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                                         Levy’s case study AdebisiOkieimen Walden University NURS 6640 Psychotherapy with Individuals July 5, 2019                                           Introduction The United States Department of veterans affairs defined post-traumatic stress disorder (PTSD) as a mental health disorder that develops in some people after experiencing a life-threatening event such as  combat, a natural disaster, a car accident, or sexual assault which results in  upsetting memories, feeling on the edge, or have trouble sleeping after the event (VA, 2013). Treatment for clients experiencing these symptoms should be well focused on addressing some of the debilitating symptoms associated with the disorder. Thus, in this paper, a case study about the Levy family will be reviewed. The review will include the problem Mr. Levy is having, the type of therapy for Mr. Levy, the therapist skills and concerns and the therapist supervisor’s professional advice in handling Mr. Levy’s case.                                                 Episode 1Episode 1 of Levy’s family case study showed that Mr. Levy’s perceives that the root cause of his problem is the fact that his old self died in Iraq. He felt he couldn’t help himself get over that and resulted in drinking as a solace to his problem and stating that he feels sick. Mrs. Levy’s on the hand, perceived that her husband is depressed and the addiction to alcohol is the cause of his feeling sick every morning as he suffers from the hangover of excessive drinking at night. The probable implication of this problem to the family could result in a divorce, as the wife stated that her vow does not cover what Mr. Levy was experiencing. The problem could also cause a financial problem for both couples because Mr. Levy’s inability to work and contribute financially to the house as a result of his every morning hangover is a financial threat. Child custody battle and emotional problem are not left out of the problems the family might experience if the problem persists.                                                                                                        Episode 2Episode 2 focuses on the therapeutic approach to treatment for Mr. Jake Levy. Despite the excitement about counseling the client by the counselor, the supervisor made it clear that assessing the client’s needs on meeting the client is the best way to decide on what type of therapeutic approach will be appropriate for the client. The suggested idea of yoga and meditation as a therapeutic approach for Mr. Levy sounds like a good idea but it does not take into consideration the personal needs of the client which makes it defective. The therapist supervisors asked her about any evidence-based research that has confirmed the use of that treatment option for a client like Mr. Levy. Supporting the therapist suggested a treatment plan, exercise was found to have a complex, longitudinal, and beneficial association with PTSD symptoms in research on the direct and indirect effects of exercise on posttraumatic stress disorder symptoms by Whitworth, Craft, Dunsiger & Ciccolo in 2017.                                                    Episode 3In episode 3, the therapist response was appropriate in a professional manner and showed empathy by allowing him to express the way he feels. The whole therapy session was to help Mr. Levy control the traumatic thought which is creating a lot of anxiety for him and the first step to helping him was to learn how to deep breath in order to feel relaxed whenever he is confronted with the traumatic thought. The use of the exposure therapy as stated by the therapist is to teach the client how to gain control by facing his negative feelings. The etiological models of PTSD identified the relationship between intrusive thoughts and avoidance behaviors as the key factors that maintain the disorder (Joseph &Gray, 2008). Therefore, the intrusive thoughts need to be controlled to alleviate the avoidance behavior and the use of exposure therapy is generally regarded as the standard of care for PTSD (Joseph &Gray, 2008). Therefore, since Mr. Levy is an Iraq veteran, the choice of exposure therapy will be ethically right for this client.                                            Episode 4 In episode 4, Mr. Levy told a very difficult story about his platoon officer, as a therapist it is important to empathize with the client by letting the client know that the experience is a difficult one as you can imagine. In a research about teaching trauma-focused exposure therapy for PTSD: critical clinical lessons for novice exposure therapists it was discovered that the trained therapist has the unique ability to hear about traumatic events, be empathetic and supportive, and be present for their clients to promote engagement with the trauma memory (Zoellner,  Feeny, Bittinger, Bedard-Gilligan, Slagle, Post & Chen,2011).I will ask the client more questions about the event to help the client deal with the difficult aspect of the traumatic effect. The use of  direct questioning during imaginal exposure should be done in a skillful manner so that it can propel the client to explore salient and important aspects of the memory that may ultimately be some of the most crucial aspects of successful recovery (Zoellner,  Feeny, Bittinger, Bedard-Gilligan, Slagle, Post & Chen,2011).                                                 Episode 5  In Episode 5, Mr. Levy’s therapist is bored about the traumatic story of Mr. Levy which is a natural response to hearing about a traumatic experience. As a supervisor, overseeing the therapist, it is important to remind the therapist about her role which is to guide the clients through the difficulty of approaching the memories of their trauma and other trauma-related fears in order to help them regain their lives even though working with individuals who have survived traumatic events is no doubt challenging (Zoellner,  Feeny, Bittinger, Bedard-Gilligan, Slagle, Post & Chen,2011).It will also be helpful to remind the therapist that the client has already shown a great deal of courage and strength to have made it through the event, acknowledged the source of his current problems, and is actively seeking help (Zoellner,  Feeny, Bittinger, Bedard-Gilligan, Slagle, Post & Chen,2011).                                         Conclusion PE is regarded as the gold standard treatment for PTSD and has been subjected to many clinical trials with supporting evidence about its effectiveness in treating war veterans with PTSD (Rauch, Eftekhari & Ruzek, 2012). Therefore, a trial of exposure therapy with Mr. Levy should yield positive outcome as used with other veterans with PTSD. Treatment outcome of exposure therapy teaches the client about his/her human resilience, strength, and courage in the face of adversity (Zoellner, Feeny, Bittinger, Bedard-Gilligan, Slagle, Post & Chen,2011).References:Fisher, M. A (2016). The Ethical ABCs of Conditional Confidentiality. In Confidentiality Limits in Psychotherapy: Ethics Checklists for Mental Health Professionals. (pp. 13-25). Washington, DC: American Psychological Association. doi: 10.1037/14860-002. Retrieved https://class.waldenu.edu/bbcswebdav/institution/USW1/201970_27/MS_NURS/NURS_6640_WC/readings/USW1_NURS_6640_Fisher_Chapter_1.pdfJoseph, J. S., & Gray, M. J. (2008). Exposure therapy for posttraumatic stress disorder. The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention, 1(4), 69-79. Retrieved from http://dx.doi.org/10.1037/h0100457Laureate Education (Producer). (2013c). Levy family: Episodes 2 [Video file]. Baltimore, MD: Author. Marksberry, K. (2017, January 04). Take a Deep Breath. Retrieved from https://www.stress.org/take-a-deep-breathNational Center for PTSD. (2013, August 15). PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23015579Whitworth, J. W., Craft, L. L., Dunsiger, S. I., & Ciccolo, J. T. (2017). Direct and indirect effects of exercise on posttraumatic stress disorder symptoms: A longitudinal study. General Hospital Psychiatry, 49, 56-62. doi: 10.1016/j.genhosppsych.2017.06.012PTSD Treatment Basics. (2018, August 08). Retrieved from https://www.ptsd.va.gov/understand_tx/tx_basics.aspWheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.Zoellner, L. A., Feeny, N. C., Bittinger, J. N., Bedard-Gilligan, M. A., Slagle, D. M., Post, L. M., & Chen, J. A. (2011). Teaching Trauma-Focused Exposure Therapy for PTSD: Critical Clinical Lessons for Novice Exposure Therapists. Psychological trauma: theory, research, practice and policy, 3(3), 300–308. doi:10.1037/a0024642

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