INTERVENTION CASE STUDY REPORT
John Smith is a 34-year old White American, a U.S. Veteran, who is single and has no children. John rents a one-bedroom apartment in San Jose, CA, and runs own private security company that brings him stable average income. John’s presenting symptoms are persistent mild anxiety experienced daily, occasional insomnia that happens twice a month and lasts for about two days, at least one or two vivid war-related nightmares each month, social withdrawal, mistrust to people and reluctance to discuss painful events that caused his illness. John’s PTSD causes constant mood swings and lack of self-confidence that comes to the surface during interactions with other people and worsens his negative self-perception. These feelings prevent him from going out most of the time and, consequently, from making new friends. Although most of these symptoms seem quite mild, together they impair the client’s normal daily life and prevent him from achieving his goals. Among John’s main goals is to get rid of anxiety and social withdrawal, as well as to become open to relationships again, especially the romantic ones. The ultimate dream is to start a family and become a loving and caring husband and father, which, he believes, he is absolutely capable of in perspective. In order to achieve his goals and fulfil his dreams, John needs to utilize his personal strengths, which are his independent spirit, self-sufficiency, loyalty, solid communication skills, intelligence, active life position and desire to build relationships, as well as his environmental strengths, which are his financial independence, vast practical knowledge in his professional field, past positive experience and very caring and loving parents and two best friends, who are always willing to help.
The client’s symptoms started about four years ago right before his retirement from the army, when the client was 30 years old. The symptoms were more severe at that time, and the client received professional treatment, which he gave up about half a year later. Nonetheless, his symptoms became milder; he observed significant reduction of the number of nightmares from several times a week to only one-two times a month. However, since his illness remained untreated for 3.5 years, it is currently in a chronic state. The official diagnosis is the Post-Traumatic Stress Disorder. John’s symptoms meet the diagnostic criteria outlined in DSM-V: the client has been subject to a life-threatening traumatizing experience; his repeated and persistent nightmares about war are intrusion symptoms; his avoidance of the painful topics falls into the category of stimuli avoidance; avoidance of social situations and general social withdrawal, moodiness that follows insomnia and nightmares are all negative alterations in cognition and mood that were not present before the military service; and, finally, occasional insomnia is an alteration in arousal and reactivity. All of these symptoms have been experienced by the client for several years now and negatively affect the client’s quality of life, causing impairment in the social area. These criteria fully satisfy the DSM-V definition of the Post-Traumatic Stress Disorder, and, for this reason, I have substantial reasons to believe that the diagnosis is accurate. The client, who has received in-depth knowledge about the PTSD during his first treatment, also agrees with the diagnosis.
Past and Recent Treatment
The client has been treated with cognitive processing therapy (CPT) and took low doses of Prazosin consistently 4 years ago, but gave up in about half a year. The therapy included group sessions with other veterans, where the client experienced discomfort because of being constantly reminded of the war. He left the therapy feeling that it was ineffective. However, he admitted that medications were perfect for treating his nightmares. He stopped taking medication 3.5 years ago believing that he has recovered. John did not complain about side-effects, except for feeling dizzy and close to fainting a couple of times, and was generally satisfied and willing to start taking Prazosin again, if needed.
Intervention Plan & Strategies: Micro
The first micro intervention strategy I will use is the exposure therapy, as it is considered one of the most effective strategies in treating the Post-Traumatic Stress Disorder. Unlike the CPT treatment, this will be an individual discussion of the traumatic experience. The first task of this intervention will be the discussion of all things that cause negative feelings in John. This will help the client understand that it is normal to talk about negative experience. The second step will be the discussion of the client’s general war experience, including negative feelings that are not connected with the traumatic event. This may open up the client and make him ready to discuss his military experience without the fear of anxiety, fear, panic and guilt. The last step will be the beginning of conversation about the traumatic event, which may start with me showing to the client the images of war and asking him to build associations. This strategy will help the client face the fact that he has experienced a traumatic event, and it no longer has power over his life. The second micro intervention strategy will be the individual social skills training, as social withdrawal and inability to make friends is one of the client’s primary concerns. The first step of this intervention will be the creation of an individual plan tailored to the client’s needs that will contain different role-playing situations that are currently most relevant for John. The second step will consist of the first role-playing situation, where I will represent a random person, with the character traits being suggested by the client. During the third step, I will suggest that we invite another person to the next session to diversify our training, so that the client is gradually introduced to communication with strangers. This method will help the client let go of the fears connected with socialization and realize that most of the time this experience is non-traumatic. If the client is unable to face his fears during both interventions, I will try slowing down our pace and finding out the reasons behind such strong avoidance response.
Intervention Plan & Strategies: Mezzo
The mezzo level intervention I will use with this client will be the group social skills training following his individual training that should prepare him to interactions with other people that have similar problems. Since it is hard for the client to make friends because of his general mistrust to people and fear of rejection, I will offer him to join a group after he has developed basic social skills and, most importantly, reduced his fear of communication with strangers. I believe that this intervention will help the client observe other people and engage with them in activities of mutual interest in a role-playing mode. Given that such interactions are semi-realistic because of their playful nature, the client may feel less overwhelmed than four years ago when he joined the CPT group that directly discussed the traumatic events. The group social skills training will then prepare the client to real-life interactions and can also be a great place to make friends. If the client feels uncomfortable, tight or shy during this training, I will remind him and everyone that these feelings are experienced by everyone in the room and outside of it, and they are normal. If the client wants to leave the group, I will suggest inviting his best friends for a couple of sessions to make him feel more confident.
The second intervention will be the family intervention involving his parents. I will ask his parents to visit him at least once a week or invite him over in order to help him with the social skills training. I will also suggest that the client invited his parents to one of the therapy sessions if he feels comfortable with it. Finally, I will suggest the family vacation to a popular, yet calming place, where the client can engage in interactions with other people, while still feeling safe surrounded by the family. This intervention may open the client to the discussion of his experience with his closest relatives. Sharing such experience with those he trusts might alleviate the tension and anxiety he has accumulated during the last 3.5 years.
Summary and Reflection of Process
Among the best methods that worked perfectly with this client was the exposure therapy that substituted the client’s bad memories about the CPT with positive experience. It was very hard for the client to talk about his trauma, so the gradual preparation to such discussion helped him lower his guard. The main challenge was to have the client work in a group because of his social anxiety. Nonetheless, after the client has invited his friends to several sessions, he became more comfortable around other group members as well.
This experience has taught me that the intervention strategies for people with the PTSD should be chosen carefully because of an incredibly painful trauma each of them has experienced. I have also learned that a social worker should be very patient and wait until the client is fully ready to open up. Accordingly, my patience and empathy were the strengths that helped me work with this client, and the ability to relax and have fun with John from time to time was very good for both of us and improved the quality of our meetings.
