Looking away from the therapist

Patient is a 58 year old African American female who has been referred to facility by her daughter. She reports that she had an abusive relationship with her husband, due to which she is experiencing hallucinations and flashbacks during which she becomes completely oblivious of her surroundings and whereabouts. She has developed a phobia for neighbors, particularly males. She has sleep disorders, particularly insomnia and feels tired easily. She gets tremendously violent at times and even physically abuses her daughter. She has diabetes and hyper tension.

Her daughter stated that she had found her sleep walking at more than one instance and that she was worried that her mother had lost all hopes of a future life. The client has not received any monetary help from the father in raising the child and has currently been referred by the daughter for Medicaid for which she needs proof of current residence address and her birth certificate. SESSION GOALS: 1. To explore Client’s Post Traumatic stress Disorder symptoms. 2. To address the attributions (self blame) about the cause of previous violence and modify the negative core beliefs

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3. To assist the client with stress management strategies. 4. To assist the client to obtain the necessary documents required for Medicaid. DIALOGUE with the client FEELINGS/ANALYSIS Client walked into the room and sits opposite the therapist. S. D: (In a nervous tone) “Have you done anything about contacting my landlord and getting my residential papers for me? ” Therapist: No, not yet. How are you feeling today? S. D. : I’m not feeling too well. Therapist: Why do you think you are feeling unwell? Do you have fever? S. D.

” (Looking away from the therapist) “No, I am useless”. Therapist: Did you sleep well last night? S. D. “well actually not……” Therapist: Have you ever experienced a life-threatening event? S. D: (angrily) what do you mean? Why should anyone threaten me? Therapist: “Have you ever experienced an event that deeply frightened you and left you feeling shocked or helpless? ” S. D. : Begins to sob initialy and then cry audibly. Therapist: “Have you ever been physically or emotionally abused or have been in a physically abusive relationship as an adult? ” S. D. :Yes

Therapist: Do you have thoughts or images about the trauma that continue to bother you? If yes, please be known that if you have been victimized, it is not your fault but the fault of the person who has assaulted you! S. D. : “No…….. It was all my fault”. (Cries uncontrollably) Therapist: “Do you tend to avoid certain people, places, or situations and feel stressed, hyper, anxious, or depressed as a result of any previous experiences? S. D. : “Yes, sometimes. ” Therapist: can you write down the incidents and memories which have had a traumatic effct on your life? S. D. : why should I write it down?

Therapist sensed that Resident was agitated. Therapist feels that the client is fearful of something and is nervous coming to the office. The therapist notes that the patient may not have had a good sleep the previous night. Taking a lead, the therapist tries to press a little further and decides to ask for the reason for feeling unwell. The therapist realizes that the client is trying to avoid any kind of thoughts, feelings and dialogue associated with her previous trauma. The client also displays cognitive problems in the feeling of helplessness apparent in her response.

The therapist decides to facilitate the client so that she can grieve over the abuse she has faced (CBT) and by venting her anger and pain appropriately. While asking this question, the therapist is prepared for an emotional or violent outburst due to distrust and even hostility. The therapist realizes that this could be the “trigger” to allow the client to vent the feelings of anger and pain. The therapist takes this opportunity to establish confidence and rapport with the client and reassures that the environment is safe and supportive for the client to disclose anything which may be disturbing her.

Taking the positive cue as a go ahead, the therapist proceeds to ask the critical question. The severe physical and emotional effects such as the apparent guilt in the client are classic symptoms of PTSD. The therapist must initiate a step to rid the client of this guilt, in accordance with the cognitive behavioral therapy. The therapist has attempted this question to reduce the guilt in the client and slowly but steadily empower her that her emotional and physical state is due to the violence and abuse she faced in her marital life.

the therapist is using the “exposure therapy” to reduce the symptoms of PTSD in the client, by exposing the client to images or memories which can repeatedly expose the client to the traumatic events of abuse in her life. The therapist initiates this suggestion so that he can challenge the distorted cognitions of guilt and anger in the client, which will be somewhat reduced by reading the narratives aloud during sessions of treatment.

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