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TREATMENT PLAN
Diagnosis:
Axis I: 309.81 Posttraumatic Stress Disorder, Chronic
309.28 Adjustment Disorder, With Mixed Anxiety and Depressed Mood
300.15 Dissociative Disorder Not Otherwise Specified (Rule Out)
Axis II: V71.09 No Diagnosis on Axis II
Axis III: Deferred to medical personnel
Axis IV: Death of a family member, divorce, living alone, job loss, arrest, victim of a crime
Client-stated Desired Outcome
"I want help with my blackouts. I want help dealing with what happened to Jason and Shaun. I'd like my finger back, too (smile). Seriously, though, I just don't want to feel like this anymore."
Treatment Goal(s)
(1) Ethan will no longer experience blackouts, symptoms of panic attacks, or any other disturbing re-experiencing of the trauma.
(2) Ethan will no longer report significant depressive symptoms.
Client Strengths in Meeting Goals
Ethan has already demonstrated immense courage in the face of difficulties. He is willing to meet regularly with a therapist in order to address his issues.
Barriers to Meeting Goals
The nature of Ethan's trauma has ongoing effects, such as his son Jason being gone and being divorced.
Interventions
Ethan would benefit from therapy to help him with his trauma. It is anticipated that panic, depressive, and dissociative symptoms would decrease as he processes these issues. There are a variety of interventions that may be helpful for Ethan. One type of therapy that tends to be intense but effective in a relatively short period of time is Eye Movement Desensitization and Reprocessing, or EMDR. This therapy aims to alleviate symptoms associated with trauma via recalling the events (just in their mind, not verbally) and experiencing bilateral stimulation, such as moving the eyes back and forth or having the knees alternatively tapped. This therapy has been the subject of mild controversy in the therapy world, but is a widely accepted and scientifically validated form of therapy. As he begins to heal from his trauma, it is likely his depression would decrease. As he incorporates difficult thoughts and emotions into his conscious mind, it is anticipated his blackouts will decrease.
Ethan may also benefit from some Gestalt Therapy techniques, such as the "Empty Chair" technique. In this intervention, Ethan would pretend his son was sitting in a chair next to him and would talk to him as if he were there. This is designed to help him integrate his thoughts and feelings, as well as process his feelings. He may also benefit from writing a letter to his son, Jason. Similarly, and likely a more difficult but beneficial task, he could write a letter to himself as if Jason had written it. He could process his experience with these interventions in therapy.
Ethan may also benefit from treatment designed to assist during his panic attacks. When a person is anxious, their body will physiologically accelerate. When a person is depressed, the body will physiologically decelerate. This physiological process often leads down a troubling spiral during a panic attack. For example, a person may run up some stairs and notice their heart beating fast. They then feel anxious that this could mean a panic attack in about to occur, and then their hands get sweaty. This confirms their belief and they begin to take short, shallow breaths which in turn leads to more panic. Soon, the person's physiology is accelerated and the person may feel that they are going to have a heart attack or die. Part of treatment for panic symptoms is simply being aware of this process. People who experience panic attacks are typically misinterpreting normal physiological responses in the body, and having an awareness of how a panic attack is formed can be very helpful in stopping them before they get out of control. Education and practice of panic reducing exercises (such as deep breathing and self-talk) will likely be beneficial to Ethan.
Throughout all treatment, it would be appropriate to take a Rogerian approach. Carl Rogers believed that all people are naturally capable of growth when given the correct environment, which he stated was one of unconditional positive regard, congruence, and accurate empathy. Ethan would benefit from experiencing this type of environment throughout therapy.
Ethan may be responsive to Cognitive Behavioral Therapy. This theory posits that thoughts, emotions, and behaviors are all connected to each other, and that in order to change one (e.g., an unpleasant emotion) you should change the others (your thoughts or behaviors). A person who tends to intellectualize things (such as Ethan the architect) may identify with this approach and be amenable to interventions in this field of therapy. However, I believe Ethan ultimately needs to process his emotions, and often staying on a cerebral plane interferes with this goal.
It is anticipated that therapy may occur weekly for 20 weeks.
Termination
As always, termination will occur at the discretion of the client with input from the therapist. It is anticipated that termination will be considered when Ethan reports a reduction in his symptoms such that he can function both socially and occupationally.
