Clinical Case Analysis of PTSD - Essay Example

? Posttraumatic Stress Disorder PTSD involves a disorder of anxiety which is normally severe and develops due to exposure to conditions which may lead to psychological trauma. These conditions may involve a death, threat to an individual’s self, someone else or to an individual’s sexual, physical or psychological integrity, which may surpass the ability of an individual to cope. The symptoms of PTSD that can be diagnosed include the re-experiencing of the real trauma through nightmares, flashbacks, increasing the arousal, and staying away from the stimuli that is linked to the trauma (Burgress, & Holmstrom, 2009). A diagnostic criterion that is formal, demands that the symptoms, and effects last for a period longer than a month (Boeschen, Sales, & Koss, 2008). This means that there would be a significant disability in the occupation, social, and other vital functioning areas. This paper explores a case study in abnormal psychology. The paper explains the case overview, case conceptualization, and the treatment plan of a client. Part one. Rowley Jocelyn was a student at Midwest University. She was a single lady aged 20 years and an extremely wonderful student. Jocelyn had a hard time in studying because her grades had just dropped suddenly. The drop in the grades, relationship problems, and sleeping problems, made her to visit a therapist. It was the only time that Jocelyn had sought such services (Oltmanns, Martin, Neale, & Davison, 2011). Even though she did not like being alone, she was not interested in her boyfriend. She informed the therapist that whenever she concentrates on a certain task, vivid violent images overcome her. These symptoms happened suddenly making her to develop fear. To be precise, the symptoms started approximately two months before she sought the counseling services from the university. In the two months she used to experience nightmares concerning dark clothed men attempting to hurt her (Oltmanns, Martin, Neale, & Davison, 2011). She therefore avoided sleep so as to avoid the threatening nightmares. In the day time she was startled whenever a person tapped her from behind. During studying of English books, some brutality images intrude her thoughts. This made her not to concentrate on her school work. Despite this Jocelyn reported some challenges with her boyfriend. The two had differed many times in the past weeks, yet she failed to identify specific relationship problems. These challenges made her boyfriend to keep a distance leaving Jocelyn alone and abandoned. After a number of therapies, Jocelyn told her therapist that an English assistance teaching assistant raped her. This had happened two months before the therapy. From her explanation, the therapist found out that she did not report the case to the police and convinced Jocelyn to visit the police station and file a case. Jocelyn was afraid of reporting this incidence as she feared further humiliation. In the next session, Jocelyn explained the story concerning the rape incidence. According to Jocelyn, she went to the teaching assistance to seek help concerning an English paper (Oltmanns, Martin, Neale, & Davison, 2011). The teaching assistant asked Jocelyn to visit his house one night in order to be tutored. Arriving at the house, she found out that the teaching assistant was living with a number of graduate students and was extremely busy working. She was left in his room to continue with the study of English. When the teaching assistant came back, he came towards her from behind as she was reading, and then grabbed her. He raped her by forcing her on his bed. Jocelyn protested verbally in vain. She did not yell aloud since she was scared that the other men in the house could not help her anyway (Oltmanns, Martin, Neale, & Davison, 2011). After the incidence, the Teacher Assistant warned her not to report the incidence and escorted her towards her dormitory. At that time, Jocelyn agreed knowing that silence could have helped her erase the memories and stop them from affecting her. In her dorm she tried to take a shower so as to wipe away the rape effects. When explaining the event, she trembled and was breathy. Even though, Jocelyn was convinced that the rape event could not affect her life, when she thought of it, it reoccurred in her thoughts. She even started to feel guilty and stupid for going into the house of the Teaching assistant. At some point she thought that her behavior was the cause of that rape. This incident made Jocelyn to miss the sections of the English discussion hence her poor performance. Part two. Even though, the medical and legal definitions may vary, rape is identified as an anal, vaginal or oral penetration involving force or threats towards a person who is unwilling. The penetration in this case, is known as statutory rape whenever the victims are younger than the consent age. In the case of Jocelyn, she was assault sexually by the Teaching Assistant. A sexual assault is any sexual contact that comes from coercion, being grabbed, touched, shown genitals, or kissed (Boeschen, Sales, & Koss, P. 2008). On the other hand, rape is a feeling of anger, aggression, need for power, and psychological torture. It is normally extremely violent compared to sexual assault and it leads to injuries to the genitals. In the case study, Jocelyn went through a rape instance. In this case, she experienced extragenital injuries, psychological torture, and genital injury. Apart from this, it could also have lead to sexual transmitted disease or unwanted pregnancy (Boeschen, Sales, & Koss, 2008). Jocelyn as a rape victim was referred to an emergency department of a hospital. The place is always staffed with the practitioners trained to handle rape cases. During the evaluation, she went through a medial assessment, a prevention and treatment of STDS, injuries, and pregnancy; forensic evidence collection psychologic evaluation, and psychologic support. The clinical diagnosis of Jocelyn involved a 5-axial, provisional diagnosis. This is a system that is used to classify different, disorders and illness. If they are considered together, the 5 levels provide the treatment giver a full diagnosis including the factors that influence the psychiatric conditions (Bohner, Jarvis, Eyssel, & Siebler, 2005). It is a useful tool, as it has a big role in the planning of an effective treatment. These levels are mostly referred to as axes. They include: Axis I: This is an axis that is normally reserved for developmental, learning and clinical disorders. In Jocelyn’s case, the disorder that presented itself in this category is axial I: post traumatic stress. She experienced increased, anxiety levels, which she found hard to cope. She also experienced difficulties in sleeping since she avoided the sleep so as to avoid nightmares (Ben-David, & Schneider, 2005). In many situations, she found it hard to stay asleep, and experienced nightmares, which is a symptom of PTSD symptom re-experiencing. This was a clear indication that she was going through the hyper arousal PTSD symptoms (Bohner, Jarvis, Eyssel, & Siebler, 2005). Axis II: This is an axis that deals with mental retardation or personality disorder. In this case, Jocelyn was diagnosised with axis 1: dependent personality disorder. This is a condition, in which, a person may depend too much on another person in going about her physical and emotional requirement. The key symptom of this disorder is that, an affected person fails to trust her own ability in making decisions (Bohner, Jarvis, Eyssel, & Siebler, 2005). Such people may be annoyed through loss, and separation. Such people may suffer an abuse in a relationship, but remain in that relationship. In the case of Jocelyn, she was abused by the T.A but did not report the incidence to the police. When her boyfriend stayed a distance form from her, she felt abandoned. Axis III: This is an axis which covers the physical and medical disorders or conditions. In Jocelyn’s case, there was no diagnosis in this category. Axis IV: This is level in which the factors affecting the psychiatric disorder and the outcome of treatment are indicated. There are many factors that may affect the disorder faced by the client (Jocelyn). Some of these factors include social issues, educational problems, work problems, legal problems, environmental and other psychosocial challenges, and the absence of enough support system (Ben-David & Schneider, 2005). Jocelyne went through most of these effects especially when her boyfriend stayed away from her accusing her of cheating on him. Jocelyn also lacked the support from her roommate. This is evidenced when her roommate accused her of lying and pointed out differences between them. Her boyfriend was self centered and unfortunate towards the incidence when he got informed. Axis V: This diagnosis is for the global, assessment function (GAF). It involves 100-point scale in which the professional of mental health will use in describing the general patient’s performance level in the daily activities, occupational, social, interpersonal, and academic functioning (Ben-David & Schneider, 2005). Part three. Treatment plan. Recipient Information Provider information Medicaid Number: 87654321 Medicaid Number: 47829737 Name: Rowley Jocelyn Name: Brian Enrick DOB: 15-10-1982 Treatment plan date: 1-11-2010 Other involved Agencies: Plan to coordinate services: Charles Peters, M.D., Psychiatrist Contacts of phone done in the first treatment month, then as required, or at least once every 2 months. Medication(s) Dose: Frequency: Indication: Prozac 40mg 1 x day depression 1. Symptoms: sadness displayed depression, poor self esteem, suicidal ideation, low energy, and fear. Goal for the long term: The depression and psychological symptoms would be reduced hence no interference to Maya’s functioning. Measurements of this would be done using a t score having 60 on the YSR depressed/withdrawn scale during the discharge. The injuries to the genitals would be treated. The completion date that is anticipated is 4-2-2011 Short term Goals: 1. Jocelyn would come up with a safety plan. 2. Jocelyn will take part in a sport activity or extracurricular activity. 3. Jocelyn will be giving a report concerning the suicidal ideation for duration of 3 weeks. 4. Jocelyn will develop the skills of coping like emotional regulation, and problem solving. The skills would be measured by her maintaining her rapport with her roommates. 5. Jocelyn will learn the identification of negative, maladaptive thoughts and how these could be replaced with adaptive positive thoughts. The skills would be measured by her showing out the skills during sessions of therapy. Established date 1-11-2010 1-11-2010 1-11-2010 1-11-2010 1-11-2010 Completion date projected 1-11-2010 1-12-2010 4-1-2010 4-2-2010 4-3-2010 Date achieved 1-11-2010 Action/Intervention Persons Responsible Individual therapy of helping Jocelyn implement and learn skills of copying and helping her to find out the process and feeling resolving. 1. Charles Peters, Ph.D. 2. Brian Rock Family therapy in developing safety plan, give psycho-education concerning depression so as to increase the communication of parents towards Jocelyne and their ability to encourage and support her in the utilization of the upcoming skills of coping. 1. Charles Peters, Ph.D. 2. Mr. and Mrs. Rowley, Father and Mother. Medical Management John Homer, M.D. Review Date: Progress Review Date: Progress 2. Symptoms: Conflict in the family as displayed by the parents being strict concerning curfews and dating. In order to come up with a baseline, Mr. peters was requested to record for two weeks: The number of occasions that he tried to talk to Jocelyn concerning the concern and she withdrew or was evasive. Jocelyn withdrew from her parents 16 times in the two weeks. Long term Goal: Reduction of the family conflict thus increasing the family interactions. Measurement would be done through the reduction of withdrawal interactions. The family was to report about two interactions for two consecutive weeks. Short term Goals: 1. Obtaining the baseline data on interactions that are withdrawn with her husband 2. Family form communication routine times in a week. Measurements would be done by family forming communication schedules. Date Established 1-11-2010 1-11-2010 Completion date projected 1-11-2010 24-11-2010 Achieved date 1-11-2010 Intervention: Therapy of the family to help and explore family dynamics, family problems, negative patterns, and problems in the family. Persons responsible: 1. Charles Peters 2. Brian Rock Therapy that is individual in exploring process, and resolving Jocelyn’s feelings about the English Teaching Assistance, structure and rules, and reinforcement of good communication, coping skills, and conflict resolution 1. Charles Peters 2. Brian Rock Review Date: Progress: Review Date: Progress: Involvement of Family: The parents will take part in the family therapy and go through the homework assignments so as to better the functioning of the family. Joselyn’s mother will formally monitor the symptoms of Jocelyn, progress and problems. Services beyond the organization scope that may be needed Management of Medication By Dr. Akatu Johnstone Estimated date of completion for the care level: 4-4-2011 Patient Signature: Provider Signature: Enricksbrian , Ph.D. Should be a real signature, No rubber stamped signatures, Electronic signatures are allowed. Date: Title of the provider: Brian Enrick, Ph.D., licensed psychologist. References Ben-David, S. & Schneider,O. (2005). Rapes perception, roles attitudes, and victim-perpetrator acquaintance. Sex roles, 53, 385 -399. Boeschen, E., Sales, D., & Koss, P. (2008). Rape traumas in courtrooms. Psychological, Public Policies, and Laws, 4, 414-432. Bohner, G, Eyssel, F, Jarvis, C, & Siebler, F. (2005). Impacts of rape myths acceptance on men rape proclivity: Comparison of sexually coercives and non-coercives men. Europeans J of Social Psychology, 35, 819-828. Burgress, W, & Holmstrom, L. (2009). Rape trauma and Abnormal psychology. New York : Oxford Publishers. Oltmanns, T, Martin, T, Neale, J & Davison, G. (2011). Case study in abnormal psychologies. New York: John Wiley & Sons. Read More