Case Study: Dissociative Diane
Diane is a thirty-six year old white female. Currently she is divorced with two children and is employed as a daycare worker. During the session the client seemed to be intelligent with excellent personal and spiritual insight into her situation. Her non-verbals indicated some anxiety (crossed legs, face twitches) and depression (teariness).
Diane is the older of two children. She was adopted as an infant after her mother gave her because she was the byproduct of a very violent rape. She describes a childhood filled with intense physical, verbal and sexual abuse by several members of her family. Beginning at age two Diane has memories of her paternal Grandfather sexually abusing her and using her in conjunction with satanic rituals. The rituals involved physical abuse as well as threats with a knife, blood and an Italian horn being laid on Diane’s bare chest. To the best of her knowledge this abuse continued until Diane was five. During this time her paternal Grandmother, who was a spiritist, said prayers to protect Diane and would often cursed other family members by putting menstrual blood in the family’s ‘Sunday sauce’.
Diane’s uncle simultaneously abused her during this time. His abuse was also sexual in nature, but was also very physically abusive. Specific memories include being thrown naked into a pile of laundry and then molested, being thrown on a bed, being molested while watched by her uncle’s friends and being slapped across the face when not being willing to perform oral sex. Diane’s maternal grandparents did not participate in any abuse, but witnessed both physical and sexual abuse and often told Diane that she had brought the actions on herself. This pattern was duplicated by Diane’s adoptive parents who would vacillate from calling her their ‘little princess’ to choking, punching and sometimes torturing Diane, particularly in her teen years.
At the age of twenty-eight Diane married her current husband. The couple was together six years until their divorce five years ago. Matt also sexually abused Diane before their marriage, causing her to hemorrhage and be taken to the hospital, at which time she was also treated for multiple bruises. Matt also came from a background of sexual abuse by his father, uncle and priest. He was forced to commit several homosexual acts in a church context as well as childhood pornography. Several years later his father was arrested as a pedophile. During their marriage Diane experiences several bouts of verbal, physical and sexual abuse and now experiences intense PTSD symptoms when he comes to pick up the children.
Currently Diane is taking Lithium for Bipolar Disorder (diagnosed at the age of thirteen during a two week stay in the state hospital). She also has been diagnosed with schizoaffective disorder and currently takes Zyprexa to counteract hallucinations. Diane also suffers from PTSD and has learning disabilities as well as difficulty with her fine motor skills as a result of the intense abuse.
Overall, Diane appears to be struggling with memories of past physical, emotional and sexual abuse. These have taken the form of:
• PTSD (hypervigilance, headaches, dissociation, flashbacks, and dizziness)
• SRA symptoms (body pains in vaginal area and lower back, confusion, hallucinations, emotional regression, recurring dreams with satanic symbols, and numbness in both her hands and arms),
• schizoaffective disorder (blunt affect, few close relationships)
Answer the following questions:
1. What are the spiritual implications for this client?
2. Is the use of religion functional or dysfunctional?
3. What spiritual interventions might be appropriate?
Students, in groups, will write a case conceptualization paper demonstrating their ability to apply clinical theory to practical case material. See the course schedule for the due date. Between them they will prepare a 10-page paper, not including the title, abstract, or bibliographic pages. Papers should include a title page (with the students’ names, the name of the course and the title of the paper), an abstract, and a bibliography page. Each paper should be double-spaced with one-inch margins, follow APA Guidelines regarding formatting, abstract, citations, and references, and include at least ten bibliographic references (with at least three being journal articles among those listed). The instructor(s) will post case studies from which to make a selection. Completed papers must include the following sections (organized with these with section titles):
1. Notation of the presenting problem(s)
2. Statement of the counseling theory chosen from the texts and reasons for choice of that theory (what are the strengths of this theory and why it would be a good selection in working with this client)
3. Application discussion of major constructs of the theory as they apply to the presenting problem (what therapeutic goals, treatment protocols, techniques, etc. would/should be used if counseling the client(s) from this particular theoretical orientation)
4. Integration of the presenting problem and theory with a Christian theistic view (include problem areas, concerns, philosophical differences and/or compatibility)
To summarize, students in the group will select one case study and one theory. They will then describe how they might counsel the person(s) utilizing the major constructs and techniques of the chosen theory, while also noting points of biblical integration
Additional Reference text to be used:
Christian Counseling a comprehensive guide. Gary R.Collins, Third edition
The Biblical Basics of Christian Conseling for People Helpers, Gary R. Collins 1993,2001