Answer these questions after reading the case study. Must be in essay format:
Susan Case Study Vignette
Presenting Problem
Susana twelve-year-old biracial female (Latina/Caucasian) who was referred for counseling services via the state child protection services (CPS). Susan engages in physical altercations with her peers on a daily basis, self-mutilates by cutting herself with safety pins, and reports feeling depressed. She also stated that she has difficulty sleeping at night and reported experimenting with alcohol and marijuana.
Background Information
Susan is the oldest child of six children in her family. She has twin sisters who are nine years of age, and three brothers ages six, four and two years of age. Susan’s mother is Latina and her father is Caucasian. Susan and her family are reportedly of a lower socio‐economic status. Susan’s mother works part time in a local grocery store as a check‐ out clerk and her father works as a stock manager at a large carpet company. Susan reported that her family “are barely making it” financially and that she often cannot have many of the material things that her female peers enjoy. A view of Susan’s social life reveals that Susan spends much time alone taking care of her siblings while her mother and father are at work. She reported that her father expects her to cook for the family and care for her mother who often complains of headaches due to her hypertension. She also reported hanging out with gang related friends whenever possible in order to drink alcohol, smoke marijuana and “have fun.” Susan attends a local public elementary school where she is reported to have progressively failing grades, particularly in math and reading. Additionally, Susan has been suspended from school on four separate occasions during this school year for physical altercations with classmates along with stealing their personal belongings. Additionally, Susan is not well liked by her peers at school due to her aggressive behavior
Susan was psychiatrically hospitalized three months ago for a suicide attempt at which time she ingested some of her mother’s hypertension medication with the intention of killing herself. During Susan’s hospital stay, she complained of a burning sensation upon urinating and a vaginal discharge. Further testing revealed that Susan was suffering from a gonorrhea infection. Upon questioning, Susan reluctantly revealed that she had repeated sexual encounters with her father for the past four years. Hospital staff reported the disclosure to CPS. Following an investigation, CPS deemed the allegations as founded. Other than the gonorrhea, Susan’s physician reported that she is in good health. She was prescribed antibiotics for the gonorrhea and medication for the depression and sleeping problems. During counseling sessions, Susan stated that her mother is a very soft spoken, dependent woman who does just about everything her father tells her to do. On the other hand, Susan described her father as a “domineering bulldog” who is angry, drunk and violent most of the time. She stated that when her father drinks, he tells her how much he needs and depends on her. It Is During These Times That The Sexual Abuse occurs. Susan also stated that her father would frequently be at her mother in front of her and her siblings over trivial issues and then he would turn to Susan for consolation and support. She went on to state that she witnessed her mother and father having a “pretty bad fight” about five months ago to the extent that her mother suffered a head injury and had to be hospitalized. Susan stated that she tends to cut herself with a safety pin after her mother and father have a fight. She stated that the cutting helps her to “feel alive again.” Susan has reported that she and her mother belong to a church, but her father does not believe in the Christian faith. Hence, she and her mother are seldom allowed to attend worship services. However, Susan stated that her mother has told her that their family problems are God’s will and that Susan should pray to be forgiven for fabricating the story about her father sexually abusing her. Susan describes her relationship with her mother as “two ships in the night” and that her mother pays more attention to her siblings than her. Susan stated that the sleep medication helps her a lot and she is now able to sleep throughout the night however she complains about having disturbing dreams.
Questions to answer in Essay format:
1) Prepare a therapy-specific examination using Trauma Focused Cognitive Behavior Therapy treatment model that discusses how the trauma-informed treatment approach would be applied in the case of Susan.
2) Using the Trauma Focused Cognitive behavior therapy as your therapy-specific examination, include the following in the treatment approach:
Psychoeducation about trauma
Stress management (including relaxation)
Affect (emotional) modulation and expression skills
Cognitive coping (changing beliefs and self-talk) skills
Creating and processing the trauma narrative
Cognitive processing skills
Behavior management training
Parent-child sessions
3) Address if play therapy approaches would be warranted for Susan and provide a detailed rationale for your position
4) How might Trauma Focused Cognitive behavior therapy be able to be utilized in a community-based program (like trauma prevention), if at all.
