Assessment and Case Formulation

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A pretreatment assessment was conducted over the course of two sessions. The therapist gathered information regarding Danielle's current emotional and behavioral functioning as well as details regarding her experience of sex ual abuse in order to formulate a treatment plan. This information was gathered through the administration of semistructured diagnostic and background interviews as well as standardized measures tapping symptoms of PTSD, depression, anxiety, and behavior problems. Ms. Williams also completed various self-report measures to assess her emotional distress related to her daughter's sexual abuse.

Results of the pretreatment assessment indicated that Danielle met full diagnostic criteria for PTSD, characterized primarily by symptoms of avoidance and intrusive thoughts related to the sexual abuse. Danielle was also exhibiting moderate levels of anxiety, including fear of men, difficulty falling asleep, and difficulty separating from her mother and grandparents. Similarly, Ms. Williams's responses to standardized measures revealed that she was experiencing moderate symptoms of depression, such as excessive guilt and self-blame, PTSD-related symptoms such as intrusive thoughts and avoidance of topics related to the sexual abuse, and excessive anger about the sexual abuse.

Based on these results, the following plan was developed for Danielle and her mother. Both Danielle and Ms. Williams met individually with the therapist for approximately 30-45 minutes on a weekly basis for the first five treatment sessions. During the remaining seven sessions, briefer individual sessions with Danielle and Ms. Williams were followed by joint parent-child sessions. Treatment goals for Danielle included (1) assisting her in the development of emotional expression and cognitive coping skills and (2) providing gradual exposure to, and processing of, abuse-related thoughts and feelings; and (3) learning about child sexual abuse, personal safety skills, and healthy sexuality. Treatment goals for Ms. Williams included (1) assisted processing of, and coping with, her own feelings about the abuse; (2) increasing her ability to support Danielle, through open communication, as she dealt with the sexual abuse; and (3) aiding her in the utilization of behavior management skills to address Danielle's problematic behavior at home.

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