Work Case Study Examples
Working Hypothesis
Josh’s fiancé being struck and killed by a drunk driver as they were about to meet for lunch and her dying in his arms, is the participating situation that triggered the start of Josh’s symptoms. The subsequent anxiety that developed, as Josh held himself responsible for his fiancé’s death as well as the death of his sister 4 years’ prior, resulted in the current maladaptive thought patterns, anxiety, and depressive symptoms Josh presented with for treatment. Josh learned through the conditioning that occurred through the traumatic event he experienced, that avoiding experiencing those memories by not going to that side of town, as well as drinking alcohol until he blacks out, reduces his symptoms of anxiety, rumination, …show more content…
depressive symptoms, and intrusive automatic thoughts, over what he could have done differently to save his fiancé’s life. Based on his schemas of responsibility, Josh tends to overestimate that likelihood of the occurrence of a negative event, the harm that could result from the event, and the consequences that could result from such responsibility. The activating situation that triggers the daily occurrence of Josh’s automatic thoughts and avoidance behavior is the reminder that his fiancé has passed away.
Josh appears to be aware that his fiancé’s death has impacted him substantially. However, he does not yet appear to have enough insight toward understanding the deaths of his fiancé and sister was not his fault. Josh being of mixed race (Hispanic and Caucasian) may have various cultural factors, that may be impacting how he is coping throughout this traumatic time. Josh also appears to come from a family of achievement, where he is expected to thrive no matter the situation. It was stated previously, that Josh’s parents compared he and his brother, by stating that Josh’s older brother never experienced symptoms of depression, as Josh did when he was a teenager. The impact of coming from a family of achievement and coming from a mixed ethnic background could be impactful on his PTSD symptoms. It is important to understand Josh from the standpoint of a clinician and understand, that his family may be impacting his precipitating factors. Josh’s family may not be supportive of his PTSD and may expect him to “normally” get over the death of his fiancé, as it has been 9 months. Cultural competence should always be in the forefront of the clinician’s mind and should also be thought of as a potential stressor for the patient (Bedoya & Safren, 2009, p. 24). The clinician should also understand ethical issues related to not providing the client with the appropriate cultural interventions they need (Bedoya & Safren, 2009, p. 25). Josh may be dealing with underlying issues related to his ethnicity, as well as issues related to the culture of his family, and how they deal with mental health.
Behavior plan
Goals
The treatment goals relate to Josh’s symptoms of PTSD.
An initial goal is to (1) increase Josh’s desire to live without his fiancé. Another initial treatment goal is (2) to decrease his recurring thoughts and nightmares. The third initial treatment goal (3) is to decrease Josh’s avoidance behavior related to him not being able to go to the side of town where his fiancé was killed. It is anticipated that increases/decreases in these symptoms will result in subsequent increases/decreases in (a) Josh’s desire to live without his fiancé, (b) Josh’s drinking to cope with his recurring thoughts/nightmares, (c) Josh’s flat affect and withdrawn symptoms and (d) Josh’s anhedonia (loss in pleasurable …show more content…
activities).
Target behaviors
The first target behavior is relaxation. Relaxation techniques will teach Josh how to better cope as his anxiety arises. The second is cognitive restructuring. Cognitive restructuring teaches patients to identify their negative beliefs related to the trauma and educates them on how to form more realistic appraisals of the implications of their experience (Leahy & Holland, 2012 p. 266). We wish to restructure Josh’s thoughts, because his thoughts related to the trauma are impacting his functioning. By decreasing distress, Josh will live a more meaningful and fulfilling life.
Maintaining conditions
A primary maintaining antecedent of Josh’s symptoms of PTSD/anxiety is the series of intrusive automatic thoughts (e.g. What if I chose a different restaurant? I didn’t do anything, I should have saved her, I wish it had been me that had been run over, or at least I should have died with her, I’m a loser, I’m not good enough, I’m an all-around screw up.) These intrusive thoughts, trigger Josh’s feelings of loss/bereavement and remind him of the traumatic event that occurred. As Josh continues to have these intrusive thoughts related to the loss of his fiancé, he is impacted throughout various aspects of his life, occupationally and socially specifically. Josh avoiding the area where his fiancé was killed is also a maintaining consequence of the symptoms of PTSD, as he avoids going toward the side of town where his fiancé was killed, he is not dealing with the reality related to the traumatic event. As Josh continues to avoid the area his fiancé was killed, his intrusive thoughts and anxiety are continued and maintained.
Treatment plan
It is recommended that Josh see a medical doctor for a complete physical exam and an evaluation of psychotropic medications. Additionally, it is recommended that Josh engage in individual, cognitive-behavioral therapy on a weekly basis.
To effectively address Josh’s symptoms related to PTSD and meet the initial treatment goals of increasing Josh’s desire to live without his fiancé, decrease recurring thoughts and nightmares, and decrease Josh’s avoidance behaviors, a treatment package will be developed that includes several empirically-based techniques that attend to the behavioral and cognitive factors of the disorder.
First, Josh will be socialized to the treatment process; that is, he will be educated regarding the cognitive and behavioral models of PTSD and the rationale for the various treatment methods will be used. Early in treatment Josh will be taught, relaxation techniques so he is better able to cope with his anxiety. He will be taught to engage in controlled breathing and muscle relaxation. Also, Josh will be taught cognitive restructuring techniques, so that his distorted automatic thoughts, dysfunctional schemas, and maladaptive assumptions related to guilt, his own death, and the death of his fiancé can be challenged. Furthermore, prolonged exposure will be taught to Josh, in order to reduce association with memories related to the trauma he experienced. Josh will be asked to emotionally expose himself repeatedly and for a prolonged period of time to memories and cues that provoke his anxiety related to the trauma he experienced. The exposure of Josh’s memories that provoke his anxiety over time, will gradually decrease the strength of his associations, resulting in better ability to cope,
decrease his alcohol use, as well as his depressive symptoms. Josh’s progress will be monitored and measured weekly, by the Beck Depression scale (BDI-II) and the PTSD civilian check list (PCL-C), progress on weekly collaboratively designed homework assignments, as well as by client self-report.
Josh’s fiancé being struck and killed by a drunk driver as they were about to meet for lunch and her dying in his arms, is the participating situation that triggered the start of Josh’s symptoms. The subsequent anxiety that developed, as Josh held himself responsible for his fiancé’s death as well as the death of his sister 4 years’ prior, resulted in the current maladaptive thought patterns, anxiety, and depressive symptoms Josh presented with for treatment. Josh learned through the conditioning that occurred through the traumatic event he experienced, that avoiding experiencing those memories by not going to that side of town, as well as drinking alcohol until he blacks out, reduces his symptoms of anxiety, rumination, …show more content…
depressive symptoms, and intrusive automatic thoughts, over what he could have done differently to save his fiancé’s life. Based on his schemas of responsibility, Josh tends to overestimate that likelihood of the occurrence of a negative event, the harm that could result from the event, and the consequences that could result from such responsibility. The activating situation that triggers the daily occurrence of Josh’s automatic thoughts and avoidance behavior is the reminder that his fiancé has passed away.
Josh appears to be aware that his fiancé’s death has impacted him substantially. However, he does not yet appear to have enough insight toward understanding the deaths of his fiancé and sister was not his fault. Josh being of mixed race (Hispanic and Caucasian) may have various cultural factors, that may be impacting how he is coping throughout this traumatic time. Josh also appears to come from a family of achievement, where he is expected to thrive no matter the situation. It was stated previously, that Josh’s parents compared he and his brother, by stating that Josh’s older brother never experienced symptoms of depression, as Josh did when he was a teenager. The impact of coming from a family of achievement and coming from a mixed ethnic background could be impactful on his PTSD symptoms. It is important to understand Josh from the standpoint of a clinician and understand, that his family may be impacting his precipitating factors. Josh’s family may not be supportive of his PTSD and may expect him to “normally” get over the death of his fiancé, as it has been 9 months. Cultural competence should always be in the forefront of the clinician’s mind and should also be thought of as a potential stressor for the patient (Bedoya & Safren, 2009, p. 24). The clinician should also understand ethical issues related to not providing the client with the appropriate cultural interventions they need (Bedoya & Safren, 2009, p. 25). Josh may be dealing with underlying issues related to his ethnicity, as well as issues related to the culture of his family, and how they deal with mental health.
Behavior plan
Goals
The treatment goals relate to Josh’s symptoms of PTSD.
An initial goal is to (1) increase Josh’s desire to live without his fiancé. Another initial treatment goal is (2) to decrease his recurring thoughts and nightmares. The third initial treatment goal (3) is to decrease Josh’s avoidance behavior related to him not being able to go to the side of town where his fiancé was killed. It is anticipated that increases/decreases in these symptoms will result in subsequent increases/decreases in (a) Josh’s desire to live without his fiancé, (b) Josh’s drinking to cope with his recurring thoughts/nightmares, (c) Josh’s flat affect and withdrawn symptoms and (d) Josh’s anhedonia (loss in pleasurable …show more content…
activities).
Target behaviors
The first target behavior is relaxation. Relaxation techniques will teach Josh how to better cope as his anxiety arises. The second is cognitive restructuring. Cognitive restructuring teaches patients to identify their negative beliefs related to the trauma and educates them on how to form more realistic appraisals of the implications of their experience (Leahy & Holland, 2012 p. 266). We wish to restructure Josh’s thoughts, because his thoughts related to the trauma are impacting his functioning. By decreasing distress, Josh will live a more meaningful and fulfilling life.
Maintaining conditions
A primary maintaining antecedent of Josh’s symptoms of PTSD/anxiety is the series of intrusive automatic thoughts (e.g. What if I chose a different restaurant? I didn’t do anything, I should have saved her, I wish it had been me that had been run over, or at least I should have died with her, I’m a loser, I’m not good enough, I’m an all-around screw up.) These intrusive thoughts, trigger Josh’s feelings of loss/bereavement and remind him of the traumatic event that occurred. As Josh continues to have these intrusive thoughts related to the loss of his fiancé, he is impacted throughout various aspects of his life, occupationally and socially specifically. Josh avoiding the area where his fiancé was killed is also a maintaining consequence of the symptoms of PTSD, as he avoids going toward the side of town where his fiancé was killed, he is not dealing with the reality related to the traumatic event. As Josh continues to avoid the area his fiancé was killed, his intrusive thoughts and anxiety are continued and maintained.
Treatment plan
It is recommended that Josh see a medical doctor for a complete physical exam and an evaluation of psychotropic medications. Additionally, it is recommended that Josh engage in individual, cognitive-behavioral therapy on a weekly basis.
To effectively address Josh’s symptoms related to PTSD and meet the initial treatment goals of increasing Josh’s desire to live without his fiancé, decrease recurring thoughts and nightmares, and decrease Josh’s avoidance behaviors, a treatment package will be developed that includes several empirically-based techniques that attend to the behavioral and cognitive factors of the disorder.
First, Josh will be socialized to the treatment process; that is, he will be educated regarding the cognitive and behavioral models of PTSD and the rationale for the various treatment methods will be used. Early in treatment Josh will be taught, relaxation techniques so he is better able to cope with his anxiety. He will be taught to engage in controlled breathing and muscle relaxation. Also, Josh will be taught cognitive restructuring techniques, so that his distorted automatic thoughts, dysfunctional schemas, and maladaptive assumptions related to guilt, his own death, and the death of his fiancé can be challenged. Furthermore, prolonged exposure will be taught to Josh, in order to reduce association with memories related to the trauma he experienced. Josh will be asked to emotionally expose himself repeatedly and for a prolonged period of time to memories and cues that provoke his anxiety related to the trauma he experienced. The exposure of Josh’s memories that provoke his anxiety over time, will gradually decrease the strength of his associations, resulting in better ability to cope,
decrease his alcohol use, as well as his depressive symptoms. Josh’s progress will be monitored and measured weekly, by the Beck Depression scale (BDI-II) and the PTSD civilian check list (PCL-C), progress on weekly collaboratively designed homework assignments, as well as by client self-report.