Case Study – James and Jane – Psychologist or Therapist
CASE STUDY prepared for psychologist or therapist. This case study has been updated with a clinical lens.
DOMESTIC VIOLENCE AND PROPOSED PSYCHOLOGICAL ASSESSEMENT AND INTERVENTION PLAN.
Disclaimer: The possible psychological roots and proposed interventions are based on the limited knowledge that was been provided within this case study. When preparing an official case study in-depth interviews, information, and assessments would be attained to test the possible theories. This case study is set out as an example and should not be taken as an absolute definitive for intervention.
Story:
James and Jane have been in a relationship for over five years and have one child William (4 years old) from their union. Jane has experienced significant physical violence as well as coercive controlling behaviours throughout their relationship. Concerns were raised following disclosure from Jane’s older son (6 years old) who informed that James was hitting his mummy and that William would be in the room with her whilst this was taking place. The children were placed in Kinship placement but James undermined William’s placement leading him to being placed in foster care
William’s initial behaviours whilst in foster care
This was understandably a significant and traumatic experience for William who was removed from his family on an emergency. William had not been toilet trained and was still using a dummy. This significantly impacted his speech requiring speech and language intervention. William would ask for snacky meals such us toast, banana, cereal and sandwiches when hungry. It was noted that he would struggle to pace himself whilst eating leading to him ‘inhaling’ his food. When been given a biscuit, he would quickly eat one whilst having his eye on the next one. His diet was very limited and he struggled to use cutlery whilst eating his dinner.
POSSILBE PSYCHOLOGICAL ROOTS: The insatiable need for food often observed in certain children can be linked to attachment difficulties. Research has documented strong connections between the vagus nerve and digestive systems, highlighting a physiological basis for these behaviours. Children with attachment issues frequently make references to their “tummy mummy” or biological mother, expressing feelings of inadequate care or safety in their early home environment. This association is meaningful as the stomach region represents a fundamental aspect of attachment – not only as the anatomical origin of children during gestation but also as a centre for emotional regulation via the enteric nervous system, sometimes called our “second brain.” The vagal-gut connection provides a neurobiological framework for understanding how early relational trauma may manifest as dysregulated eating patterns.
PROPOSED INTERVENTION: Provide consistent access to nourishing food for the child to help address underlying food insecurity concerns. Creating designated “snack stations” in accessible kitchen areas allows the child to self-regulate their eating patterns when hunger signals arise. For school or childcare settings, supplying a small, wearable pouch containing nutrient-dense options such as mixed nuts, dried fruits, or whole grain crackers gives the child a tangible safety resource throughout the day. This portable food security helps regulate their nervous system by addressing both physical hunger and the emotional reassurance that their needs will be consistently met, potentially reducing behaviours stemming from fear of abandonment or neglect. Collaborate with educational staff to ensure they understand the therapeutic rationale behind this approach while maintaining appropriate boundaries around eating times and nutrition.
Establish a meaningful connection between nutritional provision and emotional nurturing through intentionally prepared meals. Rather than simply ensuring food accessibility, create opportunities for attachment-building through the preparation process itself. Personalized home-cooked meals prepared with William’s preferences and nutritional needs in mind serve as tangible representations of attunement and care.
Include handwritten notes of encouragement or small drawings with packed lunches, creating a symbolic emotional presence during periods of separation. These messages should be specific to William’s current experiences or achievements, reinforcing that he remains in his caregiver’s thoughts even when physically apart. This practice bridges separation anxiety while building secure attachment representations.
The ritualistic aspects of meal preparation and sharing can be further leveraged as regulatory opportunities, with caregivers narrating their thoughtfulness and intentions while preparing food specifically for William. This multisensory approach—combining nutritional sustenance with relational connection—addresses both physiological and emotional hunger simultaneously, helping recalibrate William’s internal working models around caregiving reliability and emotional safety.
Story:
His play was described as rough with his toys often breaking them. He described as being constantly on the go running and bouncing off walls. He thrived on annoying the other young person in the placement.
POSSILBE PSYCHOLOGICAL ROOTS: William’s externalizing behaviours, including conduct problems and aggression, indicate he is operating in the “fight” response zone of his fear continuum. These reactions likely stem from a complex interplay of neurological and developmental factors. Evidence suggests he may experience sensorimotor processing challenges, particularly in proprioception (body awareness) and auditory sensitivity. Additionally, his interoceptive awareness appears compromised, making it difficult for him to accurately interpret internal bodily signals related to hunger, fatigue, or emotional arousal.
His compulsive eating patterns likely represent a self-regulatory mechanism rather than a response to genuine hunger cues. This behaviour signifies his autonomic nervous system remains in a dysregulated state, perpetually scanning for threats. To effectively address these issues, our therapeutic approach must focus on establishing environmental safety while simultaneously helping his body develop new neurological patterns.
By consistently implementing the recommended interventions below, we can begin to communicate safety directly to his nervous system, gradually shifting him from defensive fight-or-flight responses toward a more regulated state where adaptive learning becomes possible. This neurobiologically-informed approach recognizes that traditional behavioural interventions alone will be insufficient until his body receives consistent signals that danger has passed.
PROPOSED INTERVENTION: Conduct a comprehensive sensory processing evaluation using the Sensory Processing Measure, Second Edition (SPM-2) administered by a qualified clinician with appropriate credentials. Develop a customized sensory integration program incorporating evidence-based activities drawn from resources such as “The Out-of-Sync Child Has Fun” by Carol Stock Kranowitz.
Implement a comprehensive auditory processing intervention sequence to address William’s neurophysiological dysregulation. Begin with the evidence-based Calm auditory program (Unyte-iLs), designed to gradually downregulate autonomic arousal through carefully filtered low-frequency sounds that selectively stimulate parasympathetic activation. Following successful completion and integration of this foundational phase, progress to the Safe and Sound Protocol (SSP), a polyvagal-informed intervention that utilizes acoustically modified vocal frequencies to target the middle ear muscles and neural regulation of the social engagement system.
This sequential approach is essential, as attempting SSP without first establishing baseline regulation may overwhelm William’s processing capacity. Both interventions require administration by a clinician holding advanced certification in these methodologies, with regular physiological monitoring throughout the process to ensure optimal neural integration. Brain Gears Psychological Services maintains providers with the requisite specialized training in both protocols and understanding of developmental trauma presentations.
Coordinate timing of these auditory interventions with William’s daily routine and other therapeutic modalities to prevent sensory overload while maximizing neural integration opportunities. Document pre-intervention baselines and track measurable indicators of regulatory improvement to guide subsequent treatment planning.
Implement our structured 6Rs program to systematically recalibrate his autonomic nervous system functioning. This physiological regulation approach addresses his hyperaroused baseline state by providing targeted interventions that promote parasympathetic activation. The sequential nature of the 6Rs protocol allows for gradual neural reorganization, effectively downregulating his stress response system and creating capacity for improved emotional and behavioral regulation.
Story:
It was further noted that William would often take himself up in his room, lie under the covers and watch his tablet. He did not fall asleep whilst doing this and would often be puzzled when the carers were checking on him.
POSSILBE PSYCHOLOGICAL ROOTS: Current assessment indicates William has likely progressed further along the fear continuum, exhibiting a complex presentation that combines flight (avoidance behaviours), freeze (emotional flattening, diminished engagement with activities), and compromised adaptive functioning leading to cognitive overwhelm. This pattern strongly suggests an underlying disorganized attachment style, characterized by contradictory approach-avoidance behaviours in response to perceived threats.
This attachment profile carries significant developmental implications, as research demonstrates children with similar presentations frequently experience cascading effects across multiple domains. These typically include executive functioning deficits (affecting planning, organization, and self-regulation), specific learning challenges, information processing delays, and persistent difficulties both interpreting social cues and being accurately understood by others. The bidirectional nature of these misunderstandings often creates a self-reinforcing cycle that further entrenches maladaptive patterns without appropriate intervention.
William’s current presentation represents an adaptive response to perceived environmental threats rather than wilful behaviour, reflecting his neurobiological attempts to maintain safety in a world his system continues to experience as dangerous.
PROPOSED INTERVENTION: A comprehensive SPM-2 assessment will likely reveal multiple sensory processing deficits across various domains, potentially including proprioceptive awareness, auditory hypersensitivity, vestibular processing, tactile defensiveness, and chemosensory abnormalities, alongside poor sensory integration. These findings would suggest a fragmented sensory foundation that significantly impacts William’s ability to process and respond adaptively to his environment.
Of particular clinical concern is the documented correlation between olfactory hypersensitivity and increased suicide risk during adolescence, which places William in a vulnerable category requiring proactive intervention. Research indicates heightened olfactory processing may serve as a neurobiological marker for specific types of emotional dysregulation that become particularly problematic during puberty’s neurochemical shifts.
Effective treatment necessitates a sequential, developmentally-informed approach. Each sensory system must first be individually calibrated following normative developmental sequences before integration work begins. Additionally, assessment for retained primitive reflexes is essential, as their persistence significantly impacts both sensorimotor function and emotional regulation capacity.
Treatment should be coordinated by a master’s-level clinician with specialized training and substantial clinical experience (minimum three years) in Dyadic Developmental Psychotherapy (DDP) and a sophisticated understanding of the interconnections between sensory processing dysfunction and fear-based regulatory mechanisms. To maximize therapeutic efficacy, William’s primary attachment figure should actively participate in treatment sessions, facilitating co-regulation and the development of secure attachment patterns within this therapeutic context.
Story:
William formed a positive relationship with his foster mum and would not allow the foster dad to carry out any care on him. He often would observe the shoes the foster mum was wearing and would insist she wears the house slippers. He continues to struggle forming a relationship with the foster dad and will sometime close his eyes when he enters the room. He is always aware of where the foster dad is in the house and will sometime opt to stay in his room. However, he can sometimes engage with play with him and seek him out. However, these are very rare occasions
POSSILBE PSYCHOLOGICAL ROOTS: William’s responses suggest that interactions with his foster father function as potential trauma triggers, activating his stress response system despite the foster father’s conscious efforts toward behavioural modification. This triggering likely operates below the threshold of conscious awareness for both individuals and may involve subtle sensory cues such as vocal tone, physical proximity, movement patterns, or olfactory signals that William’s nervous system associates with previous threatening experiences. These neurobiological responses occur outside voluntary control and represent William’s autonomic nervous system attempting to protect him based on previously encoded danger associations. While the foster father demonstrates commendable commitment to adapting his approach, the neurological pathways underlying William’s reactions require specialized intervention beyond cognitive understanding alone. These dynamics highlight the importance of trauma-informed parent coaching that addresses both the physiological and psychological dimensions of their relationship.
PROPOSED INTERVENTION: The assigned case social worker would benefit from specialized training in neurobiological approaches to developmental trauma, particularly focusing on the periaqueductal gray (PAG) region’s central role in defensive responses and its impact on William’s behavioural presentation. This midbrain structure, which coordinates primitive survival responses including fight, flight, and freeze reactions, appears dysregulated in William’s case. Through targeted professional development, the social worker could acquire specific physiological recalibration techniques grounded in polyvagal theory and neuroplasticity principles.
After achieving competence in these methods, the social worker could systematically train William’s foster parents in implementing these regulatory interventions within daily routines. This “embedded intervention” approach would create multiple opportunities throughout each day to gradually shift William’s autonomic baseline toward a state more conducive to social engagement and cognitive function. By transforming routine interactions into therapeutic moments, this strategy maximizes intervention frequency while minimizing additional appointments, ultimately supporting neural reorganization through consistent, predictable experiences that communicate safety to William’s nervous system.
Mum and dad’s behaviours towards William during family time (contact).
Jane presents as flat in mood and struggles to display any emotional responses towards William. They hardly share any physical contact and usually start talking without greeting each other. Jane will follow William around and will not initiate or direct play for William. This often leads to William being bored and seeking attention from the support workers. When William is leaving, Jane struggles to comfort William or say goodbye to him. She will often opt to be left behind when William is leaving. Jane can also present as disengaged and distracted during family time. She is not consistent in attending family time.
POSSILBE PSYCHOLOGICAL ROOTS: The clinical data suggests a bidirectional trauma activation pattern wherein William functions as a significant trauma trigger for his biological mother, Jane. Her presentation indicates she likely operates predominantly in a freeze-dominant state characterized by dissociative responses when her attachment system is activated. This freeze response represents a more severe defensive position on the fear continuum than fight/flight responses, typically emerging when these more active defensive strategies have proven ineffective in ensuring safety.
Jane demonstrates marked deficits in internalized self-regulation capacities, manifesting as pronounced anxiety symptoms and what appears to be comorbid depression. Her inability to maintain emotional presence during interactions with William, combined with her unpredictable approach-avoidance behaviours, strongly indicates an underlying disorganized attachment organization in her own neurobiological functioning.
This attachment pattern significantly impairs her capacity to provide the consistent, attuned responses necessary for William’s emotional development, creating a challenging intergenerational transmission of trauma and dysregulation. Her dissociative tendencies during stress likely rendered her emotionally inaccessible during critical developmental windows for William, contributing substantially to his current presentation.
PROPOSED INTERVENTION: Jane should engage in the structured Emotional Integrative Mental Health protocol under the guidance of a certified DDP clinician for a minimum of eight sessions, with the potential to extend to sixteen sessions based on clinical progress indicators. This intervention specifically targets her dysregulated stress response system and aims to develop more adaptive coping mechanisms beyond fear-based reactivity.
Throughout this process, the clinical team will conduct regular comprehensive assessments of Jane’s autonomic regulation capacity, attachment behaviours, and metacognitive functioning. Only when consistent evidence demonstrates that Jane has established reliable access to her prefrontal regulatory systems, even under moderate stress conditions, should the therapeutic team consider introducing her into William’s ongoing DDP treatment.
This phased integration approach requires close collaboration between both clinicians and the supervising social worker, with clearly established metrics for readiness. The transition should follow a carefully graduated exposure protocol that prioritizes maintaining William’s sense of safety and therapeutic progress while simultaneously supporting Jane’s continued development of co-regulatory skills within the structured therapeutic environment.
Story:
James appears to have a good relationship with William. He is consistent in family time and engages William throughout the family time. He is good at forward planning and anticipating William’s needs. Their greet during family time is warm full of hugs and physical contact as well as the leaving with James settling William in the care at the end of family time. As a result, William will often ask for James and will hardly ask for Jane. William will ask other main carers if they are his mummy despite having family time with her.
POSSILBE PSYCHOLOGICAL ROOTS: William’s apparent compliance warrants careful clinical assessment, as it likely represents a defensive adaptation rather than genuine emotional security. His behavioural presentation suggests a trauma-informed survival strategy developed to minimize potential triggering of James, thereby reducing perceived threat in his environment. This hypervigilant compliance often masks significant underlying distress.
William’s inquiries about alternative maternal figures—clinically termed “mommy shopping”—reflect his developing awareness of his profound attachment vulnerability. This behaviour indicates his recognition that his biological mother cannot consistently meet his emotional needs, prompting him to strategically seek alternative caregiving relationships. This represents not merely a behavioural issue but rather a developmentally appropriate, albeit maladaptive, attempt to secure emotional safety in response to attachment disruption.
This pattern merits particular clinical attention as it reflects both William’s intuitive understanding of his relational frailty and his attempt to establish compensatory attachment bonds. Recognizing this dynamic allows for more nuanced therapeutic interventions that address both his adaptive survival strategies and his legitimate need for reliable caregiving.
PROPOSED INTERVENTION: The treating DDP clinician should receive comprehensive documentation regarding William’s behavioural patterns, with particular emphasis on their potential developmental origins rather than surface manifestations. This contextual understanding will enable the clinician to implement a therapeutic process that systematically addresses William’s neurobiologically-based safety concerns while respecting his autonomy in forming attachment judgments.
Through carefully structured therapeutic interactions, the clinician should facilitate William’s progressive development of internal security markers—helping him identify and interpret physiological signals that indicate safety or danger in his relational environment. This approach honors William’s need to develop his own internal working models of relationship security rather than imposing external directives about trust.
The therapeutic process should emphasize experiential learning over didactic instruction, allowing William to gradually recognize patterns of reliability, emotional attunement, and consistent boundaries among his caregiving adults. This self-directed discovery of trustworthiness supports the development of secure attachment representations while simultaneously strengthening his emerging capacity for discernment in relationships—a critical protective factor given his history of relational unpredictability.
