MSW 525 Module 3

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Case Analysis: The Case of Tina

STUDENT NAME

Master of Social Work, Chamberlain University College of Health Professions

MSW 525: Trauma Treatment for Children and Adolescents

Dr. Jessica Benito

DATE

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Case Analysis: The Case of Tina

Tina, a seven-year-old girl, was brought to the University of Chicago child psychiatry

clinic by her mother for evaluation after her school insisted due to troubling behaviors like

aggression, exposing herself, attacking peers, using sexual language, and engaging in sexual

play. From ages four to six, she was repeatedly sexually assaulted, raped, and threatened by her

babysitter's son over two years until she was six years old (Perry & Szalavitz, 2017),

significantly affecting her development. Consequently, her planning and processing higher-order

brain systems were deactivated, overshadowed by the survival-oriented low road brain (Saxe &

Brown, 2015). This case analysis will explore how her trauma and environmental factors

influence Tina's behaviors. Her adversities would likely yield a high Adverse Childhood

Experiences (ACE) test score, increasing her vulnerability to chronic health issues and mental

illness (Harris, 2018). Dr. Perry employed several interventions with Tina, although their

effectiveness was limited by time constraints, which will be reviewed.

Impact of Trauma on Tina's Neurobiology

Physical

Dr. Perry examined Tina's previous charts and found her heart rate elevated at 112 beats

per minute. The average heart rate for children in her age group is below 100 beats per minute.

Tina exhibits symptoms and behaviors that suggest abnormalities across all four brain regions.

Her sleep and attention difficulties, fine motor skills and coordination, social and relational

delays, and issues with speech and language reflect complications within the brainstem, cortex,

limbic system, and diencephalon regions (Perry & Szalavitz, 2017).

Cognitive

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Tina felt confused during her first encounter with Dr. Perry. As she climbed onto his lap

and tried to unzip his pants, he gently set her down. Her expression showed fear and anxiety,

reflecting her toxic belief about what she thinks men desire from her. She believes men to be

sexual predators based off her lack of positive male figures present in her the course of her life

and the trauma she endured. She believes that sexual behavior in public is normal. Also suffers

from language and speech delays.

Emotional

Tina demonstrated fear and anxiety when Dr. Perry turned her away. In school and with

her peers, she would be aggressive with her teachers and peers. She consistently attacked other

children, which relates to her fear of being in danger.

Behavioral

When first meeting Dr. Perry, she crawled into his lap and snuggled him, before rubbing

his thigh and attempting to unzip his zipper. She does not have healthy boundaries. The school

reported that she was aggressive, inappropriate, exposed herself, attacked other children, used

sexual language, and attempted to get other students to engage in sexual play. She also admitted

to engaging in sexual play when left alone with her brother. She struggles with paying attention,

lacks patience, and exhibits impulse control issues. Overreact to the slightest indications of

possible aggression, leading to conflicts.

Behavioral Changes

As Tina learned that her behavior was unacceptable, she learned to hide her impulses to

avoid getting in trouble. Her toxic associations led her to expose herself to others and engage in

sexual play with her peers and brother. She would scan faces for threats, searching for signs that

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someone might be trying to harm her. At ten years old, she was found engaging in sexual

activities with an older boy at school.

Dr. Perry’s Interventions and Effectiveness

Dr. Perry started his initial session with Tina by joining her in coloring. They shared

updates about their artwork, which effectively fostered trust and rapport. For the first time, Tina

saw Dr. Perry as a man who was not pursuing her for sexual reasons, making her feel

comfortable enough to discuss her interests and future aspirations. Following their first session,

contrary to his supervisor's recommendation to diagnose Tina with Attention Deficit Disorder

and explore suitable psychopharmacology, he chose to pursue a therapeutic approach instead.

Holding off on any diagnosis before he gets to know Tina more. He later diagnosed her after

getting to know her with post-traumatic stress disorder. Dr. Perry gave her and her family a ride

home one day and assisted them with shopping at a local store. While this is against typical

practices, it allowed him to better understand Tina's environment and home life. Opening his

eyes to the difficulties her family faced.

During their therapy sessions, he included activities that allowed her to lead and choose

the focus. He capitalized on spontaneous moments to introduce ideas such as patience and the

importance of careful consideration before reacting. She felt comfortable discussing various

topics, and he fostered clarification by posing questions. As her communication skills improved,

she became more receptive to feedback, which, in turn, bolstered her confidence. He often

modeled behaviors or gave explicit guidance, depending on what best fit the situation. This

method proved successful, as she began to display better behavior at school, avoiding conflicts

with peers, completing assignments, and consistently attending classes. However, despite her

school improvement, she was caught performing a sexual act with an older boy at school. Thus,

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while the treatment effectively enhanced her interactions at school and with peers, it also taught

her to conceal her sexual activities to evade trouble.

Environmental Impact on Tina's Ability to Heal from her Trauma

Risk Factors

Tina lives with her single mother and her two siblings. They struggle with severe poverty

and rely on public transportation, which is dangerous in Chicago winters, as the bus is their main

transport. They live in one of the poorest areas in the city. Her mother has introduced

inappropriate boyfriends, leaving Tina without positive male role models. Their one-bedroom

apartment was messy and had trash during Dr. Perry’s visit. Tina often stays home with her

brother after school while their mother works, feeling uncomfortable hiring a babysitter due to

past experiences. During this time, they have engaged in sexual play and typically watch TV.

They lack nearby family support.

Protective Factors

Tina’s mother consistently ensures her daughter attends all her appointments, regardless

of the challenges faced by the family. She supports her daughter and followed the school's

suggestion to have her evaluated, demonstrating her willingness to assist her the best she can

through her trauma. Tina is actively participating in therapy and treatment, and her school

routine keeps her engaged and connected with her peers. Recently, the family relocated to an

apartment closer to the clinic, making appointments just a 20-minute bus ride away. When the

children are home alone, their mother has provided an emergency contact for them to contact if

necessary.

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References

Harris, B. N. (2018). The deepest well: Healing the long-term effects of childhood

adversity. Houghton Mifflin Harcourt

Perry, B. D., & Szalavitz, M. (2017). The boy who was raised as a dog: And other stories from a

child psychiatrist's notebook: What traumatized children can teach us about loss, love,

and healing. Basic Books.

Saxe, G., Ellis, B.H. & Brown, A. (2015). Trauma systems therapy for children and teens.

Guilford Press