For this Discussion, you will analyze a case in w
For this Discussion, you will analyze a case in which a returning soldier, who is also a husband and father, experiences mental health symptoms resulting from combat.
To Prepare:
- Review the Learning Resources on psychological aspects of young and middle adulthood, psychoeducation, and military populations.
- Access the Social Work Case Studies media and navigate to Marcus.
- As you explore Marcus’s case, consider the ways in which the social environment, including the trauma he has experienced, has impacted Marcus’s psychological functioning.
Post an analysis of how the social environment has contributed to Marcus’s psychological functioning. In what ways has trauma impacted Marcus’s daily functioning? Describe how you as the social worker would integrate elements of psychoeducation with Marcus and his family. How would you adapt psychoeducation for the cognitive level of the family member?
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© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social
work case studies: Foundation year. Laureate International Universities Publishing.
Marcus
Marcus is a 28-year-old, African American male who recently returned to his hometown
after having served in multiple deployments in both Iraq and Syria. Marcus lives with his
wife, Tamika, and their 5-year-old son, Jayson. While serving overseas, Marcus was
exposed to combat and to blasts from three explosions caused by improvised explosive
devices (IEDs). As a result of his experiences, Marcus sustained several physical
injuries, including wounds from shrapnel released by the IEDs, a mild traumatic brain
injury (TBI) in the form of a concussion caused by being thrown from a blast site after an
explosion, and mild hearing loss in one ear that does not require the use of a hearing
aid. Marcus’s physical wounds had healed completely at the time of his discharge.
Marcus joined the military immediately after his graduation from high school and
planned to begin working at least part time while studying for an associate’s or
bachelor’s degree after his honorable discharge from the U.S. Army. Marcus sought
mental health treatment with me because he “felt different” after arriving back home
from military duty. Marcus reported that he was having difficulties adjusting to domestic
life and found it hard to feel emotionally connected to his wife, though he knew that he
loved her. Similarly, Marcus felt that he had difficulty being an attentive father to his son.
Marcus also reported that despite his goals for continued employment and education,
he could not motivate himself to look for a job or enroll in courses at the local
community college and spent most of his days sitting on the back porch of his home
smoking cigarettes, “staring into space,” and remembering violent scenes from his
combat experience. Additionally, Marcus was having difficulty sleeping due to
nightmares, had lost weight because of a general loss of appetite, had an increasingly
“short fuse” with his family, and reported that he felt constantly nervous and “on edge,
like something is going to blow” inside him.
Treatment
Strengths and Goals
Marcus came to treatment with several strengths, including the ability to identify his
symptoms and their effect on his life, his strong connections to his family, vocational
and educational goals, and the ability to work well within structured environments under
a great deal of pressure, as evidenced by his successful wartime military career.
Marcus reported that his goals for treatment included being able to be a more active
husband and father, to stop thinking so much about his combat experiences, and to
reengage in working and going back to school.
Neurological and Physical Evaluation
Because Marcus has a history of mild TBI, I referred him to a neuropsychologist for an
evaluation to rule out cognitive and/ or behavioral complications that could be attributed
to his past concussion as well as to a general physician to be sure that there were not
any undiagnosed medical conditions exacerbating Marcus’ symptoms. After determining
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© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social
work case studies: Foundation year. Laureate International Universities Publishing.
that there were no physical complications and no detectable ongoing symptoms of the
TBI, the neuropsychologist diagnosed Marcus with post-traumatic stress disorder
(PTSD) and referred him to a psychiatrist for an evaluation for medication. Marcus was
prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant and began
taking the medication as directed as soon as the prescription was filled. After several
weeks, Marcus reported an increased ability to sleep through the night as well an
increase in his ability to concentrate and improved appetite during the day.
Cognitive Behavioral Therapy
To address his other symptoms, including emotional numbing and intrusive memories of
his combat experiences, I employed both cognitive behavioral therapy (CBT) and
exposure-based treatment. The CBT was used to help dismantle negative and irrational
thoughts that fueled Marcus’ symptoms. For example, Marcus reported a negative belief
that if he had been a better soldier, other soldiers would not have died during IED
explosions. Treatment focused on helping to replace these negative cognitions with
more positive, realistic cognitions, such as “I did the best work I possibly could as a
soldier, even when I couldn’t control everything.” Exposure therapy was used to reduce
the intrusive thinking about combat experiences. Marcus used a special computer
program that exposed him to scenes typical of what he experienced during his
deployment, including events involving IEDs. Marcus could control how much of the
scenes he watched and worked on reducing the amount of psychological and physical
arousal that exposure to these scenes caused. Additionally, I referred Marcus to
resources in the community tailored for veterans and their families.
After 6 months of treatment occurring twice weekly, Marcus reported that he was having
significantly less conflict with his wife and was able to connect to his loving feelings for
her and enjoy spending time together as a couple. Marcus was also able to spend more
time with his young son without losing his temper or getting frustrated as quickly. In
addition, Marcus reported significantly improved concentration, the ability to sleep well
nearly every night, as well as a marked decrease in intrusive thoughts and enhanced
coping skills for managing the intrusive thoughts when they did occur. By the end of his
treatment, Marcus had also obtained a part-time job working as an accountant’s
assistant and had enrolled in two business courses at the local community college. In
addition, he had begun to volunteer, running a social group for veterans and their
families at his local church, and was enjoying the social and spiritual support he
received. He reported that he saw a future for himself in a life outside of the military and
felt that he could forge a productive place for himself in the community.
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