Introduction
Amy, the main character in this case study, is experiencing a crisis. She is a Native American and Caucasian mixed woman of 25 diagnosed with anxiety and is now seeking therapy. Amy has trouble walking around campus and complains of anxiety, fear, stress, hyperventilation, flushing, and difficulty swallowing. She was sexually assaulted during her senior year spring break, and she now has trouble concentrating in class and finding romantic partners because of the resulting flashbacks and anxiety attacks.
Anxiety symptoms stemming from a tragic occurrence during Amy’s senior year of high school have led her to seek professional help, and this paper gives a hypothetical case study of her situation. The paper will reveal how Amy deals with her anxiety and the challenges she has to address if she is recommended for therapy. The study will also examine the ethical and cultural factors in Amy’s situation.
Amy’s present state of despair is due to several reasons. The sexual assault she suffered during her final year of high school was a significant trauma she had avoided addressing for a long time. Radell et al. (2021) state that sexual abuse has a wide-ranging effect on a person’s sense of self, mental and physical development, and social feelings.
Due to the changes in her life, especially her return to school, she relives the anguish she experienced during the attack. Her sense of alienation and estrangement also exacerbates Amy’s despair from her cultural and spiritual background. Even though she firmly identifies as Native American, she is not taking part in rituals or activities that would make her feel more a part of her culture. This division is probably exacerbating her emotions of humiliation and inferiority about the assault.
Nature of Crisis
Amy’s problem is complex and multi-dimensional due to several reasons. First, she has anxiety symptoms affecting her everyday life, especially when she is on campus or walking alone. Her senior year, spring break, is the period she was sexually assaulted, and the memories of that time cause her uneasiness. She has destructive thoughts about herself, such as thinking no one would ever love her because she is “damaged goods.” Her anxious thoughts are just becoming worse because of this. She also uses alcohol as a self-medication and says she has lost touch with her spiritual beliefs. Similarly, Amy started self-harming by cutting herself to feel better about herself. As a result, she has trouble building connections with men and performing her medical rounds.
Course of Crisis
Amy has been having problems since being sexually assaulted during her senior year of spring break. She left town soon after the event and has just started seeing a therapist. She blames talking to a male coworker who asked her out on a date and returning to school for worsening her symptoms. She also recently began drinking to quell her feelings and the injuries she has inflicted herself with cutting. Amy may develop more serious mental health problems if her current symptoms persist.
However, reaching out for expert assistance is a commendable move toward wellness and restoration. Amy may learn to control her anxious thoughts and feelings with the help of counseling. She will be able to acquire effective techniques for dealing with her feelings and healing from the trauma of the sexual attack. She may rediscover her spiritual beliefs and develop healthy coping techniques like drinking less.
Crisis Intervention Model
Amy is seeking help to heal the trauma of her past sexual assault. She has been experiencing flashbacks, cutting her wrists, and drinking wine a few nights a week to numb her feelings and “disassociate” from her pain. Amy reports that although her sexual assault is a few years past, she only now exhibits symptoms of Post-Traumatic Stress Disorder (PTSD). The DSM-5 classifies PTSD’s symptoms into four groups: intrusion, avoidance of thoughts, negative mood swings, and alterations to arousal and reactivity (American Psychiatric Association, 2013). Utilizing the Eclectic/Integrated Crisis Intervention Theory model to gauge Amy’s immediate disposition and offer support services is critical.
The Integrated Crisis Intervention Theory model, is a mix of several crisis intervention models that allow the interventionist to apply methods that ground the client during a crisis, meet the client’s immediate needs, connect the client to support services, and use multiple theories to address psychological and physical behaviors. Although Amy is not an immediate threat to herself or others, the main concern is the potential for her maladaptive behaviors to escalate. Per the Psychosocial model, Amy’s substance abuse is directly attributed to a learned behavior from her environment growing up. She indicated that her father was a heavy drinker and that her mother used cannabis to “numb” anxiety. She also remarked that she has been cutting her wrists to “help release her feelings.”
Resources Available
Amy has a lot of resources, such as a supportive family and group of friends, a stable career, and she has enrolled in school. However, she will need more help than that to deal with her symptoms and get over the trauma she has suffered. To establish a collaborative relationship and build rapport, it is essential to use the Triage Assessment Form (TAF) to evaluate Amy’s affective, behavioral, and cognitive reactions and learn her goals for seeking help. This is followed by exploring Amy’s recollection of her crisis event to gain a clearer understanding of what her immediate needs are.
Because Amy has shared that she is dependent on alcohol and self-harm to numb her feelings, as a counselor, it is critical to evaluate her level of dependence and impairment and ask how these behaviors affect her daily routine—job, schooling, religious or spiritual beliefs, and her relationships with friends and family. Using the Post-traumatic Stress Diagnostic (PSD)scale can also help to measure her distress (Jongsma et al., 2021). Mental health practitioners may evaluate a patient’s PTSD symptoms and decide on the best course of therapy upon using the PSD.
After reviewing Amy’s symptoms and assessments, the next step is setting up a treatment plan using Cognitive Behavioral Therapy (CBT), Eye Movement and Desensitization Reprocessing therapy (EMDR), journaling, and joining a support group to address Amy’s PTSD and anxiety. In Amy’s case, CBT can be used to teach her calming and coping skills to manage her fears and anxiety when walking alone on campus, talking to male classmates, and recognizing maladaptive thoughts. Amy could also benefit from attending a support group for sexual assault survivors. Here, Amy can safely share her experience with others, reduce stress and feelings of shame, receive emotional support, and foster a sense of community. It is also essential to suggest meeting with Amy every week for EMDR sessions to help her explore difficult emotions and process her trauma while creating a safe space for her healing. Keeping a daily journal would also be helpful for mood tracking and recognizing anxiety triggers.
Coping Mechanisms
Amy admits to having several strategies for dealing with her anxiety. First, she no longer participates in family get-togethers because she fears her loved ones will notice her change. She also self-inflicts and drinks heavily at night to “numb out” and deal with her feelings. These strategies are not healthy in the long term, and they may even worsen her problems. Amy might focus on reducing her anxiety using mindfulness exercises and other techniques in therapy. This therapy modality incorporates several meditations, as well as introductory lessons on depression, body assessment activities, and several mindfulness exercises that demonstrate the interconnected nature of one’s emotional state, mental state, and bodily sensations (Zandi et al., 2021). The treatment aims to strengthen the link between one’s conceptual state of mind and one’s perceptual state to enhance cognitive, emotional, and behavioral regulation.
Potential/ Real Issues to be Addressed by the Client
Amy may need to resolve several concerns if she is referred to counseling. Significantly, she struggles with symptoms of PTSD associated with sexual assault. She also has trouble interacting with males, hindering her potential to maintain meaningful relationships and pursue romantic ones. Amy has turned to self-harm to regulate her emotions, an urgent issue requiring immediate intervention. Amy has to learn to control her PTSD by using healthy coping strategies. A mental health practitioner can assist in managing PTSD symptoms through treatment, counseling, and support (Smith et al., 2018).
She must first learn to identify and control her triggers to prevent future panic attacks and flashbacks. She also needs to acquire strategies for managing her anxiety, particularly on the walks from campus to her vehicle when alone. Amy also needs guidance on communicating effectively with men and developing meaningful partnerships. For this to work, she must work on her trust issues, improve her communication skills, and boost her confidence. Amy’s self-harming habit must also be addressed, and more effective ways to deal with such intense emotions must be taught.
Cultural and Ethical Considerations
Amy’s cultural identity, as a woman of mixed Native American and Caucasian heritage, holds significant importance in her life. The individual reports a sense of disconnection from their Native American beliefs and a lack of engagement in the religious ceremonies associated with their cultural heritage. Hence, it is imperative to integrate the client’s cultural heritage into the counseling sessions to facilitate re-establishing her spiritual connection. Providing a culturally competent environment that caters to patients’ religious and spiritual requirements has enhanced patient outcomes (Swihart et al., 2022).
In addition, it is fundamental to acknowledge potential cultural barriers that could impact the individual’s inclination to engage in counseling and guarantee that the counseling methodology is culturally responsive. Upholding confidentiality and safeguarding the client’s privacy are critical factors to consider as a counselor. Consequently, it is necessary to guarantee that any data disseminated by Amy remains confidential and is not revealed to any unauthorized parties.
Conclusion
The case of Amy underscores the significance of tackling symptoms of PTSD, depression, anxiety, self-harm, and substance abuse during counseling sessions. Developing safe and effective coping mechanisms is paramount in facilitating healthier relationships between Amy and her male counterparts. The mandatory consideration of cultural and ethical factors when engaging with patients from varying backgrounds is included in the counseling process. This guarantees that the counseling strategy is culturally sensitive and adheres to ethical standards. Amy’s case highlights the significance of offering comprehensive counseling services that cater to the client’s physiological, psychological, and sociocultural requirements.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: Dsm-5. Web.
Jongsma, A. E., Peterson, L. M., & Bruce, T. J. (2021). The Complete Adult Psychotherapy Treatment Planner. Wiley.
Radell, M. L., Abo Hamza, E. G., Daghustani, W. H., Perveen, A., & Moustafa, A. A. (2021). The Impact of Different Types of Abuse on Depression. Depression Research and Treatment, 2021, 1–12. Web.
Smith, P., Dalgleish, T., & Meiser‐Stedman, R. (2018). Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents. Journal of Child Psychology and Psychiatry, 60(5), 500–515. Web.
Swihart, D. L., Siva, & Martin, R. L. (2022). Cultural religious competence in clinical practice. Nih.gov; StatPearls Publishing. Web.
Zandi, H., Amirinejhad, A., Azizifar, A., Aibod, S., Veisani, Y., & Mohamadian, F. (2021). The effectiveness of mindfulness training on coping with stress, exam anxiety, and happiness to promote health. Journal of Education and Health Promotion, 10(1), 177. Web.