Crisis Treatment PLan

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JessicaCaseStudy.docx

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CCHM/558 v2

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CCMH/558 v2

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Case Conceptualization Scenario

Jessica

Jessica is a 25-year-old single female having difficulty with high anxiety, fears of getting close to people, feeling the need to be constantly perfect, and she states that she is unable to simply relax. Her sleep patterns are erratic, and she often wakes up in a panic with nightmares about her past. This is your first session with Jessica, and she shares that she was in an abusive situation at her elementary school from grades 1-7. It was a small rural area school with only 1 teacher and less than a dozen students. Everyone was abused and threatened, but she suffered the physical beating more often and more brutally. She reports that she had broken bones, black eyes, and needed stitches in her head a couple of times. She and the others at the school never reported what was really happening until she was in 7th grade and finally told her parents. Her teacher was arrested and imprisoned with a 16-year sentence and the school was shut down. She doesn’t understand why she continues to have difficulty sleeping, eating, and getting close to people when her parents did everything right after the abuse was exposed and her life has been very good.

During one session, Jessica is well groomed, dressed in business attire, and her hair and makeup are perfect. She makes good eye contact during her initial session, and she is logical and coherent in telling about the past; however, she begins to close her eyes and hangs on to the chair in your office tightly, as if it were moving. She cries, sobs, and cannot catch her breath for a few moments. She begins shaking and appears dazed. You say her name a few times, and she opens her eyes, calms her breathing but continues to sob. Jessica continues with telling you that she has a bachelor’s degree in marketing, a high-paying job in a large company, and a supportive family. She has a boyfriend who wants to get married, but she is afraid to commit to him because she feels like she is “too much work”. She states that she does not think she is worth close friendships or love because she cannot give enough back. She avoids most relationships and tries to just be perfect at work and through her diet and exercise. She knows that her background has created this belief but does not have the ability to change it. She shares that in her early 20’s she drank too much too often but has given that up and has been sober for 3 years.

Her reason for coming into counseling is because her family and her boyfriend want closer relationships with her, but she keeps pushing them away. She wonders if there is something that she could do so her relationships could become closer and healthier.