02 Oct Writer choice
37178Veronica is a 26-year-old Mexican American woman, married, with two sons, ages 3 and 2. She has a B.A. in Fine Arts, but since having children she has stayed at home caring for them. Veronica came to the clinic where you work because she had been feeling depressed for three months. The depression had started shortly after she had ended a five-week extramarital affair. During the affair, Veronica began to have flashbacks of events from 10 years in the past. These events centered around a series of repeated rapes that occurred when she was 16 years old. In addition to distressing images of these events seeming to come into her mind out of nowhere, these flashbacks included times when Veronica would momentarily feel as if the past were occurring all over again. When Veronica realized this affair coincided with the exact time of the year she had been raped, she broke off the affair. Nevertheless, Veronica became increasingly depressed and agitated as more memories resurfaced.
It was only now, a decade later, when Veronica began to label what had occurred then as rape. Veronica stated she had been raped repeatedly over a five-week period by a close friend of the family. This boy, who was the same age as Veronica, lived across the street. Because the boy came from an abusive family, Veronica’s family “adopted” him. He was best friends with her brother, and so he spent a lot of time at their home. Veronica’s parents were also quite fond of him. Prior to the rape, Veronica said she had had a “brother-sister” relationship with the boy, whose name was Mark.
Veronica gave only a sketchy account of these incidents during the first interview and made very little eye contact with you, the interviewer. During the interview, Veronica reported she had been a virgin prior to the rape and had trusted Mark quite a bit before the assault. She was verbally threatened by him, although no weapons or physical injuries were involved. Veronica was subjected to a range of sex acts, including oral, vaginal, and anal intercourse. During the assaults, her most prominent reactions were feeling detached and numb, guilty, and embarrassed. The incidents were not reported to the police, and she never received medical care.
Veronica told you she often smoked marijuana. She was defensive about her use of it and said she did not want to quit. In addition, Veronica stated one of her previous therapists had made a big deal over her marijuana use, and the therapist had told her use of marijuana was her main problem. She quit therapy. She had sought therapy twice before that time, and she had quit after one session.
Clinical History
Veronica described her childhood as a happy one. She characterized her home as the safe house in the neighborhood where all the kids could come to play and where some found refuge from problems in their own homes. Veronica’s father had been a Vietnam veteran who continued to have posttraumatic stress disorder from events he had experienced during the war. She described her father as emotionally shut off, yet spoke very fondly of him. Her mother was a Mexican woman who had met her father in the hospital where she worked as the chief of the nursing department, and he worked in the information technology department. Veronica said she had a close and supportive relationship with her mother. Veronica had one older brother who was best friends with Mark, the boy who had raped her. Veronica claimed she was close to her brother until the rape; since the rape, they rarely interacted with each other.
During therapy, Veronica told you things had drastically changed since the rape. Veronica said she had told her mother what had happened, and her mother stopped the abuse. After you questioned her further, however, Veronica recalled she had told her mother Mark had been “coming on” to her, it had gotten out of control, and she needed help getting out of the situation. The abuse ended after Veronica’s mother told Mark to leave Veronica alone. Veronica never told her mother she had been raped. Therefore, her family did not understand why she had changed. After the rape, Veronica withdrew from her normal high school activities and began to hang out with troubled kids. Over the year following the assaults, Veronica often lied and began drinking. She described herself as floating in and out of reality. She and her mother fought
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frequently. A year after the rape, a friend of hers was driving recklessly and crashed the car in which Veronica was a passenger. She recalled that over the next few years she became a “total rebel” and dated a “wild guy who was totally bad news.” She became pregnant by him and, not knowing what to do, consulted her father. Her father took over and arranged for an abortion. They never told her mother, who was very conservative and pro-life because of her strong Catholic roots. Although Veronica said she might have ultimately made the same decision, she now regretted she had relinquished her right to decide.
Veronica did not have the self-confidence to go to college, but her mother knew how much she liked drawing and encouraged her to attend a small college where she finally graduated with a B.A. in Fine Arts. Veronica said she fortunately had the “good sense” to marry a fine man four years ago with whom she had two sons. Veronica said her husband was very supportive of her and did not give up on her after the affair.
Diagnosis
On the basis of the information collected during the assessment period, Veronica was assigned the following DSM5 diagnosis:
F43.10 Posttraumatic Disorder (moderate)
F32.0 Major Depressive Disorder, single episode, mild, with anxious distress. F12.0 Cannabis use disorder, mild.
WHODAS 3.43 Moderate
Initial Treatment
As part of the stabilization treatment, you established rapport and allowed Veronica some time to talk about the rapes or any other issues. You did not make her marijuana use a focus of treatment, but labeled it as another form of avoidance and asked her not to use it before sessions or while completing homework assignments. You described the symptoms of PTSD and informed Veronica how these symptoms developed and why they had not disappeared. You presented an overview and rationale for treatment and explained why homework completion and session attendance are so important in her recovery. You also allowed Veronica to feel her emotions and let them run their course so the memories could be put away without such strong feelings still attached and so her beliefs, disrupted and distorted by the assaults, could get back in balance.
Because the incidents had happened ten years before and Veronica had no contact with the perpetrator, issues of immediate safety were not applicable. You did discuss, however, issues of general trust in others.
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