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Introduction

This case study examines Hope, a 16-year-old high school student who endured a traumatic sexual assault at the hands of her boyfriend, Luke, and the subsequent psychological and social repercussions. The intervention discussed involves a targeted therapeutic approach tailored to her PTSD symptoms, relational dynamics, cultural and developmental considerations, and the specific context of her assault.

Description of Intervention

The intervention selected for Hope is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), a well-established evidence-based treatment designed to help individuals cope with traumatic experiences. TF-CBT involves structured sessions that include psychoeducation about trauma, relaxation techniques, cognitive restructuring to challenge and change unhelpful beliefs related to the trauma, and trauma narration and processing. The goal is to reduce symptoms of PTSD, improve emotional regulation, and restore a sense of safety and control. When applied to Hope, this intervention would involve working with her to process the assault, challenge distorted thoughts (such as guilt linked to her drinking or blame from peers), and develop coping skills to manage anxiety and hypervigilance. Limitations of TF-CBT may include its reliance on the client's ability to engage in verbal processing and cognitive restructuring, which may be challenging for some adolescents depending on their developmental level or severity of symptoms. Additionally, cultural sensitivities around faith and community influence may necessitate adaptations to the standard protocol.

Rationale

The choice of TF-CBT for Hope is justified based on her diagnosis of PTSD and the complex trauma stemming from sexual assault and community backlash. Her strong familial support, particularly her close relationship with her mother, provides a foundation for engagement in therapy. Her cultural background as a Southern Baptist and her personal religious beliefs influence her worldview and may impact how she processes trauma and guilt. TF-CBT’s flexibility in incorporating cultural and spiritual considerations makes it appropriate for Hope. Moreover, her age and developmental stage align well with the cognitive-behavioral approach, which targets maladaptive thoughts and behaviors common in adolescents experiencing trauma. This intervention also addresses her isolation and peer-related distress by fostering resilience, emotional regulation, and social functioning.

Explanation of Support

Applying TF-CBT to Hope would involve several staged steps. Initially, the therapist would build rapport and provide psychoeducation about trauma and PTSD to normalize her reactions. They would collaboratively identify her specific intrusive thoughts, feelings of guilt, and behavioral issues such as social withdrawal. The therapist might incorporate spiritual beliefs into therapy, perhaps integrating faith-related coping strategies aligned with her cultural background. The trauma narration phase would allow Hope to recount her experience in a safe environment, facilitating processing and emotional release. Cognitive restructuring would target beliefs of blame, guilt about drinking, and shame inflicted by peers or community members. Relaxation techniques and mindfulness exercises would help her manage hyperarousal symptoms. Throughout therapy, the clinician would involve her mother to maintain a supportive environment and ensure therapeutic gains generalize beyond sessions.

Future Applications

In future practice, this intervention—TF-CBT—can be expanded to assist adolescents experiencing similar trauma-related disorders, particularly sexual assault survivors. It is adaptable for various cultural backgrounds by modifying components to respect individual faiths and community influences. The approach can also be used in school mental health programs, community clinics, and hospital settings. Its strength lies in addressing complex trauma with a flexible, client-centered approach that fosters resilience and healing. Additionally, schools could incorporate trauma-informed practices, using elements of TF-CBT to support students facing peer harassment, violence, or other traumatic events. The intervention’s emphasis on psychoeducation and skill-building makes it a versatile tool in the broader mental health toolkit, particularly for youth navigating the intersection of trauma, community expectations, and developmental challenges.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  • Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Trauma-focused cognitive behavioral therapy for children: Impact on emergency department utilization. Cognitive and Behavioral Practice, 18(2), 180–191. https://doi.org/10.1016/j.cbpra.2010.09.002
  • Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2013). The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. Journal of Adolescent Health, 53(4), 423–431. https://doi.org/10.1016/j.jadohealth.2013.03.013
  • Jaycox, L. H., Cohen, J. A., Mannarino, A., & Langley, A. (2010). Trauma-focused cognitive-behavioral therapy for children affected by trauma. Archives of Pediatrics & Adolescent Medicine, 164(10), 987–988. https://doi.org/10.1001/archpediatrics.2010.203
  • Montgomery, P., & Spilsbury, K. (2012). Trauma-informed care for youth in juvenile detention: Promising practices and lessons learned. Child and Adolescent Social Work Journal, 29(4), 249–255. https://doi.org/10.1007/s10560-012-0273-1
  • Pullmann, M. D., Peterson, C. C., & Kerig, P. K. (2014). Outcomes of community-based trauma treatment with justice-involved adolescents. Child Maltreatment, 19(4), 189–200. https://doi.org/10.1177/1077559514533382
  • Scheeringa, M. S., & Zeanah, C. H. (2015). Trauma-focused cognitive-behavioral therapy for children and adolescents. The New England Journal of Medicine, 372(22), 2089–2090. https://doi.org/10.1056/NEJMc1501337
  • Shannon, M. E., & Cummings, C. M. (2016). Multicultural considerations in adolescent trauma therapy. Clinical Child Psychology and Psychiatry, 21(2), 289–303. https://doi.org/10.1177/1359104515600400
  • Signer, B., & Cohen, J. (2017). Adapting trauma interventions for diverse populations. Journal of Traumatic Stress, 30(4), 377–384. https://doi.org/10.1002/jts.22278
  • Walker, P. (2016). Trauma-informed practices in schools. Journal of School Violence, 15(4), 429–445. https://doi.org/10.1080/15388220.2015.1130302

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