A Client with Psychological Trauma: Therapy and Medication

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The client’s code name is Sarah; she is a 29-year-old white woman. Sarah is a lesbian, and she does not have any particular religious affiliation, although she was raised in a Catholic family. Sarah is not married, but she is in a long-term relationship with her girlfriend. She works as a science teacher at a public school and considers herself part of the working, low- to middle-income class. Sarah is an acquaintance to me, so we do not have a professional relationship.

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A major trauma event that Sarah recalls happened in her childhood, but it has affected her life choices up to the present time. She was sexually abused by a man, a then friend of her family when she was six years old. While Sarah does not share many details about the event, it is clear that she knew the person who abused her, which contributed to her disbelief about the situation. Currently, Sarah is psychologically stable – she had been dealing with the impact of her trauma for more than two decades, and she has taken many steps to overcome her great distress. However, she still has some symptoms of posttraumatic stress disorder (PTSD) that she manages with therapy and medication.

At present, Sarah’s home environment is relatively safe – she rents an apartment with her partner. The landlord is aware of their romantic relationship and has not voiced or shown any signs of homophobia. Overall, the building in which the couple lives seems to be safe for Sarah, including both the quality of the house and the behavior of their neighbors. Nevertheless, as Sarah does not make much money from her job, the couple lives in a low-income neighborhood with poor public transport infrastructure and other connected issues. Moreover, the area of the city does not appear to be outward “LGBT-friendly,” which implies that Sarah and her partner behave with caution when outside. Sarah has noted that she has felt tense, walking alone to her house at night.

At her job, the environment is pleasant for most teachers and students, but she has had several hostile encounters with parents who expressed homophobic views. However, Sarah notes that she teaches Science and that her sexual orientation does not influence or inform the teaching materials she uses significantly. She notes that the larger part of all teachers at this school is in their 30s and early 40s while creating a pleasant and open-minded atmosphere.

The sexual abuse that Sarah experienced in her childhood has significantly affected her relationships, education, and work choices, as well as her sense of self and functioning. First of all, Sarah denied her romantic preferences for women until her mid-20s due to the stigma surrounding lesbian and bisexual women who have been abused by men. In her youth, she had low self-esteem and even though the abuse might have happened due to her misbehavior or “inherent wrongness.” She refused to pursue a relationship with a girl in her teenage years, even if she felt a connection or was infatuated with her. Instead, she entered into romantic relationships with boys, feeling that they would fix her problem.

As such, one can see that the effect of abuse has led to strong connections between Sarah’s relationships and her sense of self. Sarah perceived herself with contempt, refusing to create loving and honest ties. Aside from romantic relationships, her family ties have suffered as well. For several years, Sarah did not tell her parents or any other relative about what had happened. Nonetheless, her behavior changed due to experienced trauma, and Sarah closed herself off from the family, refusing to engage in celebrations or family activities. She started rebuilding these connections upon finishing high school, although she was still in denial about her sexual orientation. Thus, her parents learned about the sexual abuse but still believed that her heterosexual relationships were a sign of Sarah dealing with this event’s impact successfully. Moreover, as the sexual assault had happened several years before Sarah told her parents, they initially harbored a belief that she exaggerated the issue since she did not tell them about it right after the event.

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Childhood trauma also affected Sarah’s education and work history, especially during high school and college years. Although she entered into relationships with men due to internalized stigma surrounding lesbian orientation, she was wary of men and generally scared of male attention. Sarah worked while attending college, and she preferred to choose jobs close to her home, or those that did not have many interactions with clients. Finally, her general functioning was impacted by the trauma Sarah went through in her youth. The effects were especially visible in elementary and middle school, as Sarah could not always make decisions, express her thoughts, or prepare assignments on time.

While Sarah’s major traumatic event happened in childhood, she experienced some minor versions of the same pattern in her adult relationships. While denying her sexual preferences, Sarah often entered into relationships with men who did not value her independence and agency. Therefore, she went through several abusive relationships – it could be considered an outcome of childhood trauma. Sarah’s choice of partners could be based on her past fear of being “broken,” thus choosing controlling partners who would take the lead and dictate how she had to behave. The lack of real attraction toward these men from Sarah further exacerbated the tension in each relationship.

Some childhood events that preceded and followed Sarah’s sexual assault influenced her feeling of self-hate, shame, and guilt as a part of interpreting the event. While she had a positive relationship with her parents, they often devalued her emotional responses in both positive and negative cases. For instance, she was encouraged not to cry or to yell if she was distressed, and her overenergetic happy responses were also shunned, especially in social gatherings.

As a result, it is possible that the restrictions that were put on her emotions by her parents led to Sarah internalizing the thought that her view of the sexual assault was misguided. Moreover, it explains why Sarah did not immediately tell her parents about sexual abuse and continued to stay silent about it until she reached young adulthood. Furthermore, this familial relationship explains Sarah’s early coping mechanisms – heterosexual dating and denial. It should be noted that, in college, she also went through a phase of substance abuse, where she drank large amounts of alcohol. These reactions are connected to a level of rationalization and self-blame and can be interpreted as a type of self-harming behavior.

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Currently, Sarah has a much more open and amicable relationship with her family. In the later years of college and after graduation, Sarah began visiting a therapist and working to understand her response to trauma. After that, she also started accepting the fact that she was a lesbian. She convinced her parents to attend several therapy sessions, during which they understood the immense influence one event of childhood sexual abuse could have on a person’s mental and psychical health. Moreover, Sarah came out to her parents once she entered into a serious relationship with a female partner. At present, Sarah actively participates in family gatherings and traditions, bringing her partner along without significant stress.

Apart from familial relationships, Sarah has built a strong support network of friends, including her significant other. Sarah has met people through group therapy, as well as at her jobs and college. One of the major platforms for building new connections was the internet – Sarah tried online dating and made friends on social media. The combination of these resources provides the client with positive feedback, encouragement, and help.

While Sarah’s PTSD is much less apparent now, she has had behavioral symptoms connected to trauma response. One of the signs that persist to this day is hypervigilance. As noted above, Sarah often feels unsafe when walking home alone. However, she states that she also may feel hypervigilant in crowded places, during day hours, and in the company of her friends. In some cases, this state does not have any reason to occur. However, according to Sarah, sometimes someone’s worlds or actions can trigger a flashback of the traumatic event or cause her to seek any signs that it may happen again. In her childhood years, Sarah often lost sleep due to being hypervigilant, and silence seems to be a substantial cause of anxiety.

While Sarah’s cognitive symptoms increase during states of hypervigilance, she also suffers from nightmares. These problems have subsided with time and with the help of therapy and healthy relationships. In childhood and teenage years, Sarah had reoccurring nightmares, which disturbed her sleep pattern. Now, she does not have any intrusive thoughts or flashbacks – the latter appears only during episodes of hypervigilance. However, sometimes, Sarah has nightmares that either replay the event or focus on her negative experiences with men. It should be noted that her negative thinking was prevalent in teenage and college years when Sarah used alcohol as a coping mechanism and as a type of self-harm. Mostly, she focused on believing that sexual assault was her fault or a result of her being abnormal, which was later connected to her denial of her sexual orientation. Nevertheless, she never experienced intense dissociative symptoms such as loss of memory or derealization.

As discussed above, Sarah has experienced strong affective symptoms following the traumatic event. The prevalent emotions ranged from fear to guilt and shame, and the majority of them were directed at herself rather than others. Following the instance of sexual abuse, Sarah did not express anger at her parents or peers, internalizing the idea that only her inherent qualities or actions were to blame for what had happened. It is possible that fear was the emotion that progressed into hypervigilance as the person’s desire to avoid being a victim again. At the same time, guilt and shame led to a reoccurring pattern of abusive relationships, substance abuse, and denial of Sarah’s sexual orientation.

Sarah’s gender affected the event and the reaction to it, as her parents had a strict understanding of gender roles and controlled the young girl’s emotions. She was not allowed to be extremely energetic, upset, or otherwise emotional. As a result, Sarah internalized most of her feelings following the event and became distant and cold to her family members, fearing their negative response. Furthermore, her family has raised her in a Catholic environment, which led to some judgmental discussions of sexuality and even sexual abuse survivors.

It is unclear whether Sarah’s sexual orientation played a significant role in her coping with the event in her childhood. Still, it had an immense influence on her dealing with trauma later. According to Dworkin et al. (2018), sexual minority women face and have internal homophobia and heterosexism, which exacerbates their PTSD symptoms and disrupts treatment. Sarah responded to her trauma by believing that she needed to be fixed, which not only slowed her recovery but also limited her ability to engage in honest, romantic relationships. In turn, this meant that Sarah did not have a strong support network up until she started coming to terms with her sexuality.

During our conversation about the event, it was clear that Sarah has come a long way in dealing with her trauma and understanding its circumstances and outcomes. While she did not show any signs of dissociation, anger, or withdrawal, Sarah’s mood changed when she talked about some events related to the abuse. Most notably, she became upset when talking about her family and their initial reaction to her opening up about the sexual assault. One could see that Sarah’s past relationship with her family was defined by their cultural and religious upbringing. She struggled to change their perception of sexuality and the open expression of emotion. Overall, however, she remained collective and alert, recalling events and discussing questions with awareness and positive thinking.

Despite the fact that, at one point, Sarah did not have a strong support network and had to deal with the impact of her trauma by herself, she remained strong-willed and energetic. This is a point of resilience that allowed her to overcome her negative thinking eventually. Moreover, it is a sign of great strength that she finally sought help through therapy. Although it took time for her to accept that she needed help, she embraced the conversations and treatment and worked through her feelings of guilt and shame, which is challenging for people to do. Sarah’s self-acceptance that developed as a result of reflection is another strength that she has. Her relationship with her girlfriend and friends makes a network of people who are ready to help Sarah if she is in trouble. Moreover, Sarah was able to rebuild and improve upon her familial ties, which resulted in another channel of positive feedback.

To sum up, it is apparent that Sarah has been on a long journey of self-discovery that helped her understand her true feelings and desires. She is resilient and strong; she looks forward to her future life with her partner with anticipation and continuously improves her thinking and environment. The trauma that she experienced has limited her self-expression and ability to enter into loving relationships for a long time. Sarah is eager to use her resources to regain these positive emotions that she did not have in her youth.

Reference

Dworkin, E. R., Gilmore, A. K., Bedard-Gilligan, M., Lehavot, K., Guttmannova, K., & Kaysen, D. (2018). Predicting PTSD severity from experiences of trauma and heterosexism in lesbian and bisexual women: A longitudinal study of cognitive mediators. Journal of Counseling Psychology, 65(3), 324-333.

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PsychologyWriting. (2022, June 4). A Client with Psychological Trauma: Therapy and Medication. Retrieved from https://psychologywriting.com/a-client-with-psychological-trauma-therapy-and-medication/

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PsychologyWriting. (2022, June 4). A Client with Psychological Trauma: Therapy and Medication. https://psychologywriting.com/a-client-with-psychological-trauma-therapy-and-medication/

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"A Client with Psychological Trauma: Therapy and Medication." PsychologyWriting, 4 June 2022, psychologywriting.com/a-client-with-psychological-trauma-therapy-and-medication/.

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PsychologyWriting. (2022) 'A Client with Psychological Trauma: Therapy and Medication'. 4 June.

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PsychologyWriting. 2022. "A Client with Psychological Trauma: Therapy and Medication." June 4, 2022. https://psychologywriting.com/a-client-with-psychological-trauma-therapy-and-medication/.

1. PsychologyWriting. "A Client with Psychological Trauma: Therapy and Medication." June 4, 2022. https://psychologywriting.com/a-client-with-psychological-trauma-therapy-and-medication/.


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PsychologyWriting. "A Client with Psychological Trauma: Therapy and Medication." June 4, 2022. https://psychologywriting.com/a-client-with-psychological-trauma-therapy-and-medication/.