The patient “Suzy” in this case study is a sexual assault victim, aged 28, married and female. She has 5 years of military service. Because of her military service, she was trained and disciplined in a culture renowned for praising strength and abhorring weakness. In the military, the code also centers on unity and spirit of mission. Soldiers who “betray” their fellow soldiers are seen as untrustworthy and can be ostracized and marginalized. Because Suzy was sexually assaulted while serving in the military, she did not report the assault, fearing that it would lead to her being labeled a bad soldier by the others. Instead, she attempted to cope with the assault and the trauma it caused her. In attempting to cope on her own, however, Suzy encountered depression, a loss of self-esteem and self-confidence; she developed a problem with substance abuse as well as with anxiety. She has stated that she has no real support network now that she is out of the military. She is not close with her family and her old friends all have families and jobs and do not offer much assistance. She has come seeking treatment both for her trauma as a sexual assault victim and for help with her substance abuse. She is a chain smoker (something she says she was not prior to her assault) and she has difficulty sitting still for more than a few seconds at a time.
As Ward (1988) notes, the psychological impact of sexual assault is such that it can deeply scar an individual. Ward categorizes the impact in three ways: psychological, behavioral and interpersonal: psychological maladjustment issues include “anxiety, withdrawal, restlessness, tension, insecurity and emotional instability,” while behavioral issues include lying, substance abuse, inability to hold a job, and interpersonal issues include “ambivalence toward family members and fear of men” (p. 619). Of these three, Suzy demonstrates no fear of men but rather a strong disgust towards any man who tries to show intimacy towards her; she has not...…to process the assault, forgive herself, accept it as part of her personal history and stop trying to hide it or hide from it. By accepting it, she can begin to relax and feel more at ease with her place in the world. Some contextual cues from her religion could be helpful in enabling her to process this assault, showing her that being a victim of a sexual assault does not make her a bad or immoral person. Once this trauma has been addressed in this way, the CBT could begin again with a new set of behavioral goals identified that will allow Suzy to avoid triggers or to address them in a positive manner that will prevent her from turning to the abuse of substances or falling into a pit of depression or a trap of anxiety. Suzy should also work on building out her support network by opening up to friends at church and allowing herself to discuss her past and her place in life.