CASE STUDY OF

JOHN:
TREATMENT OPTIONS
AND RATIONALE

Presented
By
Timothy R. Test, Sr., Ph.D.
Northcentral University
Timothy, you have made some good recommendations. Please see my additio
and highlighting of some of your key points. In some cases, I was looking for m
regarding the interventions involved. 92%
Wendy Nickerson
P.S. Great visuals throughout this presentation and your previous one also!

Overview of Johns Case

John is a 53-year-oldseparatedveteran who has recently been diagnosed
with diabetes. He is very concerned about his health. He has been in and
out of the emergency room over the past six months with extreme heart
palpitations. It is still not clear whether he was experiencing panic or a
mild heart attack (or both). He is very worried about his marital situation
and desperately wants to reunite with his wife. In addition, his supervisor
at work has informed him that if he continues to miss days at work, he will
need to 'let him go.' John claims that he does not sleep well, eats at fastfood restaurants, and 'drinks' alone on the weekends while watching
television. He reports that he doesn't want to leave his apartment on the
weekend because he 'doesn't have the energy' and fears having more
heart palpitations. He notes that his 'whole life has been a nightmare',
noting that his father was physically and emotionally abusive to him
throughout his entire childhood.
John was referred to our office for evaluation
The following is an overview of our assessment , treatment options,
rationale for choices of treatment. and outcome.

Johns Assessment
John

presented himself to our office

for evaluation and assessment.
John self-reported being under a lot of
stress and indicated that his life was a
nightmare.
John reported that he was currently
under marital stress and was wanting
to reunite with his wife.
He reported that he was abused by his
father as a child.

Johns Assessment Continued

John informed us that he was a veteran.
John admitted that his diet consisted mainly of
fast food.
John reported spending his weekends alone due
to lack of energy.
At the time of the evaluation, John had been
experiencing heart palpitations for the past six
months.
John recently had been diagnosed with Type II
diabetes.
John had been missing a lot of work lately and
was told if he continued to miss work, he would
lose his job.

Johns Evaluation
John

admitted seeing things while in

the military that has negatively
affected his life.
John understands how his fathers
abuse as a child has affected him,
but does not know how to rise above
it.
John also admits that his experiences
with his father and with the military
has played a role in the marital
problems he is now experiencing.

Johns Evaluation Continued

John admitted to feeling depressed
lately and not wanting to socializing
with others.
Upon deeper inquiry, John admits that
the eating of fast food drinking, and
poor lifestyle may be a way of
punishing himself for the mistakes
and choices he made in his life.
John stated that the heart palpitations
coincided with the separation from his
wife.

Johns Evaluation Continued

John

stated that it seems like a vicious

cycle where the more stress that he
experiences causes more heart
palpitations which causes more stress.
John is very fearful of losing his wife, his
employment, and his life with his health
problems.
John is desperate to find resolution and
is willing to adhere to the
recommendations made in the
evaluation.

Treatment Options and

Rationale
John has a lot of unresolved issues as a result of the
abuse he received at the hands of his father.
Individuals who have more adaptive means of
managing their abuse-related negative emotions
may experience less long-term distress than those
who have greater difficulty processing such emotions
(Walsh, Fortier, and DiLillo, 2010).
Given that John seemed to be having difficulty
processing the emotions related to the abuse from
his father, it was recommended that John attend
therapy sessions in order to address these issues and
develop coping strategies.
What type of therapy?

Treatment Options and

Rationale Continued
John

was a veteran and experienced a lot

of emotional trauma as a result.
John is currently experiencing marital
problems. There is a potential link
between the emotional trauma and his
spousal relationship.
Research has demonstrated a strong
association between PTSD and problems
with family relationships among combat
veterans and their families. This has been
demonstrated among various countries
and all eras. Galovski & Lyons, 2004 for
review).

Treatment Options and

Rationale Continued
According

to Monson, Taft, and Fredman

(2009), PTSD studies consistently reveal
that veterans diagnosed with chronic
PTSD, compared with those exposed to
military-related trauma but not diagnosed
with the disorder, and their romantic
partners report more numerous and
severe relationship problems and
generally poorer family adjustment (p.
708).
There is also a higher divorce rate among
veterans with PTSD than trauma exposed
veterans without PTSD (Cook, Riggs,
Thompson, Coyne, & Sheikh, 2004; Jordan
et al., 1992).

Treatment Options and

Rationale Continued
Research

suggests that it is beneficial to

involve partners and close family members
in the counseling and treatment process
(Monson, Taft, and Fredman, 2009).
Implementing family therapies can lead to
improvements in PTSD symptoms. It is
hypothesized that this decreases the
ambient personal stress that most often
causes increases in individual symptoms
(Monson, Taft, and Fredman, 2009).

Treatment Options and

Rationale Continued
Given

the strong evidence to support

the possibility of John suffering from
PTSD, the MMPI was administered to
detect the presence of PTSD.
Given the strong evidence for the
beneficial effects of family therapy in
PTSD, this was recommended to John
and his wife in order to address
these issues and provide a support
system for John and his wife to work
on their issues.

Treatment Options and

Rationale Continued
John

exhibits signs of depression as a

result of the events in his life.
This can contribute to the lack of
energy, overeating, social isolation and
drinking.
In addition to the recommended family
therapy, concurrent individual therapy
was recommended to address personal
issues. What type of individual therapy
would likely work best for John. What
strategies?

Treatment Options and

Rationale Continued
John was referred to his physician for
a referral for exercise therapy.
Exercise has been recommended for
the modification of behaviors that
prone an individual for CAD/CHD
(Taylor, 2009).
In addition, John was referred for
dietary intervention, in order to
address his poor dietary habits and to
find better strategies for introducing
healthier nutrition choices.

Treatment Options and

Rationale Continued
John

was referred to a PTSD

support group in order to obtain
social support. As was presented
earlier, social support systems
have a dramatic effect on the
recovery times ((Taylor, 2009).
It has been found that individuals
who have small social networks
experience increased risk of
mortality (Rutledge et al., 2004).

Treatment Options and

Rationale Continued
John

was recommended to be instructed in

stress management techniques, including
relaxation and hypnotherapy. Good!
According to the American Psychological
Association (2010) Hypnosis has been used
in the treatment of pain; depression; anxiety
and phobias; stress; habit disorders; gastrointestinal disorders; skin conditions; postsurgical recovery; relief from nausea and
vomiting; childbirth; treatment of hemophilia;
and many other conditions (p. 3) Good!
John, would also benefit from EMDR.

Outcomes
John

was tested for depression and PTSD.

John attended individual therapy sessions
concurrent with family therapy to address
the depression, childhood abuse, PTSD,
and marital problems.
Following intense psychotherapy and
family therapy, John was reunited with his
wife. He reports feeling less stress and is
more capable of handling everyday issues.

Outcomes Continued
John

attends a PTSD support group which John

reports helps him to keep grounded and have
someone to talk to. He feels that it helps to
keep him grounded.
John attended numerous hypnotherapy and
stress management sessions. He was taught
meditation skills and de-stressing techniques.
Such as?? John has reported that he feels much
less stress now and this has helped him to
address past issues with his father and PTSD
issues better.

Outcomes Continued
John

attended dietary
counseling. He has since
changed his diet and reports he
is eating much better now. His
diabetes is under control and he
is not required to take
medication.
John was referred to his
physician and attended exercise
therapy. John feels much better
and more physically fit.

Final Outcomes
John reports that his heart palpitations
have subsided. This has been
confirmed by his attending physician.
Johns relationship with his wife has
improved dramatically. They have
learned coping techniques and now
communicate more.
John has continued to attend support
groups and is dealing with his
childhood abuse and PTSD.
Johns diabetes has continued to
remain under control.
John reports that he is very satisfied
with the outcome of his therapy.

References
American Psychological Association (2010). Practical
uses for hypnosis. Retrieved August 23 from
http://www.apa.org/topics/hypnosis/media.aspx#
Cook, J. M., Riggs, D. S., Thompson, R., Coyne, J. C., &
Sheikh, J. I. (2004). Posttraumatic stress disorder and
current relationship functioning among World War II
exprisoners of war. Journal of Family Psychology, 18,
3645.
Jordan, B. K., Marmar, C. R., Fairbank, J. A., Schlenger,
W. E., Kulka, R. A., Hough, R. L., et al. (1992).
Problems in families of male Vietnam veterans with
posttraumatic stress disorder. Journal of Consulting
and Clinical Psychology, 60, 916926.

Monson, C. M., Taft, C. T., & Fredman, S. J. (2009).

Military-related PTSD and intimate relationships: From
description to theory-driven research and intervention
development. Clinical Psychology Review, 29, 707
714.
Rutledge, T., Reis, S. E., Olson, M., Owens, J., Kelsey, S.
F., Pepine, C. J., et al. (2004). Social networks are
associated with lower mortality rates among women
with suspected coronary disease: The national heart,
lung, and blood institute-sponsored womens ischemia
syndrome evaluation study. Psychosomatic Medicine,
66, 882-888.
Walsh, K., Fortier, M. A., & DiLillo, D. (2010). Adult
coping with childhood sexual abuse: A theoretical and
empirical review. Aggression and Violent Behavior,
15, 113.