Clinical Project

Intervention
Psychoeducation
During the sessions, therapist helped the client to know the nature, causes and maintaining
factors of her illness. The client also had some idea about it because of her educational
background of psychology.
Technique of imagery re scripting
This process is used to change the PTSD symptoms less severe and change the abuse related
beliefs. It included a step-by-step process of imaginal exposure, mastery imagery, cognitive
restructuring/Nurturing.
First step is imaginal exposure which involves the reimagining of the abuse as much same as
possible. The client was asked to close her eyes to imagine and verbalize the whole scene and to
quote it in the present tense. If the client felt uncomfortable, she was still helped by the therapist
to stay in the scene.
Then the next phase was of re-scripting. The main aim of this re scripting was to enable the
victim to respond to the abuse she is facing and is no longer in the state of helplessness. In this
scenario the client entered the memory of abuse as her adult self and was to rescue the child from
abuse by using any means and to keep the child away from the perpetrator. The patient decided
on her own what coping strategies she was going to use. When the stage of mastery imagery was
completed, next stage was cognitive restructuring. In this stage the adult self was going to
interact with the victimized child directly. The adult-self had to console the child in any possible
way. e.g., hugging the child, reassuring to keep him/her away from the perpetrator. When the
client was ready to come out of the imagined situation, therapist helped the client to slowly come
back.
A total of 8 sessions were conducted in the period of two months and each session was for about
1 2 hours. In the first step of imaginal exposure, it was difficult for the client to verbalize her
traumatic experiences and she was continuously crying while verbalizing it. She was encouraged
and motivated by the therapist to verbalize her trauma and rated herself on SUDS scale. In the
next step when she entered the scene as herself to rescue the child, she took help from the police
to protect the child. She was still motivated by the therapist as she was finding it difficult to
verbalize the scene. Cognitive restructuring was hard for her to achieve. In the scene the child
could not stop crying and it was becoming difficult for the adult self to nurture the child. Here
the therapist entered the scene and nurtured the child. It continued till the SUDS score decreased
to zero.
When the next session was conducted, the patient was less distressed about her situation and
SUDS level started from 6 points in step 1. In step 2 of imaginal rescripting, the adult self-
rescued the child without the help of the police but her SUDS level did not decrease. The
nurturing stage was easy to achieve than the previous session. Also in the upcoming sessions, the
patient was less distressed. She also looked more empowered to deal with the situation. She was
also given homework in which she had to write a letter to her perpetrator in which she had to
express her thoughts and emotions. This letter writing was used as a coping strategy. But the
client reported that she did not get personal space at home due to which she could not complete
er homework. So, she was asked to do it during the session. The patient wrote the letter excitedly
and wrote it in a very comical way.
The last few sessions were about the adult nurturing child imagery work. The abuse was not
repeated in the imagery instead she was asked to check in on the child in her imagery. Therapist
facilitated her by asking questions like:
Where is the child now?
What is she doing?
What do you see in her eyes?
What would you like to say to the child?
How does the child respond to the adult self?
When these questions were asked and patient checked in on the child, she was happy and
playing. The child expressed that she wanted to live a happy life. When the session was about to
end, the progress was reviewed. They also discussed ways for coping with stressful situations.

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