A Case Study of Social Cognitive Treatment of PTSD in a South African Rape Survivor: The Central Role of Case Formulation

Abstract

This is a systematic case study of the psychological assessment and treatment of Zinhle (19), a Black South African student with posttraumatic stress disorder, following a rape at age 10. Treatment was based on Ehlers and Clark’s (2000) cognitive therapy, a flexible formulation driven model. The study documented the secondary trauma experienced by families following child sexual abuse and showed how treatment not only needed to target the trauma memory but also the ruptured relationships within and outside the family. This was done within the framework of Tarrier and Humphreys’s (2004) social cognitive model. At the end of treatment Zinhle no longer met criteria for PTSD, and the narrative supports Ehlers and Clark’s model as well as the social cognitive model.

KEYWORDS:

• childhood sexual abuse
• cognitive therapy
• posttraumatic stress disorder
• social support
• systematic case study
• South Africa

Additional information

Notes on contributors

Anita Padmanabhanunni

Anita Padmanabhanunni is a senior lecturer and counseling psychologist in the Department of Psychology at the University of the Western Cape (UWC), South Africa. Her research has focused on evaluating the transportability of specialist Cognitive Behavioral treatment (CBT) models for posttraumatic stress disorder (PTSD) to the South African context. In this regard, her research has contributed to the creation of a contextualized knowledge base regarding the treatment of vulnerable population groups in the country, particularly survivors of rape. This has gone a considerable way toward providing practitioners with guidelines around the flexible application of efficacious treatments in local clinical settings. Anita's research areas include psychotherapy outcome research, CBT, schema therapy, trauma and PTSD, and gender-based violence. She is involved in Master's clinical training and supervision, and lectures on CBT, qualitative research methods, and psychopathology. Her current research focuses on investigating the therapeutic value of participation in activism against gender-based violence for survivors of rape.

David Edwards

David Edwards has been a clinical psychologist and practicing therapist for over thirty years. He is a founding fellow of the Academy of Cognitive Therapy, having trained at Beck's Center for Cognitive Therapy in Philadelphia. Professor Edwards has a longstanding interest in psychotherapy integration and has done experiential training in a variety of humanistic and transpersonal approaches. David is a professor at Rhodes University, where, until his recent retirement, he provided professional training and supervision in cognitive therapy for two decades. Over a long career, he has published some 70 academic articles and book chapters, covering areas as diverse as the use of imagery methods in psychotherapy, the history of imagery methods, case studies of the treatment of simple and complex PTSD, guidelines on the treatment of trauma related disorders, case studies of the treatment of other disorders including conduct disorder, ADHD, and social phobia, and case study as a research methodology.