Ms. Glazier Case Summary

Cassie presents with multidimensional and complex problems. The problems are inter related and need to be addressed concurrently. This client presents with a history of anxiety and childhood sexual abuse which manifests as post traumatic stress disorder [PTSD], social phobia (social anxiety disorder) and depression. Wagner (2008) reports a strong association between social anxiety disorder and depression. Post traumatic stress disorder [PTSD] in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DMS-5; American Psychiatric Association [APA], 2013) specifically includes sexual violation as one of the diagnostic criteria for PTSD. Consequentially, co-morbid symptoms create dis-regulated behaviours which may have long

It is critical that clinicians be able to identify history of trauma in clients with psychotic disorders (Putts, 2014, p.83). Researchers reviewed the clients’ charts and found that in clients with at least one hospitalization related to psychiatric issues there was an 87.2% exposure to trauma identified by the researchers versus a 28% exposure to trauma identified by clinicians (Putts, 2014, p.83). The lack of recognition of exposure to trauma by clinicians has a significant impact in client’s experience during treatment because many of them lack the skills to bring up the topic for discussion during counseling, and many other clients are not even aware of the relationship between their traumatic experiences, and how those experiences have

On October 26, I had the pleasure of interviewing Heather Smith a clinical mental health counselor. Heather Smith is a licensed clinical mental health counselor in Alexandria Virginia. She specializes in PTSD, Anxiety, Trauma, Marital and Premarital counseling. In addition to these specialties, she also treats disorders such as Dissociative Disorders, Impulse Control disorders, and personality disorders. Ms. Smith also works closely with Women’s issues that include coping skills, sexual abuse, depression, and suicidal ideation. Ms. Smith services a population of clients ranging from adolescents (14-19), to adults as well.

The term “Psychological trauma” refers to damage wrought from a traumatic event, which that damages one’s ability to cope with stressors. “Trauma” is commonly defined as an exposure to a situation in which a person is confronted with an event that involves actual or threatened death or serious injury, or a threat to self or others’ physical well-being (American Psychiatric Association, 2000). Specific types of client trauma frequently encountered by which therapists and other mental health workers frequently encounter in a clinical setting include sexual abuse, physical , or sexual assault, natural disasters such as earthquakes or tsunamis, domestic violence, and school or/and work related violence (James & Gilliland, 2001). Traumatic

The sudden recovery of repressed memories from a traumatic event such as childhood sexual abuse can be both validating and confusing for clients that are seeking help with various problems. These new memories might be able to help client identify the cause of their feelings and issues that are affecting their life. However for others it can be a very difficult time because of the conflicting emotions about the abuser. Worst of all when dealing with the recovery of repressed memories they may be all together false. The accuracy of recovered memories in regards to sexual abuse is low and can come with significant consequences. These false memories can be very harmful to the client as

Rape Trauma Syndrome has three stages, Acute Phase, Outward Adjustment Phase and the Resolution Phase.17 The Acute Phase occurs after the initial attack (initial shock, anxiety).The Resolution Phase where the assault is no longer the focus of their life and have moved beyond it. The Outward Adjustment Phase is the stage that could last months or years and the one that the military system can affect positively with appropriate mental health care. In the Outward Adjustment Phase an individual may appear normal but have internal turmoil.18 Within this phase a majority of male survivors attempt to process it with two primary coping techniques: Minimization, the “everything is fine” and Suppression, act as if it did not happen.19 Men may use these coping mechanisms based on maintaining society’s definition of a man, so they try to minimize, suppress or internalize their perceived feelings of being weak or less of a man. This may cause anxiety in which they withdraw from relationships and avoid seeking

Clients who have experiences rape in the past can deal with traumatic reposes after the event. Many of them have to deal with the effect of the rape, such as anxiety, depression and post-traumatic stress disorder (PTSD). Clients may feel that they are held back because of the trauma that happened to them. Clients could feel helpless and be reminded every day of the trauma that they had to endure. The topic of this paper is the use of trauma informed practice using social work practice in women who have PTSD and other trauma symptoms from enduring a past rape.

Neveah reports a history of physical and sexual abuse starting at age “three or four,” with the most recent sexual abuse occurring approximately two years ago. She reports distressing dreams about the most recent trauma and difficulty falling and/or staying asleep six out of seven nights per week. Neveah displays avoidance in discussing details related to the trauma and reports blocking thoughts and memories of the most recent event. She reports the inability to remember aspect of the most recent trauma and reports remembering “small pieces” of her childhood trauma. Neveah makes statements such as “I will always be crazy,” “This will never fully go away,” and “I bring this on myself” when discussing herself and her symptoms. Neveah displays irritable behavior and angry outbursts when a peer or family member causes her to feel “mad”. Her behaviors include yelling, throwing objects, and making threats. These symptoms have been present for more than one month and are affecting the relationships with her

This assessment help formulate proper treatment options for counseling or pharmaceutical treatment. Some medications may have side effects that may cause severe problems in other areas of the body; therefore, the patient/victim must seek primary health care from their selective medical doctor. Memories of traumatic events can prominent several negative behaviors; therefore, victims and witnesses require much more support from these elements: therapy, medication, family/social support, and physician care will bring the patient back to normalcy. Ecclesiastes 4-9 (ESV), “Two are better than one, because they have a good reward for their

(Oltmanns,Emery, 2015) A trauma may include rape, which in Melinda Sordino’s case is what she experienced. Melinda Sordino can be diagnosed with posttraumatic stress disorder, as opposed to acute stress disorder, because her disturbance after the trauma had lasted longer than a month. Symptoms of posttraumatic stress disorder include intrusive re-experiencing, avoidance of reminders of the trauma, increased arousal or reactivity, negative moods or thoughts, and often dissociation. (Oltmanns,Emery, 2015) Weeks after the terrifying experience, Melinda Sordino experienced all of

Client continues to deny any mental health issues, but on 4/11/2016, she met with Dr. Shuster and an initial psychiatric evaluation was completed and the client was diagnosed with Axis 1: PTSD (Post traumatic stress disorder) F43.10 (Primary), rule out symptoms off. She was refer to participate in individual mental health treatment. Client reported she went for mental health assessment at Woodhull Hospital client need to submit medical documents.

Sara is in need of residential treatment due to her history of self-injurious behaviors, and multiple attempts of suicidal gestures. Sara requires a higher level of care which outpatient care is currently failing to provide her at this time. Sara continues to have depressive symptoms and anxious feelings for the last few months. The patient has had two acute inpatient admissions within the last 3 months and requires long term stabilization. At this time Sara requires 24 hour supervision and ongoing intervention and treatment.

Patient is a 35-year-old, single, Native American transgender female (male to female). She prefers to be called "Mariza." She currently lives in a sober home. Presented to CRU 2 via ambo from Scottsdale Osborn, Honor Health. She is NCOT for depression, anxiety and SI. Patient reports being raped on 2/17/17 by an unidentified men. Patient has filed a police report on the incident. Patient states, "I was raped and I just want to kill myself." She is calm and appropriate, but guarded. Patient endorses hx of SI through hanging, cutting her wrist, and OD on her Rx pills. Patient states, she was physically and sexual abused by her father and uncles. Patient has been receiving psychiatry services through Salt River behavioral health services on the

J.C., is a 41 year old female with a history of bipolar disease, who presented to the psychiatric department by EMS activated by shelter staff. She was brought in since she was presenting with manic behavior and psychotic thoughts. She currently lives in uptown Manhattan in an independent home but previously lived in a women’s shelter. She returned to the shelter, where she spoke words of retaliation and guns, and talked about her acquaintances at the shelter and her ex-husband however, she did not speak of any plan. The staff called EMS reporting this behavior and EMS then brought her to the hospital. On admission, she reported walking to and from Manhattan and the Bronx. She also has psychomotor agitation and has difficulty sitting down. She reports not taking her psychotic medication for the past 9 months. In addition, she reports no suicidal ideation, and has no history of violence. She also reports using substances such as marijuana, cocaine, and alcohol. She also smokes ¼ pack of cigarettes a day.

Existing controlled examinations of intervention efficacy specific to only sexual assault and rape are presently minimal in comparison to intervention examinations of combination or other types of trauma (Regehr, Alaggia, Dennis, Pitts, & Saini, 2013). Psychotherapeutic interventions that fail to differentiate sexual assault and rape victims from other types of trauma victims may decrease the treatment effectiveness or inadvertently harm participants in this subgroup. Trauma associated from rape or sexual assault differs from other forms of trauma and treatment efficacy should be examined in this manner. Trauma from rape or sexual assault entail symptoms of PTSD, depression, suicidal ideations and sexual dysfunction. Individuals may also indicate feelings of vulnerability, loss of control, fear, shame, self-blame, societal blame and stigma (Russell & Davis, 2007; Regehr et al., 2013; Ullman &Peter-Hagene, 2014). This research proposal intends to explore the long term effectiveness of Prolonged Exposure Therapy (PE) at reducing distress and trauma explicitly for adult victims of sexual assault and rape.