Treatment Plan

It was decided that individual CT interventions would address Mary's depressive symptoms, avoidance behaviors, as well as her sense of mistrust of others and vulnerability to harm. Initially, treatment was intended to focus on Mary's depression, which she reported as her primary concern. The clinician would initially address her depressive symptoms with behavioral activation interventions to increase Mary's social involvements and pleasurable activities. At the beginning of treatment, the clinician decided that, should posttraumatic stress symptoms arise as Mary became more behaviorally active, therapy would also focus on imaginal exposure to the traumatic event, as well as in vivo exposure to her daily triggers. Cognitive interventions would also be employed to treat the PTSD by helping Mary to challenge her negative perceptions of her own behavior during the event, its sequelae, and any self-blame or shame that might exist. The clinician anticipated that Mary's avoidance of emotionally salient material would be a possible road block to treatment; thus, the pace of therapy would be adjusted to increase rapport and trust. Because Mary's current life circumstances (financial and family problems) also had the potential to become issues in therapy, the clinician would employ problem-solving interventions if needed.

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