CASE STUDY 1
Adult Trauma Case Study
School of Behavioral Sciences, Liberty University
Author Note
I have no conflict of interest to disclose.
Correspondence concerning this article should be addressed to
Email: @liberty.edu
Abstract
CASE STUDY 2
This paper is an in-depth case study of an adult trauma survivor referred to as "Jennifer." Jennifer
experienced a series of traumatic incidents throughout her life, notably the loss of her daughter,
“Alyssa.” A thorough examination was done of Jennifer's life, trauma, coping strategies, and
emotional reactions, with a detailed analysis to follow. This study brings attention to the
significant influence of complex trauma on both mental and physical health. It accentuates the
necessity for personalized therapeutic methods designed for people with intricate trauma-related
issues. Furthermore, the paper underscores the importance of trauma-informed care and targeted
mental health support for trauma survivors.
Keywords: Trauma, PTSD, ASD, trauma-informed care.
CASE STUDY 3
Adult Trauma Case Study
A colleague referred to as "Jennifer" in this paper was interviewed on September 5th,
2023. The interview occurred face-to-face within the interviewer’s workplace setting. The initial
interview spanned approximately thirty minutes, followed by a subsequent meeting during which
the interviewee discussed her responses to the questions. The choice of this particular
interviewee was motivated by her extensive history of coping with trauma throughout her life.
Before conducting the interview, the interviewer informed the interviewee that it was part of a
doctoral course assignment focusing on individuals who have encountered traumatic events.
While the interviewee comprehended the purpose and scope of the interview, her emotional
demeanor noticeably evolved during the conversation.
Interview Findings
Jennifer
Jennifer is a 55-year-old divorced female with two children and no living parents.
Jennifer lost her mother at the tender age of seven to a brain aneurysm. It was not known if
Jennifer was her father’s biological child. Therefore, after the mother passed away, her father
gave up his custodial rights, leaving Jennifer orphaned. Despite her older brother's attempt to
adopt her to prevent her from entering the foster care system, he was denied parental rights due
to his young age. Jennifer was reluctantly taken in by her uncle and his wife, who provided her
with her basic necessities but neglected her emotional and attachment needs. Jennifer was forced
to leave her aunt and uncle's home on her 18th birthday.
Jennifer grew up in Las Cruces, New Mexico, where she met and married a military
mechanic. Because of her husband's occupation, the couple relocated frequently during the first
decade of their marriage. They eventually settled in Tucson, Arizona, where Jennifer gave birth
CASE STUDY 4
to a son and a daughter. Her husband referred to as "Ted," struggled with drug addiction
throughout their marriage, leading to two decades of arrests, incarceration, mandatory
counseling, stints in drug rehabilitation, and job loss. Jennifer bore the sole responsibility of
maintaining their home and caring for their children while dealing with an abusive husband who
battled addiction. Jennifer stayed in her marriage for her children, believing that a married couple
with issues was a better environment than a single-parent home. A decision Jennifer says haunts
her to this day. She believes that her daughter would still be alive had Jennifer left her husband
sooner. After thirty years of marriage and once both children had completed high school, Jennifer
initiated divorce proceedings.
Alyssa
Jennifer describes her daughter, who will be identified as Alyssa for this paper, as a
petite, fearless spitfire who was highly sensitive and loved deeply and intensely. A love that
Jennifer says often led to Alyssa's detriment. Alyssa had a petite frame, weighing under 100
pounds at 18 years old. Alyssa was a cheerleader whose small size made her an ideal "flyer" for
her cheerleading team but contributed to body dysmorphia. Alyssa shared a special bond with her
older brother, was close to her mother, and had deep affection for her father. However, Jennifer
stated that although Alyssa was loved by many, she struggled to find her place in the world,
which led to issues with depression.
Alyssa knew her father struggled with addiction and had not only witnessed her father
abusing her mother but experienced abuse at his hand as well. Regardless, when her father
verbally attacked her, she took his hurtful words as facts. Alyssa began dating a boy her senior
year of High School that Jennifer stated was both mentally and verbally abusive toward Alyssa.
Jennifer noted that the pressures of her parent's divorce, her father’s continued verbal abuse, her
CASE STUDY 5
involvement in cheerleading, and a verbally abusive boyfriend further exacerbated Alyssa's
depression and anxiety.
Alyssas Death
Shortly after Alyssa graduated from high school, she came home and told Jennifer that
she had a headache and needed to nap after a challenging day. She confided in Jennifer that not
only had she broken up with her boyfriend earlier in the day. When Alyssa told her dad that she
had broken up with her boyfriend, he berated her and not only blamed Alyssa for her break up
and her parent's divorce but said she would never be able to maintain a relationship, just like her
mom. Alyssa informed her mother that she intended to take some headache medication and rest
for a while. A few hours later, when Jennifer went to wake Alyssa, she found her unresponsive
and not breathing. Jennifer immediately initiated cardiopulmonary resuscitation (CPR) on her
daughter until the paramedics arrived and assumed control of the resuscitation efforts.
Jennifer fought back tears as she described the scene while firefighters fought to save
Alyssa's life. She stated that as soon as the paramedics arrived, she crawled away and collapsed
on the floor crying. She went on to say that all she wanted to do was lie on the floor and cry, but
as the paramedics started to take Alyssa away, Jennifer summoned the strength she needed to
follow after them. Alyssa spent eight days in the ICU, during which time her medical team
performed several tests to determine Alyssa’s brain activity and the likelihood of her waking up
from her coma. Tests Jennifer felt caused her daughter pain, exacerbating Jennifer's feelings of
guilt for performing CPR.
Coping Mechanisms
Jennifer's demeanor reflected her emotional turmoil as she slumped and nervously wrung
her hands together while she relived the moment in her mind. The interviewer did not proceed
CASE STUDY 6
with the interview until Jennifer sat back up in her chair and looked on expectantly. The next
series of questions asked were about Jennifer's coping strategies following her daughter’s
untimely demise. Jennifer explained that she immersed herself in her work and
compartmentalized the entire experience, admitting, "I know it was not a healthy approach, but I
did not know what else to do” (Parker, 2023). Jennifer was diagnosed with depression following
Alyssa's death and prescribed an antidepressant. However, due to her past relationship with a
drug addict, she was careful to avoid using medications or alcohol to cope.
Long Term Symptoms
Jennifer felt as though she probably struggled with post-traumatic stress disorder (PTSD)
during this period in her life and experienced both physical and mental manifestations. She could
not watch a television show that portrayed people performing CPR or using an automated
external defibrillator (AED) without having a panic attack. The sound of an idling firetruck
brought on debilitating panic attacks. The idea of ever doing CPR again brought a level of
anxiety that caused Jennifer to drop her CPR certification. Jennifer began struggling with a lack
of appetite that brought on severe weight loss. She developed a breast cyst, struggled with
insomnia, and developed hypertension. However, Jennifer states that her physical symptoms
have since returned to normal, and her PTSD has subsided. While she still experiences anxiety
when encountering idle fire trucks, she is now willing to pursue CPR recertification, and her
panic attacks have abated.
Treatment
Jennifer attempted counseling a few times during this period in her life. She initially tried
a group therapy setting, which she stated was an ineffective experience. During her time in group
counseling, she learned of her empathetic nature and stated that instead of feeling better, she
CASE STUDY 7
began to carry the grief of those around her. Jennifer's first one-on-one counselor did not
appreciate the vulnerable state that Jennifer was in and wanted to focus on her childhood as
opposed to the crisis she was currently experiencing. The second counselor Jennifer went to see
double booked her, which made Jennifer look for another counselor.
The third counselor, a pastor within her church, told Jennifer that if she never went to
another counseling session, she would be just fine. Jennifer took these words to heart and never
sought counseling again. This comment by her pastor and counselor discredited Jennifer's trauma
and gave her the perception that she could heal from her trauma without assistance. The Bible is
a constant reminder of the trials and tribulations that the Lord’s people face in their lives and the
peace that comes from believing in Christ (King James Bible, 1769/2017, John 16:33). This
counselor missed the opportunity to extend God’s love to one of the members of his church.
Jennifer went from counselor to counselor looking for answers, answers that were
ultimately denied to her. Psalm 86:6-7 resonates with trauma survivors as it reflects a plea for
divine intervention and comfort in distress (King James Bible, 1769/2017). This verse also
reflects the therapeutic journey of seeking understanding, expressing pain, and finding solace and
answers in healing. In turn, the Bible provides insights into the complexities of the human
condition, acknowledging the reality of suffering, sin, and brokenness. Christian counselors may
use these insights to foster empathy, understanding, and a non-judgmental approach toward their
clients.
Life Changing Results
Jennifer stated that the death of her daughter changed her life for the negative for a few
years. However, as the fifth anniversary of her death approaches, Jennifer has determined that
her daughter’s death has positively changed her. Jennifer stated that her daughter’s death has
CASE STUDY 8
made her a kinder and more compassionate person. Jennifer went on to state, "I am more attuned
to those who struggle with depression or PTSD. I miss her every day, so I have come to
understand that grief does not conclude; it simply evolves” (Parker, 2023). Jennifer ended the
interview after this statement, stating that she had disclosed more in this interview than she had
in the years leading up to it.
Shortly afterward, Jennifer returned to the interviewer and offered additional insights,
stating, “I know one thing you can add to your paper” (Parker, 2023). In reflection, Jennifer can
see that she was focusing on everyone else’s grief in an attempt to ignore her own. This
disassociation went as far as no longer hugging people because it was emotionally draining to
her. Instead of a hug making her feel better, she could feel the other person’s grief and sadness
emanating, and she could not hold their grief along with hers. Jennifer felt like she could not
show her grief because that would show weakness, and she needed to be strong for her son, who
was severely struggling. Jennifer stated that she also learned “there is no perfect way to lose a
child, and people say really stupid things when you are hurting, like God only gives things to
strong people” (Parker, 2023). Jennifer left the interview and went home; she said it was
important that someone knew that side of her, but she did not know how difficult it would be to
share those details with somebody.
Analysis and Discussion
Emotional pain is unavoidable in the face of life's challenges and difficulties, albeit not
all emotional pain constitutes as traumatic. Trauma is the result of direct exposure to or
witnessing life-threatening events, learning about such events happening to a loved one, or
experiencing repeated exposure to distressing details (Levers, 2022). Jennifer's recount of her life
displays a lifetime of events that impacted her physical and mental health in many ways,
CASE STUDY 9
concluding that what Jennifer experienced was trauma. However, due to the interpersonal
traumas that Jennifer experienced throughout her life, it could be determined that Jennifer suffers
from complex trauma. When trauma is extensive, it is called complex trauma, involving exposure
to multiple, often prolonged traumas. The number and mixture of interpersonal traumas an
individual has endured throughout life determines their future psychological symptoms and
disorders (Briere & Scott, 2015).
In her interview, Jennifer stated that she utilized maladaptive coping strategies after the
death of her daughter. These maladaptive coping strategies directly correlate to John Bowlby's
attachment theory. Attachment theory suggests that the emotional bond between a child and
caregiver has lasting effects on development. Secure attachments enable healthy relationships,
emotional regulation, and dependable support from attachment figures. These experiences shape
long-term self and relationship representations (Perlman et al., 2016). Jennifer did not have
attachment figures in her life after the age of seven and experienced neglect at the hands of her
extended family. This lack of secure attachments and healthy relationships resulted in an inability
to cope with traumatic events adequately.
In 1980, the American Psychiatric Association (APA) added the diagnosis of post-
traumatic stress disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders;
in 1994, they revised the manual to include acute stress disorder (ASD) (Levers, 2022). PTSD is
a mental health condition that can develop in individuals who have experienced or witnessed a
traumatic event. Traumatic events that can lead to PTSD include combat exposure, sexual or
physical assaults, serious accidents, natural or man-made disasters, and the sudden death of a
loved one (Lopez, 2022). Symptoms of PTSD can be grouped into four categories: intrusive
memories, avoidance, negative changes in thinking and mood, and changes in arousal and
CASE STUDY 10
reactivity (Briere & Scott, 2014). To be diagnosed with PTSD, symptoms must last for more than
a month and cause significant distress or impairment in daily functioning.
ASD encompasses the same symptoms, albeit temporary, lasting between two days to
four weeks (Bryant, 2017). Jennifer stated that she felt as though she was experiencing PTSD-
related symptoms. However, her symptoms abated after a few weeks. The likelihood is that
Jennifer experienced ASD with some residual effects that have the potential to develop into
PTSD. Residual effects depend on the nature and severity of the traumatic event, the individual's
coping mechanisms, the presence of social support, and whether professional intervention is
sought early on (Cardeña & Carlson, 2011).
In the interview, Jennifer mentioned that group counseling negatively affected her. This
negative response to group counseling is called negative outcome or deterioration (Roback,
2000). Therapy-induced negative therapeutic change is when a patient experiences exacerbated
symptoms, new symptoms, loss of trust in the therapeutic process, obsessional thoughts, or
begins to pursue unrealistic goals (Roback, 2000). As noted in the interview, the group therapy
process exacerbated Jennifer’s symptoms. Jennifer then moved to individual counseling, where
she lost out on the experience of trauma-informed care.
Trauma-informed counselors are attuned to connecting clients' current challenges with
past trauma, validating and normalizing their experiences. Trauma-informed practice is based on
trauma theory and involves using the provider-patient relationship to address long-term trauma
effects. This practice empowers survivors to practice autonomy and take a leadership role in their
present lives (Knight, 2014). Jennifer's first counselor did not work to create a therapeutic
alliance before delving into her past. The counselor also did not work to show Jennifer how the
past influences the present and empower her to take a front seat in her healing journey.
CASE STUDY 11
Jennifer's experiences of parental loss, neglect, marital discord, and the loss of a child
may have played a role in Jennifer's ability to adapt after the death of her daughter. The concept
of allostasis, the process through which the body strives to return to homeostasis after exposure
to a stressor, such as a traumatic event, becomes relevant in this context. Allostasis is the body's
effort to maintain stability amid change (Sapolsky, 2004). Throughout her life, Jennifer
encountered an allostatic load involving the dysregulation and overuse of the body's mediators,
ultimately influencing the brain and body's functioning (Sapolsky, 2004). In essence, Jennifer's
body adapted to the regular trauma she experienced.
Biblical Response
Jennifer experienced a series of traumas related to rejection throughout her life. Her
father rejected her after her mother's death. Her brother wanted her, but the state rejected this.
She was taken by her extended family and then rejected by them. Much like Jennifer, Jesus was
often rejected by people, including those closest to him. The Gospel of John is littered with
stories of these rejections, including Peter rejecting Jesus not once but thrice.
John 7:1 discusses how Jesus could not go to Judea because the Jewish community
wanted to kill him (King James Bible, 1769/2017). John 7 also states that not even his flesh-and-
blood brothers believed in him (King James Bible, 1769/2017, John 7:5). When experiencing the
pain of rejection, it is comforting to know that Jesus truly understands and shares his followers'
burden. Jesus experienced everything we do to redeem it and cover it in grace. For Christian
counselors, the gospel is the unwavering answer to rejection.
Conclusion
Jennifer's case study delves into the intricate realm of trauma and grief. Her life, marked
by significant losses, has led to symptoms of depression, ASD, and physical health challenges.
CASE STUDY 12
Despite initial impacts, Jennifer's resilience is evident through imperfect coping mechanisms
aimed at restoring internal balance post-trauma. The struggle to find a suitable counselor
underscores the need for specialized mental health professionals to address grief and trauma.
Jennifer's frustration with friends' misguided comments highlights the personalized nature of
grief, emphasizing the absence of a universal healing approach. Her journey toward empathy
amidst personal grief underscores the human potential for growth and compassion. Ultimately,
Jennifer's story illuminates the enduring nature of grief, the importance of effective coping
mechanisms, and the significance of compassion and support for those experiencing profound
loss. Her experiences provide insights into trauma complexities and the strength that can emerge
from traumatic experiences.
CASE STUDY 13
References
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Cardeña, E., & Carlson, E. B. (2011). Acute stress disorder revisited. Annual Review of Clinical
Psychology, 7(1), 245–267. https://doi.org/10.1146/annurev-clinpsy-032210-104502
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