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 soc

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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.