Trauma case conceptualization

Running head: INITIAL CASE CONCEPTUALIZATION: PTSD 1

May 11, 2019

Initial Case Conceptualization: PTSD

Client Information

INITIAL CASE CONCEPTUALIZATION: PTSD !2

Maria is a 25 year old African American female, with four children under the age of six

years old. To ensure her protection of her identity, I will refer to her as Maria. Maria states that

she is a christian and does not attend church often. Maria reports that she would like to become

more active in church again. Maria says that she is currently in an abusive relationship with her

spouse of seven years. While she is not physically disabled, she mentioned that she is facing var-

ious psychological challenges that have made her live in an inpatient psychological hospital.

Maria says that she identifies as a female who is attracted to the opposite sex. She is currently

working two jobs to sustain her life and the lives of her four children aged six, three, one, and

two months (1boy and 3 girls). Therefore, she is financially and economically challenged; but

she has been doing the best she could to make ends meet despite her circumstances.

Maria has managed to secure a 2-bedroom apartment that she shares with her four chil-

dren. Besides her two jobs, she also seeks welfare support to help her with daycare, medical and

food assistance. Maria also mentioned that her older brother sends her checks from time to time

to help her with the children. Additionally, she makes use of food stamps that have been availed

to her to cut the cost of food. Some non-governmental organization has also volunteered to take

care of educational needs of her two older children. While her emotional and psychological state

seems a bit unstable, Maria is physically healthy, and reports that she takes care of her physical

wellbeing, by walking 3 miles per day, to catch a bus to work.

Maria presenting issues is PTSD, she has been sexually assaulted numerous of times

throughout her childhood. She seems to be trying to forget some issues of her past that bring

back bad memories regarding her sexual abuse. She seems traumatized by her sexual past, which

INITIAL CASE CONCEPTUALIZATION: PTSD !3

is apparent in how she disregards any questions about her sexual abusive past. The relevant his-

tory behind her traumatic response to sexual-related questions stems from her experiences as a

young girl. At the time of the abuse, she was living with her grandmother, cousins, uncles, broth-

ers, and aunts. From the ages of four to nine, she was sexually abused by her family members.

The trauma from those incidents has seemingly remained with her in her adult life. It is affecting

her relationship with males.

Theoretical Approach

The theoretical approach I used for Maria was Trauma-Focused Cognitive Behavioral

Therapy (TF-CBT). This is an evidence-based theoretical approach to treatment of traumatized

children, caregivers, adolescents, and their parents. According to research, TF-CBT has a high

success rate of resolving a broad array of behavioral and emotional difficulties that are associated

with complex traumatic experiences. This theoretical approach works by reducing the negative

behavioral and emotional responses following trauma, including child sexual abuse, and other

forms of ill-treatment like domestic violence, mass disasters, loss, and other related traumatic

events (North et al., 2015).

Cohen et al. (2006) conducted a pilot study for modified cognitive behavioral therapy for

childhood traumatic grief (CBT-CTG). The purpose of this study was to evaluate the outcomes of

a modified 12-session protocol on cognitive behavioral therapy for CBT-CTG and was conduct-

ed between March 2004 and October 2005. The findings of the research suggested that the short-

ened CBT-CTG protocol, which is similar to what most child bereavement programs offer, is

widely acceptable and has a high level of efficacy for the population selected. As such, the CBT-

INITIAL CASE CONCEPTUALIZATION: PTSD !4

CTG approach led to the healing of CBT and post-traumatic stress disorder symptoms, which led

to decreased anxiety, child depression, and behavioral improvement. In another study conducted

by Cohen et al. (2012) titled “Trauma-focused CBT for youth with complex trauma”, the authors

identified that many youths develop complex trauma which includes regulation issues in the do-

mains of affect, behavior, attachment, cognition, biology, and perception. Their research seeks to

describe the practical strategies for applying TF-CBT for youth who are positively diagnosed

with trauma. The results indicate that data from youth suffering from complex trauma supports

the use of TF-CBT strategies for successful treatment. In their article, “Trauma-focused cognitive

behavioral therapy for children: impact of the trauma narrative and the treatment length”, De-

blinger et al. (2011) reported that mixed model analyses demonstrated that significant post-

treatment improvement has occurred in regard to the outcomes of the conditions identified prior.

Using the TF-CBT was instrumental in helping to select the kind of information I was

looking for in Mrs. X. After reviewing the most common treatments using the TF-CBT approach,

I was able to pursue my information collection approach by inquiring about any traumatic events

that my client had undergone during her upbringing. When she mentioned the sexual abuse case

at a tender age of four years, the symptoms that she was manifesting were proven. The treatment

of post-traumatic stress disorder focuses on the correction of upsetting or distorted attributions

and beliefs related to the traumas. As such, it provides a supportive environment in which the

victim is encouraged to talk about their traumatic experiences as well as learn skills that will help

them to cope with ordinary stressors originating from the incident (North et al., 2016). This was

applicable to the case of my client because she confessed that she was afraid of contact with me,

which is why she had avoided dating as much as she could. TF-CBT additionally helps parents

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who have not been abusive to cope with their children’s emotional distress and develop skills to

help their children (Pai, Suris, & North, 2017). This is the treatment that Mrs. X needed; this the-

oretical approach was very helpful in ensuring we worked towards that direction together.

Assessment and Diagnosis

The following is the initial DSM-5 and ICD Code 10 criteria that Maria was diagnosis

with: Post traumatic Stress Disorder 309.81 (F43.10), after collaborating with other profession-

als the F43.12 post-traumatic stress disorder chronic level best fit this client.

Criterion A: Stressor, Maria was exposed to sexual violence directly.

Criterion B: Intrusion symptoms. The sexual abuse Maria experienced persistently across

a period of five years led to unwanted upsetting memories, flashbacks, emotional distress, and

physical reactivity whereby she hates the physical touch of men.

Criterion C: Avoidance. Maria avoids any sexual-related stimuli as she mentions that she

is very wary of dating due to the mere memory of her sexual abuse earlier. Due to these trauma-

related thoughts and feelings, men are actually trauma-related external reminders.

Criterion D: Negative alterations in cognitions and mood. Maria recounted that she has

negative thoughts and feelings about her own girls that began after she gave birth to them. This is

demonstrated in her inability to remember some features of the trauma, overly negative assump-

tions, depressive thoughts about herself and the world, an exaggerated blame on herself for not

moving on with her life, decreased interest in dating, and difficulty in experiencing life positively

due to a feeling of constant isolation.

INITIAL CASE CONCEPTUALIZATION: PTSD !6

Criterion E: Alterations in reactivity and arousal. Maria has trauma-related arousal that

began and worsened with her sexual abuse. She is irritable when asked about dating; she is hy-

pervigilant; she has difficulty concentrating, and sometimes she has cases of sleeplessness.

Criterion F: Duration. The symptoms have been prevalent for a long time since the inci-

dent happened and are still going on.

Criterion G: Functional significance. Maria symptoms have caused her distress. She dis-

closed that she has been fired from some of her previous jobs due to functional impairment relat-

ing to her poor social interactions at the job.

Criterion H: Exclusion. Maria loves solitude and enjoys her solitude which are symptoms

not related to any substance use or other illnesses.

Based on the DSM-5 criterion results, and for billing purpose the ICD code 10 that

would be used for billing for this case is F43.12 post-traumatic stress disorder chronic level,

because she had still been experiencing the post-effects of her traumas (Pai, Suris, & North,

2017).

To reach a diagnosis, I compiled the information from each session with the information

from the previous sessions while looking for patterns. Within my assessments, I made use of

such instruments as checklists for anxiety, depression, trauma, and other related checklists. I,

however, did consult with other professionals about Maria. I depended entirely on my abilities to

decipher information and research. I also put into consideration the sociocultural factors relating

to the stereotypes towards African Americans when presenting this paper. All the information

collected from the diagnosis process was very instrumental in my choice of the theoretical ap-

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proach (CF-CBT) because the conclusion reached from the diagnosis was that this was a case of

posttraumatic stress disorder. I, therefore, had to match the theoretical approach to the condition

that Maria was suffering from, and the result was fully supported by the CF-CBT theoretical

framework.

Counseling Goals

The first goal was to reduce irritability when discussing her sexual abuse incident. Maria

stated that this was standing in the way of her social life, and romantic relationships . The objec-

tive is to help her to increase her comfort with social situations; the progress should be measured

through a self-assessment report given to Maria. This process will take up to 6 months.

The second goal is to increase Maria’s ability to make sense of traumatic experiences and

come to emotional terms with them. This goal will ensure that Maria does not have intense emo-

tional and physical reactions when reminded of the sexual abuse. The process will take roughly 6

months.

The third goal is to increase Maria’s participation in activities she previously avoided, for

instance, dating. This will ensure that Maria gets the emotional support she needs from a sexual

partner. This is projected to take 8 months.

Maria’s assessment information and diagnosis were critical in formulating the counselling

goals because it highlighted the various areas she needed help with most. When selecting these

goals, I considered that since Maria is a single mother, she would require more time to adjust

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than a regular person would. The three goals highlighted are reflective of the CF-CBT approach

because they underline the focus to reduce the impact of the trauma that Maria endured.

References

INITIAL CASE CONCEPTUALIZATION: PTSD !9

Cohen, J. A., Mannarino, A. P., & Staron, V. R. (2006). A Pilot Study of Modified Cognitive-Be-

havioral Therapy for Childhood Traumatic Grief (CBT-CTG). Journal of the American

Academy of Child & Adolescent Psychiatry, 45(12), 1465-1473. Doi:10.1097/01.chi.

0000237705.43260.2c

Cohen, J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma-focused CBT

for youth with complex trauma. Child Abuse & Neglect, 36(6), 528-541. Doi:10.1016/

j.chiabu.2012.03.007

Deblinger, E., Anthony P., Judith A., Melissa K., & Robert A. (2012). Trauma-Focused Cognitive

Behavioral Therapy for Children Affected by Sexual Abuse or Trauma. PsycEXTRA

Dataset. Doi:10.1037/e552572013-001

North C.S., Surís A.M. Smith R.P., & King R.V. (2016). The evolution of PTSD criteria across

editions of DSM. Annual Clinical Journal of Psychiatry, 28:197–208.

North C.S., Suris A.M., Davis M., & Smith R.P. (2015). Toward Validation of the Diagnosis of

Posttraumatic Stress Disorder. American Journal of Psychiatry, 166:34–41.

Pai, A., Suris, A., & North, C. (2017). Posttraumatic Stress Disorder in the DSM-5: Controversy,

Change, and Conceptual Considerations. Behavioral Sciences, 7(4), 7. Doi: 10.3390/

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