Benchmark- Case Study
Background
Becky, an adolescent aged 15, has been struggling with emotional distress following repeated rape incidents in the hands of his 20-year-old cousin. Becky’s parents sought professional assistance upon the realization of what transpired to their daughter. Prior to the report, Becky’s parents filed a legal report, and the investigations are underway to validate the claims of the abuse. Becky has, therefore, entered our care for psychological support in maintaining her social sobriety after the traumatizing sexual encounters.
Social Network
Becky hails from a socially supportive family, and her parents actively advocate for her recuperation as well as justice to the offender. Her younger sister is equally supportive and accepts to share the bed with her despite being oblivious of the reason for so doing. In the face of the harsh reality she has encountered, her family’s love remains her pillar and source of strength- a love which is particularly important for a teenage girl who is in the process of developing a new, trauma-free social system. Becky has maintained a strong circle of friends, although she reports of inward strained social acceptance and does not anticipate any sober social countenance in the foreseeable future.
History
Becky reports that her first negative encounter with sodomy occurred when she was 14 years old. She was out in a family barbeque in which the assaulter, her 21-year old male cousin, took chances with her. Becky revealed that from the time of the first incident, she had fallen prey to her cousin several other times, all the time bearing the emotional and physical pain in silence. The incidents have kept her from attending any family functions out of the fear that she might be victimized yet again. She was performing wellacademically until after the first incident. Her grades have since taken a downward trend. She attributes her deteriorating performance to difficulties in concentrating in class. Becky does not have a history of any mental disorder, and all her deteriorating social attitude is solely a response to the negative turn of invents in her life over the last year.. Don't use plagiarised sources.Get your custom essay just from $11/page
Assessment
A verbal assessment in the form of an informal interview was used to evaluate Becky’s history of assault, support networks, individual strengths, and treatment goals. Becky further reported to WHODAS 2.0 (World Health Organization, 2018). Her scores on the WHODAS 2.0 indicated a substantialimpairment in the domains of participation in social activities, life activities, understanding and communicating effectively, and getting along with strange people. Becky’s WHODAS 2.0 results are, to a higher degree, consistent with her verbal confession that she does not engage in fun activities such as movie nights and sleepovers with her friends. These results suggest that communication and interpersonal skills may be additional areas of clinical focus.
From Becky’s responses, the fowling assessments were made.
| Problem | Frequency | Severity | Impact |
| Intrusive Thoughts | · Spontaneous- has occurred since the first encounter; · At least four to 5 times a weak. | · Repeated involuntary memories of the experience; · Distressing nightmares of the events; · Flashbacks of the trauma. Flashbacks are sometimes so vivid that the client feels as if she is reliving the experience. | · Highly distresses the client; · The client is socially debilitated |
| Social Isolation | · Consistently with family functions. · Stays home every time she is not at school | · Limited contacts with extended family · Limited participation in family functions · Interrupted sleepovers and fun activities with friends | · Estranged family and friends · Socially drained · Highly distressing |
| Avoiding reminders | · Occurs routinely | · Avoids people, places, activities, objects, and situations that stir distressing memories of the experience. · Avoids thinking or remembering the traumatic event or the person · The client even resists talking about the person who assaulted her or how she feels about it. | · Influences communication, studying, confidence, and attitude. · Inability to seek help · Poor intimate relationships |
| Negative Thoughts, Feelings, and Perceptions | · Have become a part of her | · Ongoing distorted beliefs about herself (I am awful and tainted) · Feelings of worthlessness (No one can be trusted) · Distorted belief about others · Fear · Anger · Guilt · Shame · Horror · Feelings detached from peers · Reduced interest in previous activities of interest. | · Reduced self-esteem · Low academic productivity · Poor intimate relationships · Changes in physical outlook including haircut and makeup |
| Arousal and reactive symptoms | · Spontaneous | · High irritability and angry outbursts · Reckless behaviors, though with minimal self-harm · Ease of being startled · Problems withconcentration in tasks · Problems sleeping | · Decreased social activity level · Inability to complete daily tasks · Difficulty maintaining interpersonal relationships |
DSM-5 Diagnosis
F43.1 – Post Traumatic Stress Disorder, severe, in early remission, in a controlled (home) environment (Principal Diagnosis)
F43.0- Acute Stress Disorder (Provisional Diagnosis)
Contextual Conceptualization
Becky clearly meets the diagnostic criteria for severe post-traumatic stress disorder, having experienced the symptoms for at least one year. Researchers have affirmed that 90% of sexual assault victims experience post-traumatic stress disorder (PTSD) symptoms (Zubernis& Snyder, 2015). Especially for Becky, the multiple occurrences of the assault increased the probability of developing PTSD. Despite staying away from her cousin for several months on end, she still experiences strong emotions whenever she is exposed to behavioral cues. In addition to meeting the criterion for diagnosis as provided by the National Center for PTSD (2019), Becky further experiences high levels of de-realization and depersonalization. De-realization entails the experiences of unreality, distance, and/ or distortion (Zubernis& Snyder, 2015), evidenced when she feels as if the assaulter is physically touching her while deep inside she is well aware that her cousin is nowhere close to her present environment. Depersonalization references her feelings of being outside her own body and taking the role of an observer (Zubernis& Snyder, 2015). Becky is detached from her own self and sometimes feels as if whatever happened was merely in her dream.
Theoretical Approach to Intervention
Based on the contextual conceptualization, Becky’s treatment will be completed in a client-centered theoretical approach. A client-centered approach emphasizes on keeping power and control in the hands of the victim of sexual assault rather than the therapist(Zubernis& Snyder, 2015). This approach will identify Becky’s counseling needs in her current state of disorganization to help get her into the phase of reorganization. The initial counseling must provide emotional support with unconditional positive regard and acceptance. Specifically, Becky must first be directed talked into self-acceptance because sexual assault survivors tend to feel depressed and hopeless about their future. They also report feelings of guilt, thinking the incident was ‘their fault.’ This could explain Becky’s feelings of self-doubt, fear, and self-blame. At the moment, it is evident that Becky has spent the last year in a disorganized state of mind because she has lost personal power to resist any negativity. This disorganized state of mind has rendered her helpless and defenseless even to the traumatizing thoughts and flashbacks. To this end, therefore, the most effective way of handing power back to Becky is for the counselor to act nonjudgmental and respond to Becky as a normal, healthy adolescent girl who is merely reacting to a life crisis that can be overcome by a simple expression.
When Becky finally accepts the turn of events in her life, the counselor can initiate other treatment options in the order of their priority. It is important for to use the “Courage to Heal” workbook in reframing Becky’s developmental cognitions and rational-emotive perspectives, then lead her into practicing behavioral changes in real life social situations (Ellis, 2001)
References
Ellis, A. (2001). Overcoming destructive beliefs, feelings, and behaviors: New directions for Rational Emotive Behavior Therapy.
National Center for PTSD. (2019, April 10). DSM-5 Criteria for PTSD. BrainLine. https://www.brainline.org/article/dsm-5-criteria-ptsd
World Health Organization. (2018). WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). World Health Organization. https://www.who.int/classifications/icf/whodasii/en/
Zubernis, L., & Snyder, M. (2015). Case conceptualization and effective interventions: Assessing and treating mental, emotional, and behavioral disorders. SAGE Publications.