Case Study
Patient Demographic: Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)
Mental Status Exam: Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia
Presenting Problem: You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.
Other Contexts: The client comes into the session, sits down, and immediately begins to talk about one of her roommates in the domestic violence home that has been making her angry because the roommate comes into her room when the client is gone and borrows her personal hygiene items. The client continues to explain that she worries that the roommate might come in while she is sleeping, but that she has not done this yet. You process these feelings with the client and identify that when she was a child, her uncle would come into her room without her permission and sexually abuse her. The client also reported that one of her ex-husbands would enter their bedroom drunk at night and would often hit her while she was asleep. You and the client discuss how to make her environment feel safe and how to engage in cognitive reframing. You empathize with the client and validate her emotions.  The client brings up how she often avoids certain restaurants and stores because they remind her of arguments she has had with her past partners that led to her experiencing physical abuse

Question: The client brings up how she often avoids certain restaurants and stores because they remind her of arguments she has had with her past partners that led to her experiencing physical abuse. Which one of the following treatments would be most helpful in managing this avoidance?
(A): DBT
(B): Integrative therapy
(C): Exposure therapy
(D): CBT

Correct Answer: Exposure therapy
Explanation: Exposure therapy, when completed over an appropriate period of time with gradually more difficult exposures, can be effective in treating the avoidance-related symptoms of PTSD. Although it makes sense that an individual would want to avoid stimuli that trigger strong emotions, restaurants and stores are not actual threats to the client, and her avoidance of these settings is inhibiting her ability to live her life. Through gradual exposure, the client can see that she is safe in those environments and does not need to avoid them. DBT and CBT are each therapy modalities that have cognitive and behavioral aspects that might benefit treatment of PTSD, but they do not address the avoidance behavior adequately on their own. Integrative therapy is the blending of different therapy techniques for a holistic approach to treatment; however, this would not be as effective in treating avoidance behaviors. Therefore, the correct answer is (A)
Competency: treatment planning