M4_A2

Vignette— Veroni ca

Veron ic a is a 2 6-y e ar -o ld M ex ic an Am erican woman, m arr ie d, w ith t wo so ns, a ges 3 a n d 2. S he has a B .A .

in F ine A rts, but s ince having chi ldr en she h as st ayed at h om e cari ng f or t h em . V eroni ca c a m e t o t he cli n ic

where yo u w ork b eca use s he had b een f e el ing depres sed for three m onths. T he depressi on h ad start ed

sh ort ly a fter s he h ad e n ded a f iv e -week extram arital a ffa ir. Du ring t h e a ff a ir, V er oni ca b e gan t o h a ve

flashb acks o f e ve nts f rom 1 0 y e ars in the p ast. T hese e ve nts ce ntered around a s eri es of re peat ed r a pes

that oc cur red whe n she w as 16 ye ars old. I n a dd it io n t o di stres sing im ages of t h ese eve n ts se em ing to

c o m e into h er m ind out of now here, t h ese f lashb acks inc lu ded t im es w hen Vero nic a w ou ld m om entar il y f e e l

as if t h e p ast w ere occur rin g a ll o ver a g ain. W he n V eroni ca r e al iz ed this a ff a ir co inc id ed w ith t he exact t im e

of t h e y e ar s he had b een r a ped, sh e b ro ke o ff t h e a ff air. N everth eles s, V eron ic a b eca me increa sin gl y

depressed a nd a g ita ted as m ore mem ories resur faced .

It was o n ly now , a d eca de lat er, w hen V er onic a b e gan to la b el w hat h ad oc cur red th en as ra pe. V eron ic a

sta ted s h e h a d b een r a pe d re peate dl y over a f iv e -w eek p erio d b y a c lose fr ie nd o f the fa m il y . T his b o y, who

was t h e sa me a ge as V er onic a, liv e d a cross t h e str ee t. B ec ause t h e b o y ca me f rom an abus iv e f a m il y ,

V eron ic a ’s f a m il y “a dopte d” h im . He w as b est f r ie nds w ith h er brot her, a nd so he s p ent a lot of t im e a t t h eir

h om e. V eron ic a ’s p arents were als o q uit e f o nd o f h im . P rior t o t h e ra pe, V eron ic a s a id she had h ad a

“brothe r-s is ter” relatio nship with the b o y, whose nam e w as M ark .

V eron ic a g ave o n ly a s k etc hy ac co unt of t h ese inc id e nts d urin g t h e f ir s t in ter vie w a nd m ade ve ry little e ye

c o ntact w ith y o u, t h e int erv ie wer. Du ring th e in ter vie w, V eron ic a r e ported she h ad b een a v ir g in pri or t o t h e

ra pe a nd h ad trusted Mark q ui te a b it b efore the assa ult. She was verb all y t hrea tened b y h im , al th oug h n o

wea pons or p hys ic al injur ies w ere inv olve d. V eron ic a was su bjected t o a r a n ge o f sex acts, inc lu d ing oral ,

va gin a l, a nd a n al in ter co urs e. Dur ing t he assa ul ts, her m ost p ro min ent re actio ns were f eel ing d etache d a nd

num b, g uilt y , a nd e m barras se d. T he inc id ents w ere no t re port ed t o the polic e, a n d s he never r ec eiv ed

m edi cal care.

Veron ic a t o ld y o u she often s m oked mariju ana. S he was d efe nsi ve a bou t h er use of it a n d said she did n ot

want t o q uit. In a ddit io n, V ero nica sta ted o ne of h er pr evio us t h erap is ts h ad m ade a b ig d ea l o ver h er

m ariju ana use, a nd t h e t h era pi st h a d told her u se o f m ariju ana w as h er m ain p ro ble m . S he q u it t h era p y.

S he ha d so ught t h era p y t w ic e b efore that t im e, a nd s h e h ad q u it a fter one ses sion.

Clinical History

V eron ic a d es crib ed h er c h ild hoo d a s a h app y o ne. S he ch aracter iz ed h er h om e a s t h e sa fe h ouse in t he

n eig hb orho od w here all t h e k ids co uld co me t o p la y a nd w here so me f o und ref uge f r o m probl em s in t h ei r

ow n h om es. V eron ica ’s f at her h a d b een a V ie tn am v e teran who co ntin ued t o h av e p osttr aum atic stress

d is order f rom e ve nts he h ad e xp erie nce d d uring t h e war. S he d es crib ed h er f at her as e m otio n al ly sh ut o ff ,

y e t s p oke v e ry f o n dly of hi m . Her m other w as a M exic an wom an who h ad m et h er f at her i n t he h ospital

where sh e w or ked as t h e ch ief of t h e n urs in g d e part m ent, an d he wor ked in t he in fo rm ation te ch nolo g y

depart m ent. Vero nic a s a id s he had a c lose and s u pp ort iv e relatio nship w ith h er m other. V er onic a h ad o ne

old er brot her w ho w as b est f r ie nds w it h M ar k, t h e b o y who h ad r a ped h er. V er oni ca c la im ed she was c lose

to h er brot her un til t h e ra pe; s ince the ra pe, t h e y rar ely in terac ted wit h e ach o th er.

Dur in g t h erap y, V eron ic a to ld y ou t h in gs h ad dras tica lly c h ang ed s ince the r a pe. V eron ic a s a id she h a d t o ld

h er m other what h ad h a ppe ned, a nd h er m other s to pp ed t h e a buse. A fter y o u qu est io ned h er f urther,

h o w ever, V er onic a re cal led she had t o ld h er m other M ark h ad b ee n “ c o m ing on” t o h er, it h ad gott en out of

c o ntro l, a nd she ne ede d h elp g et ting o ut of t h e s it u atio n. T he abuse ended a fter V eroni ca’s m other to ld

M ark to le ave V er onic a al one. V eron ic a n ever t o ld h er m other s he h ad b e en ra pe d. T h ere fore, h er f a m il y

d id n ot u nd er sta nd w hy she h a d c h an ged. A fter the ra pe, V eron ic a w ith dre w f r o m h er n orm al high s ch o ol

act iv it ies a n d b eg an t o h ang o ut w it h t ro ubled k ids. O ver the y e ar f o ll o w in g t h e a ssa ul ts, Veron ic a o ften li ed

a nd b e gan d rin kin g. S he d escr ib ed h er se lf as f lo ating in a nd o ut o f re alit y . S he an d h er m other f o ught Page 1 of 2

Ps yc hol ogy of the V ic tim

Vi gnet te —Vero nica

fre quent ly . A y e ar a fter the ra pe, a f r ie nd of h ers was d riv ing rec kles sly a nd cras hed t h e car in w hic h

V eron ic a was a p as se nger. S he recal led t h at o ver t he n ext f ew y e ars she b ecam e a “to ta l r e bel ” a nd d ated

a “wild gu y who was t o tal ly b ad n ew s.” S he b eca m e p re gna nt b y h im a nd, n ot k n ow ing wha t to d o,

co nsu lt e d h er f at her. Her fa ther t o ok o ver a nd a rra ng ed f or an a b ort io n. T he y n ev er to ld h er m other, who

was v e ry co nse rv a tiv e a nd pr o-lif e b ecau se o f h er str ong Cath olic r o ots. A lt h ou gh V er onic a s a id s h e m ig ht

have u lt im ately m ade t h e sa me d ec is io n, s h e no w re gret ted she h ad r e lin q uis h ed h er r ig ht to d eci de.

V eron ic a d id n ot h ave t he s e lf - c o nfid ence to g o to c o lle ge, b ut h er m other k n ew ho w m uch she lik ed

dr aw ing a nd enco ura ge d h er to a tte nd a s m all col le ge where s h e f in all y gr adu ated w ith a B .A . in F in e A rts.

Veron ic a s a id she fortuna tel y h ad th e “g ood se nse” t o m arr y a f ine man fo ur y e ars a go w it h w hom she had

two so ns. V er onic a s a id h er h usb a nd w as v e ry su pportiv e o f h er a nd did no t g iv e up o n h er a fter the a ff a ir.

Diagnosis

On t he b asis of t h e in fo rm ation collected during the as ses sm ent p eri od, V eron ic a was as sig ned t he

f o ll o w ing DSM5 dia g nos is :

F43.10 Posttraumatic Disorder (moderate)

F32.0 Major Depressive Disorder, single episode, mild, with anxious distress.

F12.0 Cannabis use disorder, mild.

WHODAS 3.43 Moderate

Initial T re atment

As p art of t h e s ta biliz ation tre atm ent, yo u e sta bl is h ed r a pport a nd a llo wed Ver onic a so me ti m e t o t a lk a bout

the rapes or a ny ot her issu es. Y ou d id n ot m ake h er m ariju an a u se a f ocus of treat ment, but la bele d it as

a noth er f o rm of a void ance a nd as ked her n ot to use it b e fore ses sio ns or wh il e c o m plet ing hom ew ork

as sig nm ents. You d escr ibed t he sym ptom s of P TS D a nd in fo rm ed Ver onic a h ow t h ese s ym ptom s

develop ed a nd w hy th ey had n ot d isa ppe ared. Y ou p res ented an over vie w a nd r atio nale f or tre atm e nt a nd

expl ain ed w hy h om ew ork c o m plet ion and ses sion at te ndance are so im porta nt in h er recover y. Y ou a ls o

a llo wed Vero nic a t o f e el her e m otio ns a nd let t h em run th eir co urs e so t h e m em ori es co uld be p ut a w ay

w it h out such str ong f e eling s st il l at tac hed a nd so h er b elie fs , di sru pte d a n d d is tor ted b y t he as sa ults, could

g et b ack in b ala nce.

Becau se the in cid ents h a d h app ene d t e n y e ars b efore and V er onic a h a d no c o nt ac t w ith t he perp etrat or,

issu es of im m edi ate safe ty were not a p pl ic a ble. Y ou di d di sc us s, h ow ever, issu es of g enera l tru st in o th ers .

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Ps yc hol ogy of the V ic tim