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Veronica has symptoms of Post-traumatic stress disorder as a result of a rape that occurred when she was 16 years old. She also engages in substance abuse in which she fails to acknowledge as a problem. The main therapeutic model to be used for her treatment is cognitive behavior therapy. This mode of therapy will be useful in eliminating the symptoms of PTSD and also in helping her realize that substance abuse is a common comorbid disorder in people with PTSD is likely to interfere in her recovery if not addressed.
Therapeutic goals will be established depending on the behavior and symptoms of Veronica’s problems. Since a good environment and a relationship have been established by the therapist and the client, Veronica will be required to describe her feelings about the rape and Marijuana abuse. From this, she will express her feelings which lead to the grieving process, and also state what she expects from this therapeutic treatment. This will help in making sure that she participates in the formulation of goals by stating what she hopes to achieve from it, for instance, the elimination of symptoms of PTSD. Veronica will take an active role in the identification of the treatment objectives by stating how the problem affects her interaction with others and how it affects her functioning as a mother, wife, and sister. This will help in evaluating how she would like those relationships to be and hence the aim of improving functioning. Since Veronica is in denial about substance abuse, the therapist will inform the client of the possible effects of the abuse on her recovery and ask her to describe how she feels and reacts before and after taking the marijuana. The therapist will not coerce her to deal with the problem but continue making her aware of how the substance abuse is related to the signs of PTSD that she experiences. The client will also be asked to explain more about her thought patterns in relation to the abuse and describe more the floating in and out of reality she had mentioned during the interview. This will help in identifying the dysfunctional thoughts and behavior and hence assist in formulating the goal of identifying and replacing the irrational thought with more effective ones.
In the processing of the traumatic event which is the rape, the client will be allowed to freely express her feelings and as she tries to analyze those feeling specific interventions such as anxiety management will be put into place. This involves teaching the client skills to help her deal with the stress associated with remembering those traumatic moments. The client is taught relaxation techniques in order to control fear as well as slow breathing to help her relax. Anxiety management will beneficial in helping the client to develop coping strategies that she may use in the future. The remembrance of the trauma which is necessary as a part of the healing process makes anxiety management imperative in dealing with emotions evoked as a result of these memories.
Another intervention at this treatment stage is exposure therapy and specifically imaginal exposure. Veronica will recount the traumatic memory until it can no longer evoke high levels of anguish in her. Initially, this will be hard for her as a victim of sexual assault, but it will assist her to cope with it since what happened cannot be reversed. This method will be useful given that it will enable her to grief properly and let out all the repressed feelings associated with the stressor which is the assault.
Replacement of the maladaptive thoughts with more functional ones is another important procedure during the treatment process. As the client recounts the event, upsetting, distorted thoughts and attitudes towards the rape are identified and replaced with more functional and rational ones. This will also entail dealing with the issue of general trust in other people. Discussion of the flashback to help decrease the fear is also a relevant strategy in therapy (Herman, 1997, p.56). This assists the client to distinguish between memories of the trauma and current trauma-related emotions
According to Neenan and Dryden (2004, p.28), Socratic questioning can also be used at this stage to help the client in opening up and develop better interpretations of the problem. This mode of intervention is also referred to as guided discovery and assists the patient to come with solutions they had not considered before. Informational interventions can also be incorporated to help the client understand the symptoms better.
The use of homework both in the session and outside the session enables the client to gain confidence and also develop competence in solving their problems. In addition, it reduces dependence on the therapist. Veronica would be required to tackle both cognitive and behavioral assignments. The cognitive homework will aid in exercising her thought patterns while the behavioral homework assists in changing her maladaptive behavior(Neenan & Dryden,2004,p.149) One of the cognitive homework’s Veronica is Bibliotherapy whereby she will read an assignment about PTSD so as to help her understand the problem and how to tackle it. Another form of homework will involve writing or journaling her feelings in a diary. This includes writing about what triggers the substance uptake as well as the thoughts that precede it. This is vital in making the client realize that substance abuse is related to PTSD.
In case of acute symptoms of PTSD between sessions and in which the client cannot manage them on her own such as chest pain, anger, and irritability the therapist should use the assistant of medical personnel to give medication to relieve those symptoms (Herman 1997). Mood stabilizers or tricyclic antidepressants would assist the client to relieve those effects. In case the symptoms do not require medication, the therapist should offer support and encouragement to the client to help her overcome the acute symptoms.
Veronica will be helped achieve the reconnection stage of recovery through facing her husband as a result of the affair, her brother as well as other meaningful aspects of her life. One of the key points in reconnection is that Veronica reconciles with herself through appreciating her positive aspects and reconnect with others too (Herman, 1997, p.57). Another way through which she will “reclaim her word” is through defending herself and establishing new relationships through support. The relationships include connecting with her brother and her mother and restore the closeness. The client is empowered to face the world and once again becomes a part of society without fear and issues.
References
Herman, Judith. (1997).Trauma and recovery. New York: Basic books. Web.
Neenan, Michael and Dryden Windy (2004).Cognitive therapy: 100 key points and Techniques. New York: Brunner-Routledge. Web.
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