Case Study: Differential Diagnosis the Patient

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[. . .] C. Counseling: The goals of psychotherapy are to identify any underlying hopeless and fearful thoughts, assist the patient overcoming feelings of loss of control and goal planning, setting self-management goals and following through on them.

D. Therapeutic techniques would include but not be limited to:

1. Cognitive Restructuring: Challenging behaviour and dysfunctional thoughts from a number of different viewpoints. Areas of concentration include but are not limited to: cognitions/feelings about past trauma; cognitions/feelings about relationships, her husband, and how she views these; views of the world and others; self-worth, self-efficacy; others as need to be addressed in therapy. Use a combination of CBT and dynamic methods such as redirecting, using transference, and dream interpretation to assist here.

2. Gradual Exposure and Mental Imagery Program: During the course of treatment utilizing relaxation skills, imagery, and discussion transference issues.

3. Teaching relaxation techniques and breathing exercises.

E. Relationship counseling. If possible and if the client agrees, couples therapy might also be beneficial in this case. However, given the controlling nature of the husband it appears that he might not be agreeable to this. Therefore, in line with cognitive restructuring it is important to understand her conceptualization of how the relationship she is in is structured, why she allows herself to be controlled and manipulated, and how she can address this in the context of her cultural background and personal experience.

Treatment Goals

Goals for treatment should be formulated in conjunction with the patient. Preliminary treatment goals include:

1. Resume normal activity levels at home and in social situations. Return to employment if desired.

2. Return to taking prescribed medications.

3. Discuss and implement a strategy for dealing with her husband. Review patient's wants and needs and assist patient.

4. Build self-esteem to a healthy level.

5. Communicate effectively.

6. Maintain relationships.

7. Continue therapy until goals are met.

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th Ed.). Arlington, VA: Author.

Barlow, DH (2008). Clinical handbook of psychological disorders: A step-by-step treatment manual (4th Ed.). New York, USA: Guildford Press.

Becker, C.B., Zayfert, C., & Anderson, E. (2004). A survey of psychologists. Attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277-292.

Berzoff, J., Flanagan, L.M., and Hertz, P. (1996).Inside out and outside in: Psychodynamic clinical theory and practice in contemporary multicultural contexts. New Jersey: Jason

Aronson, Inc.

Carlson, J., & Sperry, L. (Eds.). (2000). Brief Therapy with Individuals & Couples. Phoenix, AZ: Zeig, Tucker & Theisen, Inc.

de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.

Frueh, B.C., Turner, S.M., Beidel, D.C., Mirabella, R.F., & Jones, W.J. (1996). Trauma Management Therapy: A preliminary evaluation of a multicomponent behavioral treatment for chronic combat-related PTSD. Behavior Research and Therapy, 34(7), 533-543.

Grunert, B.K., Weis, J.M., Smucker, M.R., & Christianson, H.F. (2007). Imagery rescripting and reprocessing therapy after failed prolonged exposure for posttraumatic stress disorder following industrial injury. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 317-328.

Holmes, E.A., Arntz, A., & Smucker, M.R. (2007). Imagery rescripting in cognitive

behaviour therapy: Images, treatment, techniques and outcomes. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 297-305.

Institute of Medicine (IOM). (2008). Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington, DC: The National Academies Press.

Kendall-Tackett, K. (2009). Psychological trauma and physical health: A psychoneuroimmunology approach to etiology of negative health effects and possible interventions. Psychological Trauma: Theory Research, Practice, and Policy, 1(1), 35-48.

Kessler, R.C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E., Howes, M.J, Normand, S-L.T., Manderscheid, R.W., Walters, E.E., Zaslavsky, A.M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry. 60(2), 184-189.

Kessler, R.C., Andrews, G., Colpe, L.J., Hiripi, E., Mroczek, D.K., Normand, S.-L.T., Walters, E.E., & Zaslavsky, A. (2002). Short screening scales to monitor population prevalances and trends in nonspecific psychological distress. Psychological Medicine. 32(6), 959-976.

Lester, K., Artz, C., Resick, P., & Young-Xu, Y. (2010). Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment. Journal of Consulting and Clinical Psychology, 78, 480-489.

Mulick, P.S., & Naugle, A.E. (2004). Behavioral activation for comorbid PTSD and major depression: A case study. Cognitive and Behavioral Practice, 11(4), 378-387.

Powell, T.J. (1992). The mental health handbook. Bicester: Winslow Press.

Powell, T.J. (2009). The mental health handbook: A cognitive behavioural approach (Third Edition). Bicester: Winslow Press.

Reber, S., & Reber, E.S. (2001). Dictionary of psychology. St. Ives Plc, England: Penguin.

Simms-Brown, R. (1982). The female in the black family: dominant mate or helpmate?

Journal of Black Psychology, 9 (1), 45-55.

Smucker, M.R., Dancu, C.V., Foa, E.B., & Niederee, J.L. (1995). Imagery rescripting: A new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. Journal of Cognitive Psychotherapy, 9(1), 3-17.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2003). Clinical interviewing. Hoboken, New Jersey: John Wiley & Sons.

Sutker, P.B. & Allain, A.N., Jr. (1996). Assessment of PTSD and other mental disorders in World War II and Korean Conflict POW survivors and combat veterans. Psychological Assessment, 8(1), 18-25.

Wagner, A.W., Zatzick, D.F., Ghesquiere, A., & Jurkovich, G.J. (2007). Behavioral activation as an early intervention for posttraumatic stress disorder and depression among physically injured trauma survivors. Cognitive and Behavioral Practice, 14(4),… [END OF PREVIEW]

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