Running head: CASE STUDY: JANE 1
Case Study: Jane
Jamie Fard
School of Behavioral Sciences, Liberty University
Author notes
I have no known conflict of interest to disclose. Correspondence concerning this article
should be addressed to Jamie Fard
Email: jfard@liberty.edu
CASE STUDY: JANE 2
Case Study: Jane
Key Issue
Biological
oJane, a 54-year-old African American woman, is married.
oJane said that recalling the details of her terrible vehicle crash causes her heart to race,
her breathing to become shallow, and her body to break out in a cold sweat.
oAccording to Jane, the accident left her with several broken ribs, a broken arm, and a
lump on her forehead.
Psychological
oJane said she thinks about the accident several times a day.
oFive nights a week, Jane said she had nightmares about the accident. Jane said she had
trouble sleeping, was irritable and angry, and felt guilty.
oJane felt anxious and fearful.
oJane said she is easily startled in a car and is terrified of driving.
Social and Spiritual.
oJane stated she has many friends from both her professional and religious circles.
oJane stated that she has not been as active in the community since the accident because
she fears getting back in the car.
oJane and her husband have a good marriage, but she has not seen her kids since the
accident because she cannot drive.
oJane feels guilty that she has not seen her parents since the accident and is neglecting
them. o Jane said she had faith in God, which caused her accident.
CASE STUDY: JANE 3
Client Concerns
Symptoms Behavior stressor
Remembering the past
repeatedly
becoming irritable and
snapping at others
A car accident occurred about
two weeks ago.
Failing to focus Disappointingly irritable and
quick to anger
Worry over how she handled
an accident led to internal
Frequent nightmares five
times a week
Poorer productivity in the
workplace
Social life has suffered as a
result.
Anxiety Cannot participate in normal
social/work/social activities
Loneliness and isolation and
feeling of worthlessness
Feeling sad/frustrated/guilt Anger with God, inability to
take care of parents
Increased feelings of not
being good enough
Assessment
. The assessment for posttraumatic stress disorder (PTSD) typically involves a clinical
interview and the administration of a standardized questionnaire or scale, such as the PTSD
Checklist (PCL-5), to assess the presence and severity of PTSD symptoms (Blevins et al., 2015).
A diagnosis of PTSD requires the presence of specific symptom clusters, including re-
experiencing, avoidance, negative alterations in cognition and mood, and arousal and reactivity.
The assessment for Acute Stress Disorder (ASD) involves a clinical interview and the
administration of a standardized questionnaire or scale, such as the Acute Stress Disorder Scale
(ASDS), to assess the presence and severity of ASD symptoms (Bryant & Harvey, 2000). A
diagnosis of ASD requires the presence of specific symptom clusters, including dissociative
CASE STUDY: JANE 4
symptoms, re-experiencing, avoidance, arousal, and anxiety. PTSD and ASD can be assessed by
a mental health professional, such as a psychiatrist or psychologist, with expertise in trauma-
related disorders. (Zoellner & Feeny, 2014).
Diagnostic Impression
Signs and symptoms:
DSM-5 Diagnostic Criteria: Acute Stress
Disorder F43.0 (American Psychological
Association, 2013)
Client's Signs/Reported Symptoms:
·Criteria (A):
·Being subjected to any of the
following forms of death, injury, or
sexual violation (actual or threatened).
·Experiencing a traumatic event
firsthand, observing a horrific event, or
hearing about a traumatic event from a
close relative or friend.
· being repeatedly exposed to
distressing aspects of a traumatic
occurrence
The client was involved in a terrible car
accident. In the past 18 days
When nine or more of the following symptoms
are present:
·Memories of the trauma keep
returning, even when you don't
want them to.
·Having recurring nightmares about
the trauma
·A dissociative response
(flashbacks)
·Excruciating emotional anguish or
pronounced physical reactions in
response to internal/external cues
·The client complains that she
can't stop thinking about the
accident and wishes she had
handled it differently. Accident
nightmares five times a week
·Physical reactions (accelerated
heart rate, sweating) induced by
recalling an accident or the
prospect of returning to the
driver's seat
·Non-driving and highway
avoidance
·Insomnia caused by recurrent
nightmares
CASE STUDY: JANE 5
that resemble an aspect of the
traumatic event are examples of
posttraumatic stress disorder.
·Debilitating inability to feel
happiness
·change in one's perception of their
surroundings or of one's reality.
·An inability to recall key details of
the event
·attempts to suppress upsetting
thoughts, feelings, and
recollections of the event
·Attempts to limit exposure to
triggers that bring up disturbing
thoughts, feelings, and memories
of the incident
·Disruption of sleep
·Displays of irritability and anger
·Hypervigilance
·Lack of Focus
·startle overactive reflex
·Sleeplessness caused by
difficulty falling asleep
·Insomnia after waking from a
nightmare
·She becomes irritable with her
family and husband and snaps
at them.
·Reports of anger expressed by
oneself
·Increased vigilance while
behind the wheel, caused by the
need to avoid congested
highways on the way to the
office.
·an incapacity for focused
attention
The disturbance that significantly impairs
social, occupational, or other essential
domains of functioning
The client is unable to take part in regular
religious or community events. In addition,
because of current circumstances, the client
cannot drive themselves to work.
Disturbance not caused by the physiological
effects of a chemical or another medical
condition, such as a brief psychotic episode
There is no history of substance abuse. There
is no medical condition.
Disturbance lasts between 3 days and one
month after trauma.
A car accident happened 18 days before the
visit.
Other DSM-5 Conditions Considered
CASE STUDY: JANE 6
At first look, the other DSM-5 diagnoses I evaluated were posttraumatic stress disorder, but it
does not yet fit the requirements due to the time since the event. However, we could consider that
diagnosis a possibility one month after the trauma (APA, 2013).
Developmental Theories and/or Systemic Factors
Several developmental theories and systemic factors could be relevant to understanding the
experiences of a 54-year-old African American woman diagnosed with ASD and PTSD. Here are
a few possible examples:
Developmental theory: According to Erik Erikson's theory of psychosocial development, middle
adulthood (ages 40-65) is characterized by generativity vs. stagnation. At this stage, individuals
are focused on leaving a legacy and contributing to future generations but may feel unproductive
or stagnant if unable to do so (Kersting & Geiger, 2019, p. 10). This could be relevant to
understanding the experiences of a 54-year-old woman with ASD and PTSD, as she may face
additional challenges in achieving generativity and feeling productive due to her mental health
diagnoses.
Systemic factor: Research suggests that African Americans are more likely to experience trauma
and PTSD than individuals from other racial or ethnic groups due in part to experiences of
racism and discrimination (Williams et al., 2014). This systemic factor could be relevant to
understanding the woman's PTSD diagnosis and any challenges she may face in accessing
appropriate care and treatment.
Developmental theory: According to Lev Vygotsky's sociocultural theory, individuals' cognitive
development is influenced by the cultural and social context in which they grow up. This theory
could be relevant to understanding the woman's experiences with ASD, as she may have faced
CASE STUDY: JANE 7
unique challenges related to her cultural background and the societal attitudes and expectations
around ASD (Piven, 2010).
Systemic factor: The prevalence of ASD diagnosis is lower among African American children
than among white children, which could reflect cultural biases in the diagnosis process and
differences in access to diagnostic and treatment services. These systemic factors could be
relevant to understanding the woman's experiences with ASD, mainly if she were not diagnosed
until later in life (Mandell, Novak, & Zubritsky, 2005).
These are just a few examples of how developmental theories and systemic factors could be
relevant to understanding the experiences of a 54-year-old African American woman diagnosed
with ASD and PTSD. Other factors, such as the woman's personal history, family dynamics, and
social support network, could also be essential to consider.
Multicultural and/or Social Justice Considerations
Despite being African American, Jane is open to receiving treatment. She comes from a deeply
religious family and holds firm religious convictions. However, her race is a massive cause for
alarm because African Americans are more prone to develop PTSD after experiencing trauma,
and this condition has a long-term prognosis (Sibrava et al., 2019).
Treatment
For PTSD, evidence-based therapies include Prolonged exposure therapy (PE): a type of
cognitive-behavioral therapy (CBT) that involves a gradual approach to trauma-related
memories, feelings, and situations in a safe and supportive environment (Foa et al., 2020).
Cognitive processing therapy (CPT) is another type of CBT that examines, and changes negative
beliefs related to trauma. According to Shapiro (2018), Eye Movement Desensitization and
CASE STUDY: JANE 8
Reprocessing (EMDR) therapy involves recalling the traumatic event while engaging in rapid
eye movements or other forms of rhythmic, bilateral stimulation (MB Stein et al., 2019).
For ASD, treatment options may include According to Peters-Scheffer et al. (2011), Applied
Behavior Analysis (ABA) is a comprehensive early intervention program that is effective for
children with autism spectrum disorders. In addition, according to a study by Schaaf et al.
(2014), occupational therapy and sensory integration help individuals develop skills for daily
living, such as self-care and social interaction.
Speech therapy: is a type of therapy that helps individuals improve communication skills and
social interaction (Travers et al., 2016).
Medications may also manage symptoms such as anxiety, depression, or aggression.
Cultural Consideratine
When working as a female Middle Eastern counselor with a female African client diagnosed with
PTSD and ASD, it is essential to consider cultural differences that may impact the therapeutic
relationship. Some cultural considerations may include the following:
Respect for cultural norms and values: It is essential to be aware of and respect the cultural
norms and values of both the counselor and the client (Gelfand, Harrington, & Jackson, 2017).
Understanding of gender roles and expectations: In some cultures, there may be specific gender
roles and expectations that may affect the counseling process (Sabik, 2019).
Awareness of religious beliefs and practices: Religion can be essential to a person's cultural
identity and may affect their attitudes and behaviors toward mental health (Miller-McLemore,
1998).
Respect for privacy and modesty: Modesty and privacy are highly valued in many cultures, so it
is essential to be sensitive to these values in the therapeutic setting (Bosk, 1992).
CASE STUDY: JANE 9
Knowledge of trauma and mental health stigma: In some cultures, there may be a stigma
associated with mental health and seeking help for mental health issues.
It is vital to approach counseling with cultural humility and respect while considering each
client's unique needs and experiences.
CASE STUDY: JANE 10
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