Read Susan's case study in the article "Treating Adults with Complex Trauma: An Evidence-Based Case Study."

Susan Case Study:

Susan (pseudonym), a 25-year-old married White woman, was referred to me by a counselor due to limited success in therapy. Susan reported being sexually, physically, and verbally abused by her birth father from ages 5 to 16. She disclosed the sexual abuse (SA) to her mother at age 8, but it continued. Because of her disclosure and outcry, her parents blamed her for disrupting the family. The SA occurred two to three times a week from ages 5 to 12. At 13, her parents divorced. The SA continued during weekend visits with her father. At 16, Susan moved in with her grandmother and the SA ceased. During high school and college, Susan had problems regulating her emotions and flashbacks of the abuse. She also reported significant memory gaps, as well as fragmented and discontinuous memory. In college, she discovered that she had been involved in relationships she could not remember. Furthermore, friends and family members noted times she acted differently, "unlike her normal self" and being many "different Susans." These revelations added stress to Susan's marriage and to her fears of abandonment. She also reported hearing voices in her head since childhood. When questioned, she disclosed that she had not engaged in self-injurious behavior or had any thoughts of suicide.

1. What trauma symptoms are present?
2. What are the key assessment issues to consider?
3. What environmental factors may trigger the identified trauma symptoms?
4. What evidence-based trauma treatment would be appropriate and why?
5. What client strengths should be integrated into service planning?
6. How could you assist the client in enhancing coping skills?
7. What cultural considerations should inform service planning?
8. How could you assist the client in strengthening social supports?