Throughout this essay, I will be exploring different types of therapy and why they would be best suited for the client in the case study provided by the lecturer. In this case study, the client moved back into her mother's home after a severe domestic violence attack, leaving her with permanent hearing loss in her right ear. She has a strained relationship with her mother and has begun drinking alcohol as a coping mechanism. Her low moods have escalated as her ex-partner is still contacting her causing distress with emotional and coercive abuse. 
Since the Covid-19 pandemic, calls to Domestic Violence and Abuse (DVA) helplines have increased by 50%. Supermarkets and pharmacies such as Asda, Tesco and Boots have begun providing safe spaces, designated by the government, for victims to disclose abuse and seek help. In addition, the Domestic Abuse Best Framework was adopted by the Crown Prosecution Service (CPS) in 2019. This followed the government's first Hidden Harms virtual summit, which focused on the importance of multi agencies to prevent DVA. Furthermore, the Domestic Abuse Bill (2021) and Victim's Law (2021) have given back legal power to victims of DVA. However, there are issues such as the CPS DVA charging rate decreasing across England and Wales consecutively over three years. Ending in March 2021, it was at 70% whereas in 2018, the charging rate was 76% (Brown, 2021; Elkin, 2021).
In this case study, I decided the best form of counselling and therapies would be assimilative integration of the following: Cognitive Behavioural Therapy (CBT) and Psychological Advocacy Towards Healing (PATH). Using a variation of these types of therapy would benefit the client by using the core beliefs of each. For example, the core belief of CBT is that the client is more than capable of healing themselves, giving the client her control back. In addition, having the client keep track of her triggers and reactions, such as drinking alcohol, may enable her to notice a pattern. She can then begin creating a plan of action to prevent this, taking control of her life through positive actions (Kinsella & Moya, 2021).

Transactional Analysis (TA), which was developed by Eric Berne et al. (1960), is constructed around three different ego states: the parent ego state, the adult ego state, and the child ego state. These combine to create an individual's personality. TA would be beneficial for the client to deeper understand herself and how she sees the world. The adult ego state is the part of the person responding to the world in a logical, rational, information processing manner. The parent ego state refers to a two-key dimensional part of the parent, which is critical in standard-setting and nurturing. Finally, the child's ego state can be viewed as the remaining traces of how individuals experienced the world when they were very young. There are two dimensions to the child: the fun-loving side and the hurt side.  
From a TA perspective, a psychologically healthy person will be able to have access to and express all of these ego states in the appropriate situation. For example, when the client tends to drink after her abuser calls her, even though the relationship has ended. This continuation of the cycle of psychological abuse and domestic violence could be intervened by an awareness of her ego states.
Daniel Goleman (2005) coined the term emotional intelligence, a critical tool needed for a person to become more aware of their emotions and what they mean. Alongside TA, the counsellor would need to be more aware of the dynamic flow of feeling with their client as it can lead to oversharing, especially if the client feels they have to prove or create this bond from past trauma. However, this can be a limitation as some counsellors tend to operate as though their primary goal is to initiate an emotional expression or catharsis. Instead, what would benefit the client is if the counsellor enabled them to use their emotions to guide action. 
If the counsellor is well-versed in spotting the signs of dynamic change such as transference, it can begin the process of countertransference. This would need to be upheld by the BPS guidelines (BPS, 2018) and ethically sound to ensure the safeguarding of the client. This is crucial as the client could feel that a part of herself has been taken away due to the abuse and hearing loss. Therefore, having the client understand this could invoke her to look deeper into herself and the situation and potentially begin the healing process (Andersson et al., 1994).
In this case, with a sensitive subject such as domestic violence, victim-defined advocacy is potentially the best way to help a client. The counsellor would then need to understand the client's perspective by learning the client's risk analysis, current safety plans, life circumstances, priorities, past safety plans and relationship decisions (Kinsella & Moya, 2021). Once this information has been divulged, it can become more evident to the client and the counsellor what actions might need to be taken to create and implement a strengthened comprehensive safety plan. It is vital to remember that as a counsellor, each client and the abusive situation are different, leading to different triggers. Therefore, this information needs to be handled sensitively and creating a partnership would give insight into how and what would help the client progress and heal. One of the best ways for the client to take control and find a more positive way of dealing with the situation is using the Chain Analysis of Problem Behaviour and SMART goals. These have been implemented by CBT practitioners which slowly encourage the client to accept they are not to blame and the violence that had been commited against them was wrong. Retraining the brain through risk assessment and understanding the patterns to prevent them from occuring again (Evans & Feder, 2015). 
Ferrari et al. (2018) found that through their study if counselling and CBT were not adapted to the needs of (DVA) survivors, it would not help them come to terms with their trauma. Especially if the counsellor would not talk about DVA and instead focused on mental health. The survivors felt the perpetrator was made imperceptible and unhelpful. Not talking about the abuse meant they did not get to the core of the issue and deal with the client's experiences of DVA.
The pluralistic approach would be best for the client as shared decision making would be essential in building the client's confidence back up and beginning the journey of retaking control over her life. Using this type of therapy would also be essential as it relies heavily on collaborating with the client through dialogue to gauge what works best for the client.
Wiklund et al. (2010) found that implementing a health promotion model can better address destructive processes, such as how the client uses alcohol as a coping mechanism. This could be the client displaying goal-oriented strategies of emotion regulation as it would be directly drawing attention away from the low moods and abuse and focusing on the drinking.
The study also found how gender-related violence has become a prominent issue in Sweden, especially among young people, emphasising the significance of bringing this issue forward to the public. Understanding that if dealt with correctly, it can prevent re-traumatisation, especially with raised awareness of signs and symptoms of DVA through societal processes. This can bolster survivors to come forward without the fear of being ostracised enabling them to get the help they need. 
The National Institute for Health and Care Excellence (NICE) was used in Ferrari et al.'s (2018) studies, which examined how PATH worked with a randomised sample of 130 women living in refuges across England and Wales and 130 women from a community control group. PATH is an amalgamation of feminist, experiential, psycho-educational, cognitive-behavioural and dynamic theories and technical strategies. The results were positive, discovering that alongside PATH and CBT, Post Traumatic Stress Disorder (PTSD) symptom were improved. However, the most encouraging results were from using CBT, PATH, and group therapy combined as this type of therapy relieved not only PTSD symptoms but also symptoms of depression. 
Group therapy would also be beneficial, such as using Bassot's Integrated Reflective Cycle (2013). Using this cycle in a safe and healing environment can gain different insights and create a support network as sharing experiences can create bonds and trust with each other (Condino et al., 2016).
The use of PATH would be beneficial for this case study as it focuses on topics such as managing loss, depression, low self-esteem and PTSD. These sessions also provided relief in sleeping difficulties (Condino et al., 2016). The main differences between these studies are that DVA advocates delivered PATH with supervision, not licensed therapists. 
Devries et al. (2013) examined over forty-one cross-sectional studies that found a positive correlation between DVA and heavier alcohol consumption in women. Specifically, this was done through longitudinal studies and observations over a meta-analysis with women who survived DVA later in life. However, only one study with a sample of 40 community controls and 45 alcoholic women found a positive relationship.
However, these studies' limitations were that it was not followed up. Most of these studies were conducted in affluent areas, even though the review included worldwide databases. There is insufficient research and evidence to make this a definite direct correlation. 
There is also the issue of the strained relationship between the client and her mother. Stanley and Humphreys (2017) found that 'Whole family' interventions have become a breakthrough for some survivors of DVA and engaging families. This was achieved by exploring interviews with practitioners and family members alongside learning from the logs and case notes. There is flexibility with this study as the interviews were conducted both separately and as a family. This could benefit the client as this therapy could help heal the trauma and potentially strengthen the relationship with guidance and appropriate aftercare. 
Another issue that the client has is the hearing loss in her right ear which happened during a DVA attack. Her hearing loss could be a trigger as it would be a constant reminder of the abusive relationship with which she is still coming to terms. The abuser could use this trigger to manipulate her and cause further distress. Bhargava (2013) anticipated that there would be a language barrier due to the client being deaf. However, a diagnostic evaluation was utilised and found no language or communication issues with the client Jerry. This study gave in-depth knowledge of how being deaf means that counselling sessions need to be adapted to benefit the client. In this case, the client benefitted from the framework put forward by Glasser (1960), which was reality therapy. This therapy focuses on the future and not the past issues, which can be vital when the client has had the time and guidance in coming to terms with being a DVA survivor and to look towards the future and specifically look at what she wants from life and the goal she wants to achieve. This therapy has helped depression as it does not dwell on the past, instead, it provides a more positive outlook toward the future and what the client can achieve. 
In conclusion, it would be beneficial for the client to access PATH with group therapy alongside CBT. This would ensure the client is getting support for the trauma she has experienced being in a DVA relationship and begin the healing process in a safe and positive environment. In addition, over time, utilising the skills learned through these therapies would mean she can understand her triggers and look at them from a different perspective, leading to a positive outcome. First, however, the therapies would need to be adapted for the client's hearing loss if it is an issue. This could be accomplished by using text or a group therapy chat room, to begin with under the counsellor's supervision, which she can build confidence in before attending group therapy sessions in person.