Sarah is a 35-year-old lady who has come for treatment complaining of depression, anxiety, and difficulties in regulating her emotions. Born into a highly tumultuous family environment, she concedes to pervading childhood trauma – in the form of both physical as well as emotional abuse by her parents. The trauma is still further complicated by a highly recent traumatic event in Sarah’s life, a devastating car accident – that serves to add intense emotion to the same. She is unemployed, encountering financial troubles, and lives alone. She feels very isolated from everyone around her: friends and family.
Comprehensive Trauma-Informed Assessment
In terms of observations of behaviors, Sarah suffers from symptoms that reflect avoidance, withdrawal, and impairment in daily life functions. Emotionally, she has to deal with frequent episodes of sadness, hopelessness, fear, and panic. She is psychologically torn by low self-esteem, negative self-talk, and an intrusion of memories due to traumatic experiences. She spiritually feels disconnected from any spiritual self. Socially, Sarah lacks social support, and this overall perception tends to make her feel socially isolated and lonely. While Sarah seems to have a somewhat stable home life, other environmental stressors are also involved, as the overarching societal stressor of being unemployed is coupled with a lack of financial stability. From a cognitive perspective, Sarah’s thought content is harmful and punishing to oneself.
Among the strengths and protective factors, Sarah strongly seeks help and admits she needs support. She is aware of her problems and, most importantly, is motivated to improve. What is more important is that Sarah can access health services and open herself to various treatment interventions.
To assess Sarah’s current state, the standardized measure that would be advised would be the PTSD Checklist for DSM-5 (PCL-5). This arises from having dealt with a lifetime traumatizing experience and another new trauma in her life; there is a specific emphasis placed on post-traumatic stress symptoms within this particular measurement. The choice of PCL-5 in these recommendations arises from its help in identifying the severity of Sarah’s condition and because it provides quantifiable data points for the sole purpose of tracking her progress through the length of therapy.
Diagnosis and Differential Diagnosis
Primary Diagnosis
The diagnosis was primarily PTSD, which reverberates most aptly with Sarah’s clinical profile. Her development to trauma from childhood, along with last week’s traumatic event related to the car accident, fits explicitly with the stipulated criteria stated within the DSM-5 for PTSD—symptoms relating to intrusive memories and avoidance behaviors.
Differential Diagnosis
- Major Depressive Disorder (MDD): Due to the shared symptomatology of sadness, hopelessness, and emotional dysregulation, MDD was being considered. Upon further review, it appears that Sarah has many depressive symptoms, including sadness, hopelessness, and emotional dysregulation, though those are also present to a lesser extent (Lanktree & Briere, 2017).
- Generalized Anxiety Disorder (GAD): Considering that anxiety symptoms were the dominant ones in her report, GAD would be another consideration. However, the fact that her anxiety is primarily related to the intrusive memories and trauma cues does firmly put the diagnosis of PTSD in her case (Blaustein & Kinniburgh, 2019). GAD usually includes much worry about different things in life, rather than Sarah’s case, where most events tie it down to trauma.
Treatment Plan Goals
Reduce Symptoms of PTSD and Improve Overall Mental Health
This seeks to use trauma-based evidence interventions on Sarah, which include intrusive memories, avoidance behavior, emotional regulation, and hyper-arousal to the trauma. The intervention here is trauma-focused cognitive-behavioral therapy (TF-CBT), a widely recognized trauma intervention (Blaustein & Kinniburgh, 2019). TF-CBT allows the application of alternative exposure techniques in managing avoidance behaviors, all under the predispositions of cognitive restructuring and training in altered modes of coping or emotion regulation.
Enhance Coping Skills and Emotion Regulation Strategies
This is an approach that would give Sarah practical means of coping and being in control over her emotional regulation to address distressing symptoms and daily stressors. The reaction includes mindfulness-based interventions through mindfulness meditation and grounding exercises to help Sarah acquire self-awareness with emotional regulation (Blaustein & Kinniburgh, 2019). It will instill further distress tolerance and improve interpersonal effectiveness skills that will prepare her to increase coping mechanisms and fortitude to handle difficulties, from the skills in Linehan’s Dialectical Behavior Therapy (DBT).
Increase Social Support and Decrease Feelings of Isolation
A particular focus would be developing a rapport with some strong, supportive people who would help Sarah reduce feelings of isolation and loneliness. In this direction, the intervention would help her become a part of some support groups or peer-led initiatives through which she gets to communicate with those similar to her people so that mutual support and understanding develop (Blaustein & Kinniburgh, 2019).
Trauma-Informed Practice Elements
Psychoeducation
In the psychoeducation process, the therapist’s purpose is to provide Sarah with a deeper description of PTSD as an illness, her reaction to trauma, and how it continues to impact her mental well-being (Lanktree & Briere, 2017). Psychoeducation materials that offer an understanding of such experiences not only come in a static format but also through participatory mediums where clients like Sarah get engaged in discussions that provide more enlightenment regarding her symptoms.
Safety and Trustworthiness
One of the cardinal necessities of Sarah’s healing process is a habituated and trustful environment—one in which she is free to test her experiences and can voice and trust herself without the burden of fear. The strategy implemented should ensure clear boundaries and explicit expectations for this therapeutic relationship, resulting in an environment focusing on safety and trust (Lanktree & Briere, 2017). I will secure both the emotional and physical safety of the client at all times in a session through the employment of trauma-informed therapies, considering that in recovering from past trauma, clients are undergoing a most vulnerable process.
Empowerment and Collaboration
Promoting change with the principles of empowerment and collaboration encourages active participation by Sarah and the practitioner in building a joint treatment plan consistent with her goals, strengths, and preferences. This comprises shared decision-making processes, setting common treatment goals, and choosing interventions according to Sarah’s desires, needs, and values (Lanktree & Briere, 2017). Regular feedback will be solicited from her to incorporate her inputs in the treatment plan so that there remains a continuous dialogue that helps take care of her evolving experiences and provokes and reinforces her sense of ownership and empowerment for her recovery.
Social Cultural Issues
The patient’s age, 35 in this case, really determines the therapeutic approach: how willing she will be to take an active part, to be open in expression, and ready to accept the material of treatment interventions. Developing programs relevant to her experience, cultural context, and generational perspective is critical. Secondly, Sarah’s identity plays a crucial role in her self-concept and the coping strategies with which she handles her environment and feels secure in the therapy room. Therefore, this makes culturally appropriate care important so that the therapy can acknowledge, take into account, and positively reaffirm some of the unique difficulties and strengths such a racial identity offers. This consideration can help build effective communication strategies, which is equally essential if providing services in the United States is her proficiency and immigration status, and providing keen attention to the language needs in acculturation impacts the mental health process. Identifying possible language barriers and offering language-sensitive materials will increase Sarah’s involvement or comfort in the sessions. These gender roles, in turn, influence Sarah’s expression of emotions and her need for help; therefore, we merit a gender-attuned examination that supports rather than presumes ways for her to seek out and express emotions.
Managing Countertransference
The whole engagement in Sarah’s case extracts an array of emotional, psychological, and physical responses—countertransference. I easily give my most profound empathy and, at most times, share sad feelings because of the magnitude of her trauma history. The tales of abuse trigger a protective reaction and, from time to time, even soft frustration about those who have brought this about. As far as I can understand, these reactions arise from my affective history, further subjected to the natural human tendency to suffer empathically with others. In clinical situations, I regularly review discussions and do emotional processing under supervision so that emotional contagion does not distort the therapeutic alliance. Besides their treatment setting, in personal therapy, people can talk about any unresolved issues after coming up within the context of a session with Sarah. Emotionally tuning into my reactions is extremely helpful and aids in understanding Sarah’s experiences at a deeper level, helping me tread the fine line between empathy and professional detachment.
References
Blaustein, M. E., & Kinniburgh, K. M. (2019). Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency (2nd ed.). The Guilford Press. New York, London.
Lanktree, C. B., & Briere, J. N. (2017). Treating Complex Trauma in Children and Their Families: An Integrative Approach. Los Angeles: SAGE.
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