Case Study
Patient Demographic: Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined
Mental Status Exam: Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with
Presenting Problem: You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.
Other Contexts: The client reports that a worker from the local child protective services office met with her and that she is worried about what the coach will do in response when he finds out that she reported him. The client says that she has not returned to school but that the school has provided the classwork and homework needed to keep up; she feels like the school is supporting her well enough to not fall behind. The client confirms that all of the symptoms that she described during her last session are still present

Question: Which one of the following is an appropriate short-term goal for post-traumatic stress disorder?
(A): Improve the client’s ability to talk about her traumatic experience.
(B): Significantly reduce negative symptoms associated with the trauma.
(C): Use cognitive behavioral strategies to reduce the daily impact of the trauma.
(D): Reduce avoidance of triggers for trauma symptoms.

Correct Answer: Use cognitive behavioral strategies to reduce the daily impact of the trauma.
Explanation: Using cognitive behavioral strategies to reduce the daily impact of trauma is the most relevant short-term goal for this client because it is achievable in the most immediate future. Reducing negative symptoms in a significant manner is not likely to occur in the short term, nor is reducing the avoidance of triggers, because it takes time to process a traumatic event and implement the coping skills necessary to achieve these goals. Talking about a traumatic experience is not always beneficial for clients and may, in fact, cause more harm. In the early stages of treatment following a traumatic event, it is often more beneficial to manage the effects of the trauma than to force conversations about it. Therefore, the correct answer is (D)
Competency: treatment planning