Case Vignette
Marylyn is a 17-year-old African American girl. She lives with her mother, grandmother, and 11-year-old twin sisters. Three weeks ago, she was attacked by a group of young men while returning home after her theater class. They were bullying and beating her. They were going to take the girl into their car and could probably rape her, but a man who was passing by called the police and made them go. At present, the girl has recovered physically, and the bruises have almost disappeared. However, her mental condition is unsatisfactory. She has been depressed since the day of the accident. She experiences nightmares in which the sex offenders did what they intended to do. The girl gave up her theatre class and did not leave the house alone. In fact, she stays in most of the days. She threw away skirts, bright tops, and dresses. She believes that she should become less noticeable and blames herself for everything that happened to her. At the same time, she suffers from a lack of self-realization because she had an active life before the accident. She wants to come back to college and the theatre class, but the symptoms she observes do not let her do so.
During the treatment of the patient, the Target Memory (T-ICES) is the day the girl was attacked. The Image that appears most often is one of the offenders trying to make her get into the car. The Cognitions in her mind are that even the neighborhood can be dangerous, and it is better to stay at home. The Emotions she experiences are fear, mistrust, and loneliness. The Sensations she remembers are danger and panic.
The unmet needs include the lack of psychological stability, deficiency of self-confidence, and the lack of feeling of safety. However, her strengths, which include the ability to concentrate, creativity, and strong motivation, will be helpful in the interventions that are aimed at meeting the needs of the patient.
In her treatment, it is necessary to eliminate the feeling of guilt for the accident. Moreover, it is important to cope with the nightmares because they do not let her sleep normally and make the situation even more complicated. Finally, the symptoms of depression should be removed to let the girl return to her usual active life.
Treatment Plan
At present, the primary goals of the girl are to be able to leave the house without fears and to sleep without nightmares. Thus, the treatment plan is concentrated on minimizing the existing symptoms of posttraumatic stress disorder and eliminating nightmares, thus providing normal sleep.
Big Behaviors
- Nightmares and bad sleep
- The unmet need for psychological stability results in the interruption of sleep because of trauma.
- The TF-CBT Intervention applicable for the patient is the development of a self-relaxation technique that will allow the young girl to calm down when she becomes hypervigilant.
- Strength: the major strength of Marylyn is her ability to concentrate on her actions, even being stressed. It can be helpful in developing the self-relaxation technique.
- Self-accusation
- The unmet need for this symptom is the lack of self-confidence.
- The TF-CBT Intervention that can be used to manage this condition is the compare and contrast writing. The young girl should note down the reasons for blaming herself and the reasons for the actions of the offenders.
- Strength: her main strength useful for this intervention is the creativity that allows her to imagine the forces that were driving her offenders.
- Depression (staying in for days)
- The unmet need is the feeling of the lack of safety.
- The TF-CBT Intervention would be the development of strategies for self-protection. Probably, an appointment to a self-defense class can be useful.
Strength: her main strength is strong motivation to overcome her depression and return to her usual active life.