Stacey is a female college student.  She was out late one night when she came upon a group of men who beat her and raped her.

After the assault she was always on guard and whenever she saw a group of male students gathered together in the student union she thought about the attack.

Immediately, she would become anxious, start having heart palpitations, and would turn and walk in the opposite direction. Additionally, she became afraid of the dark and stopped walking outside at night.

She became very jumpy and easily startled. She became increasingly anxious and withdrawn and depressed.  She no longer enjoyed her favorite activities.

These behaviors continued months after the incident. After several weeks of being unable to sleep she went to see the campus psychologist, Dr. Wu who treated her with prolonged exposure therapy.

During the therapy, Stacey revealed how the trauma brought up memories of childhood sexual abuse that she had experienced.  While working with her, Dr. Wu referred her to Dr. James, a psychiatrist who prescribed her a medication.

Stacey’s friend, tried to provide her with support.  Her friend had been assaulted a year ago. Like Stacey, she began having symptoms the day after her attack, but her symptoms went away within a couple of weeks.

Question 1 (1 point)

Based on the information in the case, which of the following is the most likely diagnosis for Stacey?

These all refer to grown children moving back into their parents’ homes for various reasons.  Discuss your thoughts on why you might move back in with your parents after leaving the nest and what outcomes could emerge from this living situation.

Do you think it’s a good idea for adult children (over age 21) to live with their parents?  What “house rules” do you think should apply?

Background InformationNicole Gibson is a 25-year-old single mother whohas two children, a boy and a girl, aged 5 and6, respectively.

Nicole works for a nonprot or-ganization supported by AmeriCorp that offersself-improvement programs for at-risk youth.

Green House is an organization designed to teachyoung people home-building skills while theyearn minimum-wage salary and an annual stipendof $4,000 to pay for college tuition and books.

Additionally, the program provides paid time offto pursue a GED or high school diploma alongwith individual or group counseling opportunitiesseveral times a week.

Nicole also participates in aprogram that allows her to live independently ina low-income housing unit while attending schooland working.

Nicole is raising her two children on a salary of$800 per month and an infrequent child-supportcheck of $200 per month. She has no telephoneor car and must travel by public transportationto work and the day-care center.

Traveling fromher apartment to work, including dropping herchildren at the day-care center, requires her totake six buses each way every day. Nicole mustget up at 4:30 .. in order to get her childrento day care and herself to work by 8:30 .

.She gets home at 7:30 at night, despite the factthat she finishes her work day at 4:30 in theafternoon.

As a case manager at the housing unit, you meetNicole during a home visit. Nicole expresses a de-sire to obtain counseling to assist her with her lifeskills and family-of-origin issues that have madeit difcult for her to function well at work

. Youagree to see her for counseling once a week for2 hours. One hour will be used to assist Nicolewith life skills such as parenting and home main-tenance skills.

The second hour will be utilized forcounseling.Progress Note from Your First Sessionwith NicoleAs a child, Nicole lived in New Orleans with herparents and older sister, Marcia. Nicole’s par-ents remained married until she was a teenager.

Nicole’s father sexually abused her from the timeshe was 8 years old through her mid-teens. Heforced her to have sexual intercourse with himapproximately three times a week.

Several of herfather’s friends were allowed to sexually abuseher as well.Nicole’s mother was physically, verbally, andmentally abusive, often striking her, calling hernames, reading her private journals out loud toother family members, and watching her in thebathroom.

On one occasion, Nicole’s mother struckher across the face with a belt buckle, leaving a per-manent scar above her upper lip. On another occa-sion, Nicole’s mother took a poem that Nicole hadwritten and submitted it to a magazine under herown name.

Her mother claimed a prize but neveracknowledged the fact that it was Nicole’s poem.Her older sister was also physically and verballyabusive to her.Nicole left home when she was 18 years old andmarried the father of her two children.

She referredto this as “getting married to escape hell,” stressingthe fact that although she couldn’t stop the “torture”of her family situation, she could leave it behind bygetting married.

She stated that she left the marriagebecause her husband was a very “passive” person,and she didn’t want to turn into someone like hermother.Before her marriage, she fell in love with a mannamed Douglas with whom she now has an es-tranged relationship.

Nicole and Douglas were neversexually involved even though they have been inti-mately involved on and off for about 8 years. Nicolestated that sex makes her feel “dirty, ashamed, andsick to her stomach.

” She hasn’t spoken with or seenDouglas for about 6 months, as he will not returnher calls.

Nicole has severed all ties with her family oforigin since if she speaks with them she will onlyend up “feeling like dirt and getting real mad.”

Al-though Nicole is not involved at the present time inan intimate relationship, she does nd support ather job with coworkers and has one close friend,Vickie, in whom she can conde.

Nicole has had difculties at her job, however.She stated that she gets very upset when anyonegets “in her space.” When the pressures at workbecome more than Nicole can handle, she feelsangry and panicky and “just wants to be leftalone.

“During the rst session, Nicole stated that shedidn’t want to do anything but lie in bed. She statedthat she often cries all weekend, becomes easily angered by her children, and often resorts to yellingand spanking them.

Nicole also stated that she was having difcultydoing chores (e.g., going to the Laundromat orgrocery store, cooking, cleaning). There were pilesof laundry in her bedroom and trash everywhere,including old food, which reeked.

She stated shehas had difculty sleeping at night due to recurrentnightmares of “childhood stuff” and always feels”too tired.” She avoids any situation that remindsher of “family stuff” but is afraid that she’s turningout just like her mother.

Nicole possesses a great deal of intelligence andhas the ability to seek out support and help when itis needed. She also has a very good sense of humorthat she displayed throughout the interview.8.1-1

What diagnoses are you considering at this time? What will be your primary area(s) of explorationat the next session?Second Session with NicoleNicole begins the second session with you by de-scribing a situation that occurred during the weekat work.

A male coworker asked her if she wouldlike to go out for dinner after work one evening,and when Nicole declined the invitation, the co-worker lightly touched her shoulder and said, “Oh,come on Nicole, you need a little fun in your life.

“Nicole states that she overreacted to this gesture byswinging at the man and striking him on his chest.She tells you she doesn’t know what came over her,but she felt like she was warding off an attack ofsome kind and couldn’t tolerate having this mantouch her.

When you ask her if this type of thing has hap-pened on other occasions, she admits that she doesn’tlike to be touched by anyone. “It even bothers mesometimes if my own kids grab me when I’m notprepared for it.

“Nicole states that she was so upset by this inci-dent that she stayed home from work the next daybecause she was just “too tired” to get there ontime.

“My supervisor gets real mad when I’m late,even though I tell him I can’t do anything about itif the bus isn’t running on time. I just didn’t wantto deal with it the other day.

“You ask her why she thinks she reacted sostrongly to her coworker’s touching her the otherday. Nicole pauses for several moments and thensighs deeply.

“I think it’s related to all that ‘child-hood stuff’ with my father. I just can’t get it out ofmy head. I think it’s going to haunt me for the restof my life.

“Nicole describes several depressive episodes toyou in which she felt she just couldn’t move becauseit took too much energy. During those times, shewould forget to eat and would be unable to get tosleep until early in the morning.

Her children wouldconstantly ask her, “What’s wrong, Mommy? Whycan’t you play with us?” Nicole states that herchildren’s comments made her feel like a “terriblemother.

“When you ask her about her goals for the fu-ture, Nicole states that she really doesn’t have anygoals, although she would like to go to college andbecome a teacher. She says she isn’t sure she’ll livelong enough to complete an education.