Occurring Seemingly Without Reason After Reading

Case Vignette #1: Sierra

Sierra is a 18-year-old college student who is in the first semester of her Freshman year at NYU. She arrives at the college counseling center and explains that she has been having severe and recurrent nightmares over the past six months. The content of these nightmares is related to an incident where she was sexually assaulted by a friend while she and a group of friends were on a skiing vacation together. After the incident, the person who committed the assault acted as though nothing had happened and Sierra acted that same way as well to avoid any suspicion or embarrassment. She then avoided that friend for the rest of her senior year in high school. She told no one about what had happened for six months but then began having nightmares in which the assault was replayed. She then told her new boyfriend, who she is in a committed relationship with, and her mother. Both believed her and offered their support. You as the intake clinician at the university counseling clinic are the third person she has told about her situation.

At this point she is sleeping only 3 or 4 hours a night because she is scared to go to sleep. This has made functioning at school very difficult. She has become increasingly anxious during the day time as well and feels increasingly isolated from the people around her. She has nightmares that wake her up screaming almost every night and her suitemates in her dorm eventually convinced her to go to the counseling center for help.

Question #1: What is your diagnosis?

Question #2: What other questions would you like to ask the client to get any extra information that would be helpful?

Question #3: What treatment or treatments would you recommend for Sierra? (There are evidence-based treatments available for her diagnosis so be sure you are providing treatments that are known to be effective or have a very good reason for providing alternative options.)

Case Vignette #2: Logan

Logan is a 27-year old graduate student at Colorado State University. He comes to the University Counseling center because he has cried uncontrollably on a number of occasions in the past two weeks. He states that his crying spells have happened each time after seeing a scene set in a hospital on TV. He states that this is most likely due to the fact that he just spent a week living and looking after his mother in the hospital while she was recovering after having her bladder and part of her intestines removed to treat her bladder cancer. The crying spells only last about 5 minutes and do not leave him overly upset but Logan is concerned about them because prior to this he had only cried a few times in the past ten years and at these times there was always an emotional incident taking place that explained the crying. He is worried that the crying is occurring seemingly without reason and seems to be beyond his control.

Question #1: What is your diagnosis?

Question #2: What other questions would you like to ask the client to get any extra information that would be helpful?

Question #3: What treatment or treatments would you recommend for Logan?