Case I

Case I: A twenty-nine year old male diagnosed with post-traumatic stress disorder who was referred by his therapist…this therapist wanted to better understand her patient and obtain information on treatment planning (What follows is a summary of a report written primarily for the treating therapist who requested it):

The patient is currently experiencing significant distress, which will motivate him to seek help. This positive treatment indicator is checked, to some degree, by his suspicious distrust of others. This patient’s personality profile indicates that he looks for selfish motives behind acts of good will. Furthermore, he reacts stubbornly against being told what to do. If he feels strongly pushed in one direction, he is apt to go in the other direction. He will be encouraged from being afforded a reasonable sense of autonomy and choice throughout the treatment. The irritability that is associated with his anxious and depressive symptoms will be softened by an empathetic and nondirective tone. These cautionary notes are necessary due to the considerable discomfort he displays in assuming the role of a patient, especially in a psychological setting. He seems to carry caricatured masculine gender roles, believing that men should suffer in silence, as he believes that they did in generations past. His depressive symptoms and discomfort as a psychotherapy patient will work against each other; the former will make him want to open up and seek help, the latter will make him want to shut down and leave treatment.

The personal weakness that he equates with seeking treatment might be softened by occasional psycho-education. He may be more likely to see the psychological trauma and pain that he is undergoing as legitimate and worthy of treatment if he views it as a medical condition. His conception of his current state may be augmented by discovering that post-traumatic stress has been the natural reaction of many people exposed to traumatic experiences in the context of war, plane crashes and car accidents. Seeing traumatic anxiety as a medical condition that is physiologically represented in the brain will undoubtedly alter his perception of the treatment and might soften his feelings of shame.

The patient is undergoing significant frustration and will require an empathetic ear before being able to move on to planning his future therapeutic goals. He may require a long period of lamentation about the past before being able to look to the future. Indeed, he will not be able to look to the future until he has accepted his newly imposed physical limitations [the patient was in a severe car accident]. Acceptance will enable him to look forward to the future and progress in treatment. Attention and genuine empathy with his loss of physical prowess will engender trust and enable progression. Finally, this patient’s personality profile indicates that he might prematurely terminate treatment. Lapses and vacations should be avoided whenever possible, as they will offer opportunities for premature termination. Ongoing compliance will be best insured by empathy, education, reliability and concrete treatment goals.