Case Study Blaine

Identification of Issues and Problems Before finishing the initial session, I make sure to ask questions about present or historical suicidal thoughts and attempts. Blaine indicates that he is not suicidal and that he has no intentions of hurting himself or others. I explain to Blaine that I want to request his previous records from the VA and get a chance to look over them. Further, I let Blaine know that I would like to be a fellow traveler with him on a journey of self-discovery and he accepts the invitation. I schedule his next appointment one week from the intake appointment and let him know that by that time I will be able to go over his VA records then, meet with him and discuss the choices he has. Blaine's VA records are sent to

In assessing Blaine I am able to pick out key themes that go beyond a simple diagnosis of PTSD. From his own description, Blaine is informing me that he struggles with feelings of guilt and shame as a result of his deployments and the traumatic experiences he had. Moreover, Blaine has voiced his existential struggles using language such as, “determined to be a certain way,” “[a]nd what for,” and “I just feel so alone”. I recognize the verbalization's as Blaine's struggle with the existential givens of life and his need to find meaning.
Rationale for Applying Existential Therapy and Description of Techniques From the initial appointment with Blaine, I am able to understand his resistance to the Behavioral approaches and medicine. Although there is plenty of evidence-based research indicating the effectiveness of these methods, there is still controversy surrounding the comparative effects as established by research (Stein, Ispect, & McAnda, 2009). Further, a systemic review and meta-analyses conducted by Lee et al. (2016) indicate that trauma-focused therapies should be the preferred first-line intervention to treating

The idea behind Paradoxical Intention is to get the person to do exactly what they are afraid of. Explicitly, Blaine's inability to sleep induces what Smith (2012) terms “Anticipatory Anxiety”. Therefore, I would challenge Blaine to attempt, instead of falling asleep, to see how long he could go without falling asleep. From this perspective, the Anticipatory Anxiety that keeps Blaine from sleeping would instead allow him to fall asleep as a result of alleviating his fear (Smith, 2012). According to Smith (2012) Frankl's (1988, 2006) technique of Paradoxical Intention has been shown to be effective in allowing those with military-related PTSD to get the requisite sleep while avoiding the use of medication. As an additional benefit of this application, this technique may also help with Blaine's use of alcohol to induce