This case study examines a 17-year-old female client presenting with post-traumatic stress disorder symptoms following three car accidents two months prior. The paper addresses key assessment issues including nightmares, sleep disturbance, and problematic alcohol use as a coping mechanism. Clinical diagnosis is established using DSM-V criteria, with discussion of immediate therapeutic needs and pharmacological interventions. The analysis includes examination of trauma biology, family notification protocols, and safety-focused treatment planning, emphasizing the counselor's responsibility to ensure client safety while maintaining ethical guidelines and building therapeutic rapport.
Maryam is a 17-year-old Caucasian female attending university and was referred to the agency by her primary care physician for complaints of sleep disturbance. She reports drinking three to four glasses of vodka mixed with orange juice nightly to aid sleep and denies current prescribed medication. Medical findings indicate she sleeps only 2–4 hours per night with frequent nightmares. Laboratory results show mildly elevated liver enzymes and a blood pressure reading of 130/94. During the intake appointment, Maryam appeared anxious, with dark circles under her eyes and tearfulness. She was appropriately oriented to time, place, and person but presented with diminished speech volume, soft prosody, and a flat affect.
Maryam disclosed significant anxiety regarding driving, fearing she will either harm others or be harmed herself. She is currently missing classes due to sleep deprivation. Two months prior to this appointment, Maryam was involved in three motor vehicle accidents in which she ran a red light and injured two individuals. She expresses profound guilt and shame, stating, "I made such a horrible mistake; I don't deserve to live. I am so stupid." Maryam is residing on campus away from her family, who live out of state, and faces active legal proceedings related to the accidents. This case study addresses key assessment issues, immediate clinical needs, specific therapeutic interventions, diagnostic formulation, the neurobiological basis of trauma, and family notification protocols. The primary treatment goal is ensuring Maryam's safety.
Several critical assessment issues emerge from Maryam's presentation. Her fear of driving developed after the accidents two months ago, and her nightmares are a significant symptom cluster. Most notably, her alcohol use warrants careful evaluation. She reports no alcohol consumption prior to the accidents, indicating that drinking began immediately following the trauma. Her current tolerance of 3–4 glasses of vodka nightly, coupled with elevated liver enzymes consistent with a two-month drinking trajectory, suggests substance use developed as a maladaptive coping mechanism in direct response to trauma exposure.
Maryam meets diagnostic criteria for Post-Traumatic Stress Disorder (PTSD) as defined in the DSM-V. Symptom duration exceeds one month (two months have elapsed since trauma), and she demonstrates re-experiencing symptoms (nightmares), avoidance behaviors (refusing to drive, missing classes), negative alterations in cognition and mood (guilt, shame, belief she does not deserve to live), and alterations in arousal and reactivity (anxiety, sleep disturbance). While Maryam displays some features consistent with Acute Stress Disorder—namely severe anxiety and dissociative symptoms—these conditions are most acute within the first month following trauma exposure (Gibson, 2014). Because the accidents occurred two months prior, PTSD is the more appropriate diagnosis. The DSM-V confirms that Maryam meets the full diagnostic criteria for Post-Traumatic Stress Disorder.
From a crisis intervention perspective, Maryam presents in acute crisis. At 17 years old, she is navigating multiple stressors simultaneously: three accidents, chronic sleep deprivation, guilt and shame over injuring others, legal complications, social isolation from family support, and escalating substance use. Behaviorally, she displayed anxiety, tearfulness, and exhaustion during intake. In the crisis literature, crisis is not defined solely by the traumatic event itself but rather by the individual's reaction and coping capacity in response to that event (Jackson-Cherry, 2014). According to Erikson's Stages of Psychosocial Development and Caplan's crisis theory (1961), Maryam is experiencing a situational crisis—an unexpected, unplanned event (the accidents) that overwhelms her existing coping resources. Crisis counseling requires short-term intervention focused on supporting the client, providing concrete assistance, stabilization, and connection to resources (Caplan, 1961).
Given that Maryam is oriented to time, place, and person, immediate intervention should address the trauma systematically and sequentially. Talk therapies will help Maryam develop adaptive responses to triggering events and reduce the anxiety that prompts alcohol use. Psychotherapy combined with pharmacological treatment represents the evidence-based approach for PTSD. Therapeutic techniques should include psychoeducation about trauma and its neurobiological effects, teaching relaxation skills and anger management, providing sleep hygiene recommendations, and encouraging exercise and balanced nutrition (Heller & Palmieri, 2005). Addressing Maryam's guilt, shame, and negative self-evaluation is essential, as these cognitions maintain both PTSD symptoms and substance use.
Maryam's alcohol use must be addressed as a primary clinical concern. Antidepressant medications such as sertraline (Zoloft) or paroxetine (Paxil) are appropriate pharmacological options for PTSD and may help regulate her mood and reduce worry (DSM-V, 2013). Early intervention priorities include establishing safety, reducing acute distress, gathering comprehensive information, and providing practical assistance. A detailed history is essential: clarifying when her drinking began relative to the accidents, assessing frequency and quantity patterns, and determining whether substance use treatment should be integrated into her trauma-focused care plan. The initial specific intervention necessary is thorough information gathering to inform a comprehensive, coordinated treatment plan.
Understanding the neurobiological basis of trauma helps clinicians recognize normative physiological responses to threatening situations and anticipate how PTSD develops. While Maryam does not report amnesia or memory gaps regarding the accidents, neurochemical findings are evident in her symptom presentation. Her intrusive negative thoughts—particularly her conviction that she does not deserve to live—reflect increased noradrenergic activity characteristic of trauma survivors (Caplan, 1961). Paroxetine (Paxil) may be therapeutic in this context, as it acts on the serotonin system to improve emotional memory processing and reduce rumination and depressive ideation (Caplan, 1961).
Family notification is clinically and ethically necessary. Maryam is a minor, and parental involvement is both legally required and clinically beneficial. Informed consent and confidentiality documentation must include parental signature and acknowledgment. Beyond legal compliance, family support is a protective factor in trauma recovery. Parental engagement can provide Maryam with emotional validation, practical resources, and continuity of care. The counselor should also initiate contact with Maryam's roommate to ensure immediate safety and monitoring until family members can establish more formal support systems.
"Exposure therapy, therapeutic relationship building, and discharge safety"
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