforced for criminal behavior whereas other individuals have not been; (3) some individuals have been punished for criminal behavior whereas other individuals have not been; and (4) an individual will be intermittently reinforced and/or punished for criminal behavior, that is, he will not be reinforced or punished every time he commits a criminal act. However, intermittent reinforcement will maintain a response pattern, and a large part of our social behavior is maintained on an intermittent schedule of reinforcement.

As was stated earlier, punishment is defined as the withdrawal of a reinforcing stimulus or the presentation of an aversive stimulus. There are

several contradictory notions concerning the effect of punishment on behavior.

Punishment will reduce a response rate but, unless it is severe, punishment will not eliminate a response rate. Once the punishment is discon- tinued, the rate of response will return to its normal pattern. Some authors have stated that punishment is not the opposite of reinforcement, since the withdrawal of punishment results in an increase in the response that was formerly pun- ished. However, it should be remembered that the withdrawal of a positive reinforcer results in a decrease in a response that was formerly reinforced.

The problem lies in the fact that punishment is usually paired with a response that is strongly maintained by other reinforcing stimuli, whereas a reinforced response is not paired with other con- tingencies. There are two stimuli-not one-con- trolling a punished response: the reinforcing stimulus (food), and the aversive stimulus (shock). If we punish a food response, we can expect that the response will continue because of the strength of food as a reinforcer. The removal of food as a reinforcer will eliminate the response. Punishment will completely elimate the response if food is not contingent on the response.

Is the elimination of the food response due, however, to the removal of food (extinction), or is it due to punishment? Since we can accomplish the same results without punish- ment, we must conclude that the effective control is one based on extinction. We must, however, pro- vide an alternative response pattern for obtaining food. Under these conditions punishment is an adequate control of behavior. Given two responses, one of which leads to food, the other to food and punishment, the organism will soon cease respond- ing in the latter and. respond only in the former situation (6).

Continuous punishment will not control behavior either, for satiation takes place the same as with a reinforcing stimulus. Food and money are not effective reinforcers except as they are placed on an intermittent schedule. Likewise, to control a delinquent by punishing him 24 hours a day is like trying to control him by feeding him ice-cream 24 hours a day.

Holz and Azrin have shown that punishment can become a discriminative stimulus if it is followed by reinforcement (7). If a rat is shocked before the food mechanism operates, it will administer a shock to itself in order to get food. This experiment led to the so-called “masochistic rat”.

The use of punishment as it is currently administered by the legal system does not eliminate criminal behavior, although undoubtedly it does reduce the crime rate; but it does shape other behaviors, known as avoidance respomses. An organism will respond in such a way as to avoid an aversive consequence. This, of course, is negative reinforcement. Escape responses, which are like avoidance responses except that they terminate an aversive stimulus rather than avoid it, likewise

increase in rate in the face of aversive stimuli. Law enforcement procedures shape a great deal of avoidance and escape behavior, but this can be quite unrelated to the behavior the law is trying to prevent and control.

Assignment: Mr Sage has previously been diagnosed as suffering from Anxiety Disorder

Perpetuating factors ?

provide one reference for each factor identified

o What factors are likely to maintain the problem?

Are there issues that the problem will worsen, if not addressed

Strain theories view deviance as a result of the tensions or strain experienced by people because of their position in and relationship to the larger social structure.

Thompson, WE, & Gibbs, JC 2016, Deviance and Deviants : A Sociological Approach, John Wiley & Sons, Incorporated, Hoboken. Available from: ProQuest Ebook Central. [14 October 2019].

Created from acap on 2019-10-14 19:18:58.

Protective factors?

one reference for each factor identified

oWhat are client strengths that can be drawn upon?

oAre there any social supports or community resources?

References I used for the content above, they need to be in Harvard style

Holz & Azrin, DiscriminativePropertiesof Punish- ment, 4 JOURINAL oF THE EXFERnsENTAL ANALYSIS OF BEHAVIOR 225-232 (1961); Holz & Azrin, Inner Actions Between the Discriminative and Aversive Properties of Punishment, 5 Ibid. 229- 234 (1962).

Homans , Social BEHAVIOR: ITS ELEMENTARY forms(1961).

Flora, SR 2004, Power of Reinforcement, State University of New York Press, Albany. Available from: ProQuest Ebook Central. [16 October 2019].

SUTHERLAND & CRESSEY, PRINCIPLES OF CRIMI- NOLOGY 74 (5th ed. 1955).

56 J. Crim. L. Criminology & Police Sci. 294 (1965)
Criminal Behavior and Learning Theory

Baron-Cohen, S. (2003) The Essential Difference . London: Penguin Books.

Fonagy, P., Gergely, G., Jurist, E. and Target, M. (2002) Affect Regulation, Mentalization and the Development of the Self. New York: Other Press.

Fosha, D. (2003) Dyadic regulation and experiential work with emotion and relatedness in trauma and disorganized attachment. In M. Solomon and D. Siegel (eds), Healing Trauma: Attachment, Mind, body and brain . New York: W.W. Norton, pp. 221– 81.Gerhardt, Sue (2004) Why Love Matters: How affection shapes a baby’s brain. Hove and New York: Brunner-Routledge.Riddley, M. (2003) Nature via Nurture: Genes, experience and what makes us human. London: Fourth Estate.

Saltaris, C. (2002) Psychopathy in juvenile offenders: can temperament and attachment be considered as robust developmental precursors? Clinical Psychology Review 22, pp. 729– 52.

Schore, A. (2001a) Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal 22(1– 2), pp. 7– 66.

Howe, David. Child Abuse and Neglect : Attachment, Development and Intervention, Macmillan Publishers Limited, 2005. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/acap/detail.action?docID=296380.
Created from acap on 2019-10-15 14:38:19.

Beail N.& Warden S. (1995) Sexual abuse of adults with learning disabilities. Journal of Intellectual Disability Research 39, 382–7.
Kerry Gibson andMandy Morgan, Narrative Research on Child Sexual Abuse: Addressing Perennial Problems in Quantitative Research, Qualitative Research in Psychology, 1080/14780887.2011.606597, 10, 3, (298-317), (2013).
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