Presenting Problem Jack is only a few months shy of his 18th birthday. He presents emotionally as a confused, anxious and angry child of about half his physical age and yet his physical appearance is that of a somewhat large rather intimidating young man. Jack was referred by his Youth Justice worker to seek therapy for his anger issues and subsequent violent outbursts toward his family, in particular his mother and also in public assaults. Jack’s referral was suggestive of reactive attachment disorder and post-traumatic stress disorder. Precipitating Factors Jack has a history of violence and substance abuse within the family setting - father (Mark 51 years) is an alcoholic and abusive toward Jack’s mother (Jill 45 years), his mother also abuses alcohol, self medicates and has been diagnosed with Bulimia and depression. Jack has two siblings, Jane (21 years) and Max (20 years), both have substance abuse issues and Jane has also been diagnosed and treated for Anorexia Nervosa. Jack was diagnosed with epilepsy at age nine years, Asperger syndrome at 15 years, psychosis and behavioural issues also at 15 years. At the age of 13 years, Jack had a partial removal of his frontal lobe in order to reduce his severe epileptic seizures. Whilst this was successful in seizure reduction, it unfortunately grossly impaired Jack’s ability to reason and interfered with his mental thought processes of consequence. Since the surgery, Jack has become increasingly violent and irrational. Although, prior to the surgery, Jack was constantly victimised and bullied by his peers making his school life a living hell and making surgery a necessity. Diagnosis and Assessment Taking into consideration the entirety of Jack’s background and precipitating factors, it would be fair to assume that Jack has suffered significant complex trauma as a result of multiple negative experiences in his lifetime. Jack presents as somewhat hyper-vigilant and hyper-aroused, with a relative reduced capacity to concentrate for any length of time. Jack shows issues with attachment capacity, demonstrated through a heightened need to control, developmental delays, ambivalence toward developing close relationships, aggression and inappropriate modeling - this is suggestive of a Disorganized Attachment Style (Perry, 2001). Jack also has difficulty articulating his emotions and has an incredibly poor self-image. In the initial interview, Jack revealed that for over a year or more he had been experiencing recurrent distressing nightmares, memory lapses, hallucinations (not drug induced), sleep difficulties and avoidance, and an intense feeling that he was going to meet an early death - these symptoms correspond with the DSM-IV-TR Criteria for PTSD (Stagg, 2013). Identify Familial and Developmental Factors Relevant to the Case Since birth Jack has witnessed both physical and verbal abuse exchanged between his mother and father, more often than not perpetrated by his father and later by his elder brother. When Jack became taller than his mother, he too began the verbal abuse. Jack re-enacted inappropriate modeling and upon interview, Jack was unaware this behavior was inappropriate at all - after all, everyone spoke to his mother this way. Jack’s behavior quickly escalated and it wasn’t long before the verbal abuse became physical and Jack didn’t stop at just assaulting his mother. Jack was unable to control his outbursts and his behavior heightened to a point where not a wall in the home was left intact. Jack’s ferocious rages rained terror on his mother - the police placed an Interim Violence Order on Jack and he was placed in the custody of his grandmother. Jack felt abandoned by his mother and began to self-harm and seek solace in marijuana and crystal meth (ICE) - occasionally Jack would demand his mother purchase the drugs for him, threatening to kill her if she failed to do so and also making her responsible for his dilemma. Jack’s control over his mother is still a major point of concern. Jill’s (Jack’s mother) demeanor is also indicative of unresolved trauma and possible mental health and substance abuse issues. Jack sees Jill as the perfect victim - he has spent his entire childhood witnessing his father emotionally, verbally, financially and physically abuse his mother and on occasion, his elder sister, Jane. Jack expressed his low self-image and feelings of worthlessness - repeatedly describing suicidal ideologies, stories of self-harm and the showing off of scars (some superficial while others obviously would have required medical attention). On several occasions during the sessions Jack broke down in uncontrollable tears and rocked back and forward in his seat - behavior reminiscent of a small child. In accordance to Perry (2001), children can often regress to an age much younger than their physical years and at such times need the interaction and/or therapy to be attuned to their emotional age not their physical one. As re