Chapter 3. Michelle’s Case: “My doctor must think I’m losing my mind.”
3.1 Screen 1
The individual cannot recall important life-related information—typically, traumatic or stressful information. The memory problem is more than simple forgetting.
The individual experiences significant distress or impairment.
The symptoms are not caused by a substance or a medical condition.
(Information from: APA, 2013)
Client-centered therapy involves supporting clients and reflecting their words back to them to help them help themselves. In Michelle’s case, a humanistic or client-centered therapist would offer support and comfort while trying to guide Michelle to reach her own insights and make her own decisions about her condition.
CBT first identifies the client’s problematic behaviors, and then uses techniques from classical conditioning and operant conditioning or modeling techniques to try to change those behaviors. The cognitive piece of this therapy involves challenging distorted thoughts. A form of behavioral therapy—behavioral exposure techniques for PTSD—would involve encouraging Michelle to remember the accident, often by writing out and then reading the account of the traumatic event. By diminishing the power of these memories over the client, the technique helps reduce specific symptoms and improves overall adjustment. In Michelle’s case, after applying this technique the therapist would specifically address her thoughts that all cars are unsafe. Treatment would include monitoring Michelle’s irrational beliefs and trying to come up with rational responses to counter these beliefs.
Repeated, uncontrolled, and distressing memories
Repeated and upsetting trauma-linked dreams
Dissociative experiences such as flashbacks
Significant upset when exposed to trauma-linked cues
Pronounced physical reactions when reminded of the event(s) Continual avoidance of trauma-linked stimuli
Negative changes in trauma-linked cognitions and moods, such as being unable to remember key features of the event(s) or experiencing repeated negative emotions
Conspicuous changes in arousal and reactivity, such as excessive alertness, extreme startle responses, or sleep disturbances
Individual experiences significant distress or impairment.
(Information from: APA, 2013)
The individual is exposed to a traumatic event—death or threatened death, severe injury, or sexual violation.
The individual experiences at least one of the following intrusive symptoms:
Repeated, uncontrolled, and distressing memories
Repeated and upsetting trauma-linked dreams
Dissociative experiences such as flashbacks
Significant upset when exposed to trauma-linked cues
Pronounced physical reactions when reminded of the event(s)
The individual continually avoids trauma-linked stimuli. The individual experiences negative changes in trauma-linked cognitions and moods, such as being unable to remember key features of the event(s) or experiencing repeated negative emotions.
The individual displays conspicuous changes in arousal and reactivity, such as excessive alertness, extreme startle responses, or sleep disturbances.
The individual experiences significant distress or impairment, with symptoms lasting more than a month. (Information from: APA, 2013)
Individual experiences one or more of the following:
Repeated episodes of sleep or sleepiness within a day A period of 9 hours or more of sleep that does not rejuvenate the person Inability to wake up completely after awakening suddenly Individual experiences significant distress and difficulty in thinking, and in work and social activities
The pattern is not explained by other disorders or by the effects of a drug.
(Information from: APA, 2013)
Individual experiences distress that is far greater than the stressor warrants and/or experiences significant difficulties at work or in social setting or other spheres.
The pattern is not due to another disorder or to bereavement. (Information from: APA, 2013)
A conversational treatment used by psychodynamic therapists that includes techniques such as free association, or letting the client talk about whatever comes to mind, and therapist interpretation, which involves giving insight and offering an opinion on patterns noticed in the client’s free association and other indicators such as dreams or nightmares. A psychoanalyst would treat Michelle by seeing her 3–5 times per week for several years. Psychoanalysis is costly, and it requires a long time commitment.
Cognitive therapy involves challenging distorted thoughts. A cognitive therapist works with patients to address their maladaptive thoughts. In Michelle's case, you would specifically address her thoughts that all cars are unsafe. Treatment would include monitoring her irrational beliefs and trying to come up with rational responses to counter these beliefs. Cognitive treatment would likely work best in conjunction with another type of treatment, such as behavioral therapy.
Behavioral therapy, first identifies the client's problematic behaviors, and then uses techniques from classical conditioning and operant conditioning, or modeling techniques to try to change those behaviors. A form of behavioral therapy, behavioral exposure techniques for PTSD would involve encouraging Michelle to remember the accident, often by writing out and then reading the account of her traumatic event. This technique diminishes the power of these memories over the client and helps reduce specific symptoms and improves overall adjustment.
Medication involves taking a chemical agent prescribed by a medical doctor to alter brain chemistry, which subsequently alleviates psychological symptoms. In Michelle’s case, a psychiatrist, who has a medical degree (MD), could prescribe an anti-anxiety medication to help control her severe symptoms of anxiety, or a sleep aid to treat her insomnia. The psychiatrist would meet with Michelle regularly to monitor her symptoms and to adjust the dose of her medication as necessary.
A behavioral exposure treatment in which the therapist guides clients to move their eyes in a rhythmic manner from side to side while recalling the images of objects and situations related to the trauma that they usually avoid.
This is a form of crisis intervention in which the therapist helps the client talk about feelings and reactions to the incidents during or immediately following the trauma.
Taryn A. Myers, PhD, Virginia Wesleyan University
3.2 Screen 2
Please note: Clinical Choices allows you to enhance and test your understanding of the disorders and treatments covered in your textbook, in a simulated case study environment. It is not intended to replicate an actual intake interview or therapy session or provide training on therapeutic techniques. Clinical Choices is for educational purposes only and is not intended as a substitute for clinical training.
3.3 Screen 3
The receptionist hands you intake paperwork prior to your interview with your new client, Michelle, who was referred for therapy by her primary care physician. The referral includes the following information: “female patient in MVA [motor vehicle accident] 3 months ago, multiple injuries, experiencing recurrent insomnia.” Select the button to review the paperwork before you begin the interview.
New Client
Michelle: Case #11006
Psychological Clinic
Intake Paperwork
Client Name: Michelle
Age: 42 years old
Gender: Female
Ethnicity: Asian-American
Occupation: Part-time legal secretary
Current living situation: I live with my husband and 3 children
Why are you seeking services at our clinic? My primary care doctor referred me for therapy because I’m having a hard time sleeping after a car crash.
3.4 Screen 4
You will now ask Michelle a number of questions you would typically ask during the intake interview. As you conduct the interview with Michelle, begin to think about her symptoms, what her diagnosis might be, and later, what type of treatment might be most helpful to her. Select the “play” button to hear Michelle’s responses to your questions. To read the transcript for these answers, select the “transcript” button.
3.5 Screen 5
“Hi, Michelle. It’s nice to meet you. What we are doing today is called an intake interview. I’m going to have you tell me what brought you here today, and I’m going to ask you some questions that I ask everyone who comes to the clinic. This information will tell me how best to help you. This may mean having you continue to see me for therapy at this clinic, or it may involve referring you to another mental health professional or facility. Let’s start. Tell me about what brought you to the clinic today.”
Transcript
Michelle: [in distress] My doctor must think I’m losing my mind. I was in a really serious car accident 3 months ago. Another car hit me head on. I just haven’t been myself since the accident. I was in the hospital for 3 weeks with multiple broken bones and other severe injuries. I was taking a lot of pain medication but after I was discharged I stopped taking most of it because I didn’t like how it made me feel. For 2 months or so, I’ve been having trouble sleeping. It takes me at least an hour to fall asleep, and if I wake up in the middle of the night, it’s really hard for me to fall back to sleep. [pauses] … Then of course I’m exhausted in the morning [feigns upbeat energy] but I have to be up and at ‘em so I can get my kids ready for school then get myself to work. I am so tired at work ... I just want to quit … but … my husband made me see my primary care doc, and she referred me to you.
3.6 Screen 6
“Your accident sounds very frightening, and the recovery process sounds like it has been very difficult for you. Has your trouble sleeping affected other areas of your life?”
Transcript
Michelle: It’s hard for me to concentrate at work because I’m so tired. Also – and this sounds absolutely horrible, I know! – I feel as if I don’t have any more love to give my husband and my kids. Intellectually, I know I love them, but I just can’t feel that love for them anymore. So I have to put on a happy face to show them I love them, and it’s so hard ... [sighs] and then I feel guilty that this feeling just doesn’t come naturally. It’s also exhausting, which doesn’t help with feeling tired and the lack of concentration.
Question 3.1
Based on her initial report of her symptoms, which of the following stress-related disorders could Michelle be suffering from? Select all that are possible diagnoses for Michelle. Select the disorder name to review the diagnostic criteria for each disorder.
Acute Stress Disorder (ASD)
bI0LPa9lfHQ+dYqkPost-Traumatic Stress Disorder (PTSD)
bI0LPa9lfHQ+dYqkInsomnia
wCfH0QtRgXJ8o+c+Hypersomnolence Disorder
bI0LPa9lfHQ+dYqkAdjustment Disorder with Anxiety
wCfH0QtRgXJ8o+c+Dissociative Amnesia
Hint
Revisit your interview with Michelle to review her symptoms. Think about the time frame and symptoms she is experiencing.
3.7 Screen 7
“I realize this may be difficult, and you don’t have to go into a lot of detail right now if it is difficult for you to discuss, but can you tell me more about your accident?”
Transcript
Michelle: I really don’t remember anything about it. That’s the weird thing. All I really remember is … my injuries and how painful they were. I had to stay in the hospital for quite some time. I know it was difficult on my husband and my kids with me out of commission. And of course I worried about my kids … but you know … [pauses] I do sometimes have memories of the crash. They come to me all of a sudden. I think I started remembering a few weeks after the accident. They come out in my dreams. I will finally fall asleep, after tossing and turning for hours, and then I wake up because I see the car speeding toward me and I’m thinking, I’m going to die. [begins to get teary and upset] All I can think about was the fact that my 3 children are going to have to grow up without a mother. [sobbing softly for a moment ] … I’m sorry … I’m sorry … [deep breath intake as she regains her composure] I – I think I can remember a bit more about the accident now… I was driving on the highway and there was only one lane of traffic because of construction. Even though I had the right of way I looked up to see an SUV driving at full speed towards my little car. I was terrified, paralyzed with fear. I thought I was going to die. I still don’t remember the accident [pauses] ... or what happened right after.
3.8 Screen 8
“That must have been very frightening for you, Michelle. Sometimes when people have experienced a traumatic event, like your accident, they get what we call “flashbacks.” These are very vivid memories or experiences of the traumatic event that come to people all of the sudden. People might even feel like they are back in that moment. Have you experienced any such flashbacks?”
Transcript
Michelle: Oh my gosh! I didn’t know there was a name for that. [with recognition] Yes, yes! Sometimes I feel like I am back in that moment … and I can see someone being loaded onto a stretcher and wheeled away. It’s almost as if I’m there ... I think … [pauses] I think it might be the driver of the SUV. He was killed in the accident … I didn’t find that out until later. … No matter how hard I try not to think about the accident, I still keep seeing it over and over again in my mind. Sometimes, it actually feels like I’m in the car, being hit all over again. I’ll wake up from a vivid dream about the accident in a cold sweat with my heart racing, and I’ll be too scared to go back to sleep.
Question 3.2
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Think about what Michelle said about how the flashbacks are negatively impacting her life.
3.9 Screen 9
“It’s understandable that this accident is still frightening for you. Has this experience affected your relationship with your family?”
Transcript
Michelle: Yes … yes … I am so much more anxious about my children’s safety now. This accident made me realize that even if you do the right thing it doesn’t matter – there is danger all around us … your life could be over any minute. I worry about my kids, [emphasis] even when I’m not with them, and especially if they are going somewhere in a car. [sharp intake of breath] … I haven’t driven since the accident because I’m terrified to get behind the wheel again … So my husband drives me everywhere, and I spend the entire time looking around to make sure no one is going to crash into us. I won’t let him take the highway … I don’t want to drive by where the accident happened. It takes forever to get to and from work, and my husband is trying to be nice but he is understandably aggravated by all of this. This means more time in the car for me to be anxious about getting into another accident, and for him to feel like I don’t trust his driving. I feel so bad about inconveniencing him that … [quietly] I haven’t told him about the memories or – what did you call them? Flashbacks? – because I don’t want to burden him any more.
Question 3.3
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Think about when Michelle’s symptoms started.
3.10 Screen 10
“It sounds like your family doesn’t share your feeling of danger on the road. Speaking of family, can you tell me a little more about your own childhood? What was it like growing up in your family?”
Transcript
Michelle: My parents got divorced when I was 8 years old, but they separated probably 2 years before that. So it was just my mom for most of my life, raising me and my little sister and brother. My mom would sometimes get so overwhelmed that she would just lie on the couch for what seemed like weeks. She couldn’t do even the most basic tasks. When she had these “sad spells,” I would have to step it up and take care of my brother and sister. [sighs] I was a nervous kid … I was especially afraid to try new things. I didn’t have much contact with my dad growing up, but occasionally I would spend the weekend at his house. He wasn’t very warm. I felt really scared and alone at his house, but I was always afraid I’d cry because he’d get annoyed and tell me to just suck it up. I remember feeling really confused about how I should deal with these challenges in my life because when things got tough my mom would get overwhelmed and withdraw but my dad never seemed to deal with it either. He’d just act like nothing happened at all.
Question 3.4
How could Michelle’s childhood have influenced what is happening to her now? More than one answer could be correct. Select all that apply.
Caring for her siblings made Michelle less empathetic to her own children.
bI0LPa9lfHQ+dYqkMichelle’s anxiety as a child could carry over into how she reacts to stressful situations today.
wCfH0QtRgXJ8o+c+Her parents’ divorce made Michelle a very anxious person.
wCfH0QtRgXJ8o+c+The time between Michelle’s parents’ separation and their divorce caused additional anxiety for Michelle.
wCfH0QtRgXJ8o+c+Michelle’s father’s anxiety modeled anxious behavior for Michelle.
bI0LPa9lfHQ+dYqkMichelle’s mother’s depression could have influenced how Michelle saw the world.
Hint
Think about how the behavior of the most significant people in Michelle’s life may have affected her.
3.11 Screen 11
Question 3.5
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Think about what piece of information you need in order to make a decision about whether you can proceed with treating Michelle.
3.12 Screen 12
“So, Michelle, how do you feel about coming to therapy?”
Transcript
Michelle: [sigh] I really don’t know that I need to be here. I think that if I can manage to get more sleep at night, I’ll be able to focus on my family … my work … I’ll have the strength to fight off these memories. I asked my primary care doc for sleeping pills, but he said I had to see you before I could get them. I don’t understand why I can’t just get over this – other people do. I don’t think I really need to see a shrink.
3.13 Screen 13
Question 3.6
Which of the following symptoms describe Michelle’s experience? Select all that apply.
A need to organize
bI0LPa9lfHQ+dYqkExposure to a traumatic event
bI0LPa9lfHQ+dYqkActual or threatened death
bI0LPa9lfHQ+dYqkSerious injury
wCfH0QtRgXJ8o+c+Sexual violation
bI0LPa9lfHQ+dYqkRecurrent, distressing memories
bI0LPa9lfHQ+dYqkRecurrent, distressing dreams
bI0LPa9lfHQ+dYqkFlashbacks
bI0LPa9lfHQ+dYqkAvoidance of reminders of stressor
bI0LPa9lfHQ+dYqkForgetting part or all of stressor
wCfH0QtRgXJ8o+c+Exaggerated negative beliefs about herself
bI0LPa9lfHQ+dYqkPersistent negative emotions
wCfH0QtRgXJ8o+c+Extreme startle response
bI0LPa9lfHQ+dYqkBeing on guard or hypervigilant in cars
bI0LPa9lfHQ+dYqkDifficulty sleeping
wCfH0QtRgXJ8o+c+Sleeping more than usual
Hint
Think about the symptoms Michelle described throughout her interview and how they are affecting her life.
3.14 Screen 14
Question 3.7
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Hint
Think about the following symptoms Michelle is having:
- Difficulty sleeping
- Reexperiencing memories of the event
- Symptoms lasting longer than a month
Question 3.8
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
In making your decision, think about Michelle’s previous experiences.
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From the File. You remember a former patient who experienced symptoms similar to Michelle’s. You review this case to help you diagnose Michelle.
Transcript
SHARON: I'm still angry. I'm still apprehensive. I'm still jittery. I can't be by a window. Or I constantly think planes are flying so low. Why is that plane flying so low?
REPORTER: We've all seen the images. But Sharon, like tens of thousands of New Yorkers who escaped from lower Manhattan, lived it. They felt the steel sear into concrete, witnessed the sight of people leaping to their death, choked on the taste of pulverized glass and stone.
Now, many of the survivors relive those moments every day, struggling to leave them behind.
Sharon Falcone is back at work, but not back to normal. Every day, she braces herself for the commute to her temporary office. She says she can't manage it without something to read, something to distract her from the memories of that day.
SHARON: Around 8:45, I was on the phone with my sister. And I remember-- sorry.
REPORTER: Does this happen every time you--
SHARON: Not all the time, just sometimes.
The building shook. It felt like an earthquake. And then stuff just came flying out of the sky.
REPORTER: She ran down 55 flights in the South Tower, just before the second plane hit her building.
SHARON: And people just started running. And I thought, I'm going to be killed from the stampede. People didn't know what to do. They didn't know where to run. The thing was that nobody felt safe.
REPORTER: Loud, unexpected noises provoke panic. Like the day a generator backfired and the whole office evacuated.
SHARON: I just completely lost it and cried. That feeling that I hoped that I would never feel again came back.
REPORTER: What feeling is that?
SHARON: That I don't know what's happening, that it's something greater than me and I don't have control of the situation. I have to get out of the building. I have to make it home OK. I have to see tomorrow.
Question 3.9
kQDqOXOqSWDER3cGQtsenzN0ZkHlToYqmgdxETbf2boG4KXccQCY5EdzA2EBCgxuyC8X/OvZrDSqwjUptknrDzu4e+RsMVm7x4WfAGRJAk34oEOnxwsecjzlszilz37Y+exdyuaZgtJGrDxDfOZMvlT75RLxXKrZXtjKTqGGhAdxOF5pcEySXp9C06BXsdOOQuestion 3.10
Rgxl+GK+5ka5nYEW+MJwCTDH9z6G9C1XyeD9xePu+TrnEmY8USF0H4tNNLMkd2YQPi2vfJqiqWAy3ObhZyncsmaa9n14R1kobof0DeI5YrLO99BVWNA9LielEQXH8R8yyEgJ8Rb50QSOpXM8qIknOwJdOA51mHJlxncfVkZceGzK/NpNylgDkt4XRo1ON28xwdQ2df2pdDJoAvwNeRRGOw4MrQLVH5LPF+HX0CZj9pB3OyP6o01zcyuSqng0HPzSeFKMAFTH0iiwZ59PTdxQgsLm79RAHgHyMM6U6O6bvNF+26BM30zXnyI1LhtcWGNFpJggtkBU6KgpishYgOmkSA0SuUhGzAXrdlIOsWmcyWdT1z9a3UTIbvit70NzeiHUWlWwlIomI8AWb8ecOow6aqeJpd+4OGpkHI/EEY5YK7o5TZD7aIVD22mCaQcZe2G+9dOk0PCiJ+1XuMAKjYfMCeDNV9U=Question 3.11
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Hint
Think about Michelle’s case as you answer this question.
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Question 3.12
Which of the following treatments would be helpful for Michelle? Select all that apply. Select the name of the therapy to display a brief description.
Psychoanalysis
bI0LPa9lfHQ+dYqkCognitive-Behavioral Therapy (CBT)
bI0LPa9lfHQ+dYqkMedication
wCfH0QtRgXJ8o+c+Client-Centered Therapy
wCfH0QtRgXJ8o+c+Psychological Debriefing
Hint
In making your choice, think about Michelle’s symptoms after the car accident and which type of therapy might be most helpful in addressing those symptoms.
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EPILOGUE
As a therapist, you are trained in cognitive-behavioral exposure techniques. You teach Michelle relaxation techniques before encouraging her to remember and recount the events of her accident, usually aloud and repeatedly. Michelle is nervous about remembering her accident, but you explain that although it is difficult at first to talk about the traumatic event, this type of therapy will help reduce her symptoms. With your help, Michelle is able to remember the horrific details of her trauma, and she sobs in your office when she recounts the story for the first time. After she repeats the story over a few sessions, she is able to recount the accident without becoming so overwhelmed. She also finds that she is able to sleep better at night.
Eventually, you help Michelle tackle some of her distorted thoughts that resulted from the accident, such as her belief that her children will be in an accident every time they ride in a car. Michelle decides to stay at her job and enjoys the independence she feels when she is out of the house. Her biggest challenge was to try driving again, but you are able to use virtual reality to reexpose her to driving before she gets behind the wheel in the real world. After practicing in the virtual world, Michelle is able to drive, a huge accomplishment for her. Although Michelle’s memory of the accident will never go away, Michelle finds she is able to feel genuine love for her family again and better communicate what she is experiencing to her husband.
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Real World Application
Watch this video about veterans engaging in therapy for PTSD, then answer the questions that follow.
Transcript
JOSHUA MUSSER: I was sitting on my couch. And I was watching the Marines roll through Baghdad. And I just, I felt horrible. I, you know, knew that I could sleep all day. I could be as hot or as cold as I wanted to. I could eat as much as I wanted to. And basically, I just, I started getting this really guilty feeling. Next day, I was in a recruiter's office. And two weeks later, I was in boot camp.
NARRATOR: Scenes like these motivated Joshua Musser to enlist in the Marine Corps. He was sent to Iraq, where he fought in the Battle of Fallujah, the bloodiest battle of the war.
JOSHUA MUSSER: You're getting home. And you're getting used to being home and everything. And then of all sudden, it kind of levels out. And then, you know, the nightmares started. And you know, just couldn't handle stress and anxiety anymore.
[EXPLOSIONS]
NARRATOR: Help came in the form of virtual reality exposure therapy.
WOMAN: When Josh came in, I think he was very distant and less willing and able really to talk about what happened to him.
NARRATOR: Under the helmet, as demonstrated here, Joshua experienced the sights, smells, vibrations, and sounds of war a customized virtual scenario targeted specifically to treat his psychological trauma.
WOMAN: People often try not to think about what happened to them. And what we found over time is that that's the worst thing that you can do when you experience a trauma. If you don't think about it and don't process it and deal with it, that's what eventually can cause PTSD and a chronic problem.
JOSHUA MUSSER: They put you back in Iraq, where you kind of have one foot here and one foot there. The only thing outside of that Iraq that you hear is her voice. And so when she sees that I'm really starting to stress out, because I would shake really bad. I would sweat. But she would be in my ear and be pulling me back.
NARRATOR: Three months after being treated, Joshua's doctors say his PTSD levels have significantly improved.
JOSHUA MUSSER: I know that with my PTSD, I'm never going to get rid of it. It's never going to be gone. But now I feel like I'm on the way to controlling it and on the way to living with it and managing it.