“It's Like Uprooting Trees”: Responsive Treatment for a Case of Complex Post-Traumatic Stress Disorder Following Multiple Rapes

Abstract

This systematic case study documents 27 sessions of assessment and treatment with cognitive therapy of Bongi (23) who presented with major depression, posttraumatic stress disorder and borderline traits. Bongi had been raised in a punitive environment, had been raped three times, the first time at age 9, and had been in a series of abusive relationships. The treatment illustrates the importance of therapist responsiveness in addressing this kind of complex presentation, the importance of drawing on case formulation to guide the course of treatment and the range of different interventions that need to be incorporated into an integrative treatment of a complex case. Self-report measures of depression, anxiety and posttraumatic stress indicators provided evidence that the therapy contributed to positive changes and the qualitative therapy narrative gives details of the nature of some of those changes. Although treatment was not complete when Bongi moved away, Bongi herself judged that the therapy had been a valuable experience which had resulted in her feeling more alive, more confident, and better able to take care of herself.

Keywords:

• cognitive therapy
• complex posttraumatic stress disorder
• integrative psychotherapy
• posttraumatic stress disorder
• systematic case study