Sample Psychology Paper on Post traumatic stress disorder case study

Rhonda is a 28-year-old female referred to your agency by a local probation officer.  Rhonda reported that she has “fired” three counsellors and, most recently, was “kicked out” by her counsellor at a local community agency. Rhonda stated that she “fired” her previous counsellors because they were “clueless and didn’t get me.”  Her most recent counsellor “kicked me out because I threatened to kick him as if he didn’t back off.”  You note that she smiles as she repeats her threat to the previous counsellor. She then lets you know she is on probation for alcohol use and her “anger issues.”

Rhonda states she seeks a counsellor who can “handle my past and actually knows how to help me get over it.”  Rhonda then tells you she had 19 surgeries before age 10 to resolve a generic heart defect. She reports that she continues to be under the care of a cardiologist because her heart condition will continue to be an issue throughout her life. Rhonda reports experiencing significant anxiety whenever she drives by a hospital or has to go into a hospital to visit friends.

During the first ten years of Rhonda’s life, she was sexually abused by a neighbour. Rhonda reports that she was also sexually abused by her sister during the same period and continued until her sister moved away to college. Rhonda was 16 years old when the sexual abuse from her sister stopped. Rhonda disclosed to her mother the abuse she experienced from the neighbour and her sister shortly after the neighbour was charged with sexually abusing another child. Rhonda’s mother stated that she did not believe that Rhonda’s sister had abused Rhonda because “I am a good mom and would have known if something like that was happening under my roof.”  However, her mom did believe Rhonda’s disclosure of sexual abuse by the neighbour. Still, she felt there was no need to report Rhonda’s abuse when the neighbour, who had already been charged for abusing a different child in the neighbourhood, would go to jail. Rhonda states that her relationship with her mother has been “hot and cold” ever since Rhonda disclosed the abuse.

She also reports that she is unsure whether her father is aware of the abuse she endured from the neighbour and her sister; Rhonda never disclosed this information to him directly, but she suspects her mother would have told him. The family never discussed Rhonda’s disclosure of sexual abuse, and Rhonda does not know whether anyone ever confronted her sister about the abuse. Rhonda has never talked to her sister about it and avoids most family gatherings that she expects her sister to attend. Rhonda states that she regularly gets high if she finds herself at family gatherings that her sister attends.

Rhonda reports that she continues to have flashbacks of different episodes of abuse. She identifies her heart surgery scars as a trigger. She states that when anyone, including herself, touches her scars, she gets flashbacks of the sexual abuse by her neighbour because his large hands would brush over her scars when he was fondling her breasts. She also identifies the smell of a particular lotion to be a trigger of the abuse she endured from her sister. She states she can still not tolerate the smell and texture of any lotion and has never bought a bottle of lotion as an adult.

Rhonda is currently unemployed but is looking for a job. She reports that she has a difficult time maintaining employment because she moves around a lot. When asked what causes her to move around a lot, she reports that she has had a few relationships (six in the last year) that did not work out well and that she was living with each of them at the time of the breakups. Rhonda states she is currently “trying on” being a lesbian because she believes that “women are more understanding than men, so maybe a woman would get me better and not leave me.”  Rhonda said that she struggles to manage her money or maintain any relationship stating that “most people in my life end up leaving me.”

When asked what she had been working on with previous counsellors, Rhonda stated that she had been working on different coping skills. In the past, Rhonda would harm herself or get high when her trauma was triggered. She now tries to engage in deep breathing and relaxation techniques, but “they aren’t as effective as burning myself.”  Rhonda does report a history of suicidal ideation and identifies that she typically feels suicidal when the other person ends her romantic relationship. Although Rhonda reports a history of suicidal ideation, she reports no attempt to take her life.

Rhonda is coming to counselling to comply with her probation. She is currently working on substance abuse issues with another counselling agency. She had been clean and sober for six months. Rhonda is coming to your agency (outpatient setting) with the hopes of working on her past sexual trauma. She states that sexual trauma is the root of her anger, relationship problems, and substance abuse issues. She believes that if you can “make the bad stuff in my past go away,” she can get off probation and stay out of trouble.

Diagnoses: Posttraumatic Stress Disorder and borderline personality disorder.

Justification 1:

Rhonda reported experiencing a lot of anxiety whenever she drives by a hospital or when she has to go to a hospital to visit friends. Rhonda also reports experiencing flashbacks of different episodes of abuse. The lady identifies her heart surgery scars as a trigger and the smell of a particular lotion. Rhonda is currently unemployed and has difficulty maintaining employment due to her moving around a lot. The lady has had six different relationships in the past year. Rhonda engages in substance abuse and self-harms to cope with her trauma. She has a history of suicidal ideation when the other person ends her romantic relationship.

Justification 2:

Rhonda has been referred to an agency by a local probation officer due to her “anger issues.” She reports that she had “fired” three counsellors in the past and most recently was “kicked out” by her counsellor at a local community agency because she threatened to kick him if he didn’t back off. Rhonda reports having had a “hot and cold” relationship with her mother since disclosing her abuse. She has difficulty maintaining employment due to moving around a lot and has had six relationships in the past year. She engages in substance abuse and self-harm as coping mechanisms.

Differential Diagnoses: Anxiety Disorder.

Justification:

Anxiety disorders are characterized by persistent fear, worry, or dread of everyday situations. Anxiety disorders manifest in various ways, including panic attacks, phobias, social anxiety, and obsessive-compulsive disorder. Rhonda experiences significant anxiety when she drives by a hospital or has to go into a hospital to visit friends, indicating an anxiety disorder.

 

 

 

 

Treatment Plan

 

Problem/Concern #1: Rhonda has post-traumatic stress disorder and its associated symptoms.
Goal #1: Rhonda will develop the ability to identify and manage her triggers and symptoms of post-traumatic stress disorder to reduce their intensity and frequency.
Treatment Objectives Interventions Expected Date
1a. Rhonda will learn to identify and manage her triggers of post-traumatic stress disorder within three months. 1. a.i Rhonda will be educated about PTSD and its symptoms.  
  1. a.ii The lady will be taught relaxation techniques to help her cope with her triggers.  
1b. Rhonda will develop the ability to recognize and manage her symptoms of PTSD within three months. 1. b.The lady will receive cognitive-behavioural therapy (CBT) to help her recognize her symptoms and develop coping strategies to manage them.  
  1.b.ii Rhonda will be taught mindfulness techniques to help her focus on the present moment and reduce her symptoms of post-traumatic stress disorder.  

 

Problem/Concern #2: Rhonda has borderline personality disorder and its associated symptoms
Goal #2: Rhonda will develop the ability to manage her emotions and impulses to reduce the frequency and intensity of her impulsive behavior.
Treatment Objectives Interventions Expected Date
2a. Rhonda will learn to identify and manage her emotions within the shortest time possible. 2. A.i The patient will be educated about borderline personality disorder and its symptoms.  
  2.a.ii Rhonda will be taught emotion regulation techniques to help her manage her emotions.

 

 
2b. Rhonda will develop the ability to recognize and manage her impulses. 2. B.i The patient will be provided with dialectical behavior therapy (DBT) to help her recognize and manage her impulsive behaviors.  
  2. B.ii Rhonda will be taught problem-solving skills to help her solve her behaviors appropriately.  

 

 

 

 

MHS 6070: HW #2, Case Study Rubric

Student Name: _____________________________Total Score: _________________

 

Areas of Competency Exceeds Expectations Meets Expectations Below Expectations Score
Diagnosis

 

Correct diagnosis

 

20 points

Error(s) in diagnosis

 

10 points

Incorrect diagnosis

 

0 points

20

10

0

Code Correct code

 

5 points

  Incorrect code

 

0 points

5

0

Specifiers Correct specifier

 

5 points

  Incorrect specifier

 

0 points

5

0

Correct recording procedure for diagnosis

 

Correct recording procedure

 

10 points

One or more errors in the recording procedure

 

5 points

Incorrect recording procedure

 

0 points

10

5

0

Problem/Concerns Identified accurate problems/concern.

 

10 points

  Identified inaccurate problem/concern.

0 points

10

5

0

Goal Identified accurate goal statement.

 

10 points

  Identified inaccurate goal statement.

0 points

10

5

0

Treatment Objectives Identified 2 accurate treatment objectives.

 

10 points

Identified 1 accurate treatment objective.

 

5 points

Identified inaccurate treatment objectives.

0 points

10

5

0

Interventions Identified 4 accurate interventions.

 

10 points

Identified accurate interventions.

 

2.5 points of each

Identified inaccurate interventions.

 

0 points

10

5

0

Expected Date Identified appropriate expected dates.

 

10 points

  Did not identify expected dates.

 

0 points

10

5

0

Suicide risk assessment (CACREP Standard 2.F.7.c) Indicates a thorough suicide risk assessment in treatment plan.

 

10 points

Mentions a suicide risk assessment (but lacks specificity)

 

5 points

Did not indicate suicide risk assessment in treatment plan.

 

0 points

10

5

0

TOTAL POINTS       100

 

Exceeds Expectations: Demonstrates evidence of strong knowledge, skills and dispositions in this area.

Meets Expectations: Demonstrates evidence of limited to satisfactory knowledge, skills and dispositions in this area.

Below Expectations: Demonstrates little to no evidence of knowledge, skills, and dispositions in this area.