Evidence-based Research

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© 2022 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

Jake Levy

SOCW 6311

Jake Levy (31) and Sheri Levy (28) are a married Caucasian couple who live with their

sons, Myles (10) and Levi (8), in a two-bedroom condominium in a middle-class

neighborhood. Jake is an Iraq War veteran and employed as a human resources

assistant for the military, and Sheri is a special education teacher in a local elementary

school. Overall, Jake is physically fit, but an injury he sustained in combat sometimes

limits his ability to use his left hand. Sheri is in good physical condition and has recently

found out that she is pregnant with their third child.

As teenagers, Jake and Sheri used marijuana and drank. Neither uses marijuana now

but they still drink. Sheri drinks socially and has one or two drinks over the weekend.

Jake reports he has four to five drinks in the evenings during the week and eight to ten

drinks on Saturdays and Sundays. Neither report having criminal histories.

Jake and Sheri identify as Jewish and attend a local synagogue on major holidays.

Jake’s parents are deceased, and he has a sister who lives outside London. He and his

sister are not very close but do talk twice a year. Sheri is an only child, and her mother

lives in the area but offers little support. Her mother never approved of Sheri marrying

Jake and thinks Sheri needs to deal with their problems on her own. The couple has

some friends, but due to Jake’s recent behaviors, they have slowly isolated themselves.

Intake and Assessment

The social worker’s first encounter with Jake was at an intake session at the Veterans

Affairs Health Care Center (VA). During this meeting, Jake stated that he came to the

VA for services because his wife had threatened to leave him if he did not get help. She

was particularly concerned about his drinking and lack of involvement in his sons’ lives.

She told him his drinking had gotten out of control and was making him mean and

distant. Jake had seen Dr. Zoe, a psychiatrist at the VA, who diagnosed him with post-

traumatic stress disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce his symptoms

of anxiety and depression and suggested that he also begin counseling.

During the assessment, Jake said that since his return to civilian life 10 months ago he

had experienced difficulty sleeping, heart palpitations, and moodiness. He told the

social worker that he and his wife had been fighting a lot and that he drank to take the

edge off and to help him sleep. Jake admitted to drinking heavily nearly every day. He

reported that he was not engaged with his sons at all and he kept to himself when he

was at home. He spent his evenings on the couch drinking beer and watching TV or

playing video games. When Jake’s options for treatment were discussed, he expressed

fear of losing his job and his family if he did not get help. Jake worked in an office with

civilians and military personnel and mostly got along with people in the office. Jake

tended to keep to himself and said he sometimes felt pressured to be more

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© 2022 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

communicative and social. He was also very worried that Sheri would leave him. He

said he had never seen her so angry before and saw she was at her limit with him and

his behaviors.

Based on the information Jake provided about his diagnosis and family concerns, he

and the social worker agreed that the best course of action would be for him to

participate in weekly individual sessions and a weekly support group that was offered at

the VA for Iraq veterans. The social worker then offered a referral for couples

counseling at the local mental health agency. The social worker also printed out a list of

Alcoholics Anonymous (AA) meetings in his area if he decided he wanted to attend in

order to address his drinking. He would continue to follow up with Dr. Zoe on a monthly

basis to monitor the effectiveness of his medications.

Sessions

During the following session, the social worker spent time explaining his diagnosis and

the symptoms related to PTSD. Jake said that he did not really understand what PTSD

was but thought it meant that a person was “going crazy,” which at times he thought

was happening to him. He expressed concern that he would never feel “normal” again

and said that when he drank alcohol, his symptoms and the intensity of his emotions

eased. The social worker explained to Jake that PTSD is a severe anxiety disorder that

develops after a person has experienced an event that results in psychological trauma.

The event may involve the threat or perceived threat of death to oneself or to someone

else. The social worker also explained that the disorder is characterized by re-

experiencing the traumatic event, including the symptoms of increased arousal, and by

the desire to avoid stimuli associated with the trauma. They discussed how Jake’s

behaviors fit into this cycle of hyperarousal and avoidance, including his lack of sleep

and irritability and the isolation and heavy drinking. He talked about always feeling

“ready to go.” He said he was exhausted from being alert and looking for potential

problems around him. He told me he always felt on edge, and every sound seemed to

startle him.

He shared that he often thinks about what happened “over there” but tries to push it out

of his mind. It is the night that is the worst as he has terrible recurring nightmares of one

particular event. He said he wakes up shaking and sweating most nights. He then said

drinking was the one thing that seemed to give him a little relief. The social worker gave

him a handout on PTSD and reviewed the signs and symptoms. Jake seemed relieved

to receive the information. The social worker conveyed that naming the issue or concern

was often helpful in the healing process. During the first few sessions, the goal was to

help Jake feel safe and validate his feelings. As such, the social worker consistently

assessed his feelings of safety, including any potential suicidal ideation. Jake was

reluctant to attend AA at that time, so he and the social worker began monitoring his

drinking and his behaviors after several drinks.