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Sasha is a 14 year-old who was raped by her neighbor as she
was walking home from school. She is afraid that her father,
who is very religious, will either not believe her or will try to kill
the neighbor. Either way it will end badly for her family. Sasha
does not want anyone to know about the rape and called a
hotline to find out where she could get help without involving
her parents. Also, she was deathly afraid that she would be
pregnant and her first thought was how to get the morning after
pill so that this would not happen. Once she got this pill she
came to your clinic for counseling. She has not agreed to
include her mother in therapy since she knows her mother will
just tell her father. Cont. - ANSWER -She has severe PTSD
symptoms: flashbacks, nightmares, avoidance, sleep
problems, and self-blame. She is also considering suicide but
this is a sin in her religion so she would not go through with it.
Nevertheless, she believes her life is basically ruined.
Sasha agrees to participate in TF-CBT but absolutely refuses
to allow her mother to know about the rape. You are very
concerned about her social isolation. You:
a) Tell her that it is critical that she consider group therapy.
,b) Tell her that if she doesn't tell someone in her family you may
have to commit her to the hospital.
c) Ask if she has any relatives (e.g., older sister, cousin, aunt,
or grandmother) who might be able to participate in therapy
and who would keep the rape confidential.
d) Refuse to see her without the participation of one of her
parents as TF-CBT cannot be implemented without caregiver
involvement.
Sasha agrees to ask her cousin Leila, age 25, to participate in
treatment with her. Leila agrees without knowing why Sasha is
in treatment and promises to keep everything confidential.
During the next session Sasha tells Leila why she is in therapy.
Leila is very supportive and agrees to continue to participate in
treatment. Sasha says that in her religion any girl who loses
her virginity, even through rape, is no longer pure or fit for
marriage. You: - ANSWER -a) Validate Sasha's concerns and
tell her you to understand why she is so depressed. Engage
her in psychodynamic treatment for adolescent depression
instead of TF-CBT.
b) Tell her that no religion holds girls responsible for having
been forcibly raped.
c) Tell her that any religion that believes this is harmful to
women.
d) Tell her that you are very interested in her understanding of
how her religion addresses the issue of rape. After she has
explained this, ask her if she is interested in hearing how you
have heard it explained differently by a member of the clergy
from her religion.
, 20. After several sessions of treatment, Sasha's mother
becomes suspicious of all the time she is spending with Leila.
She asks Leila why she has been picking Sasha up every week
and taking her places. Leila does not feel comfortable lying to
her aunt about this and asks you how to handle this matter.
You: - ANSWER -a) Suggest that they continue to come to
therapy without telling Sasha's parents. Nothing about Sasha's
family situation has changed since therapy began.
b) Suggest that it is best that Sasha not continue therapy
unless she is able to tell her mother that she is coming to
therapy.
c) Suggest that Sasha and Leila assess potential benefits
and risks of being open about therapy with Sasha's mother.
Sasha has learned new skills and has gained significant
support from Leila that she did not have at the start of therapy.
d) Tell Sasha that family therapy, including the mother and
father, would be more appropriate than TF-CBT.
You are providing TF-CBT to a 7 year-old boy who saw his
mother's boyfriend (who was gang involved) shot by a member
from a rival gang. This child has also been exposed to a great
deal of domestic violence perpetrated against his mother and
has seen his mom and many other adults use substances. He
has been living with a kinship caregiver, his aunt, for about
four months. In the first session you have with this boy and his
aunt, she reports having trouble getting him to listen to
directions and commands and is very frustrated by these
behavior problems. She understands he has been through a