Sheffield Women’s Counselling and Therapy Service

Sheffield Women’s Counselling and Therapy Service

Case study

In order to protect her identity, I will refer to this client as Jane. Jane has given her written consent for us to use this material. 

Jane presented at assessment with having been “abused and traumatised throughout her life from an early age and through to present day”.  Jane had been admitted to psychiatric unit over 20 years ago and has relapsed at various times since then, at assessment she had a CPN and a Mental Health Support worker. 

The following is a summary of her Trauma Symptom Inventory (TSI) score at the beginning of therapy. Jane has what is termed as a classic post traumatic presentation, in that she reported both the intrusive and avoidant components of (Post Traumatic Stress Disorder) PTSD or AS (Acute Stress). Her TSI score showed clinically significant scores for intrusive experiences, dissociation defensive avoidance. Jane’s profile is a classic presentation of a client who has been sexually victimised.

Jane’s initial score also highlighted that she had clinically significant depression scoring. Client who have an elevated score on the depression and dissociation scale are frequently seen as withdrawn, passive or avoidant. Clients with this profile may have a difficult time expressing distress and may avoid seeking help from clinicians. If the D/DIS client does not enter into psychotherapy their depression may be relatively resistant to treatment unless the dissociative element is addressed as well.

Six months after therapy started

I took Jane’s TSI score after 6 months of weekly one hour therapy. Jane’s depression score had fallen. Her dissociative score remained clinically significant, however her intrusive experience become reduced Jane at this time was developing a more solid core self.

At the end of therapy

In the final sessions I under one final TSI score. We were both delighted to see that all Jane’s scores for all categories fall below the clinically significant range. Jane reported significant change in all areas of life and relationships. Jane is now more able to recognise self defeating patterns of relating to self and others, more able to hold personal boundaries and engages more effectively with supportive activities outside of the therapeutic relationship. Jane was most pleased with an increase sense in ”self belief, confidence and assertiveness”. Jane said “I believe in myself more now and I am trusting myself more than I have ever done before”.

Jane has also given her permission for us to use the following images. The first image represents a sand tray image that she created to represent the beginning of the therapy:

Words associated with objects: trapped, all messed up, running scared, frightened, confused, didn’t want to live 

At the end of therapy:

 Words associated with objects: “Developing inner strength and awareness”, “Solid part of myself feels”, “strength of the lion”, “wisdom of the king”, “contentment of a fairy”, “Feel a sense of each one building despite life still having ups and downs”

It was a pleasure and privilege for me to work with Jane.  As a therapist I was able to use the TSI score to inform the therapy and in the early stages it supported me to work with Jane in the most effective way.  TSI was also incredibly validating for both Jane and my self as we could see how far she come. 

Wendy Jackson, Psychotherapist