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theses

This dissertation consists of the systematic, psychotherapy case study of "Leo," a 20-year-old Hispanic college junior who presented to therapy with Post-Traumatic Stress Disorder (PTSD), Major Depressive Disorder, mild, and Alcohol Use Disorder. Leo was the first Cognitive-Behavioral Therapy (CBT) case assigned to me in my first year of doctoral clinical training as part of an initial course on CBT, and treating Leo's comorbid diagnoses presented complex technical challenges. My supervision and the associated therapy in Leo's case involved two originally unplanned phases. Phase 1 (sessions 1-13) was associated with a traditional, less structured supervision model, which focused on targeting Leo's alcohol use with a generic modality of CBT that included such elements as Motivational Interviewing (MI) in order to lower the frequency of his dissociative episodes and to facilitate Leo's capacity to fully experience his emotions. Phase 2 (sessions 14-25) was associated with an emerging, more structured supervision model, which views the supervisory process as an explicit introduction to and the dedicated practice of specific interventions and skills--in this instance, those associated with Cognitive Processing Therapy (CPT; Resick & Schnicke, 1992). Specifically, this supervision targeted Leo's increased ability to fully experience his emotions by focusing on: (a) psychoeducation regarding the effects of trauma and how defensive avoidance interferes with adaptive processing of the trauma; (b) teaching Leo thought monitoring and assessing the impact of his trauma on his beliefs; and (c) using imaginal exposure to memories of his trauma in order to examine and challenge the emotions and beliefs impacted by his trauma, allowing for non-pathological re-encoding of his memories of the event. The first part of the case study briefly describes Leo's clinical situation at the end of Phase 1 and then focuses in detail upon Phase 2, illustrating the strengths of Phase 2 as a successful example of the structured psychotherapy training model in action. An analysis of the supervision and therapy in Phase 2 presents evidence that the successful resolution of Leo's PTSD immediately following treatment and at 18-month follow-up was facilitated by a number of elements in the supervision, including: (a) explicit training of the therapist in CPT prior to supervision; (b) process-oriented supervision of CPT via the microanalysis of taped sessions; and (c) continued CPT training to complement ongoing supervision

ETD_9931

Psy.D.

Includes bibliographical references

doi:10.7282/t3-wv7b-r146

ETD doctoral

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