Case Study - Rhonda Rhonda is a 28-year-old woman who has been referred to your agency by a local probation officer. Rhonda reported that she has "fired" three counselors in the past and most recently was "kicked out" by her counselor at a local community agency. Rhonda stated that the reason she "fired" her previous counselors is that they were "clueless and didn't get me." She states that she thinks her most recent counselor "kicked me out because I threatened to kick his ass if he didn't back off." You note that she is smiling as she reports the threat she made to the previous counselor. She then lets you know that she is currently on probation for substance use and her "anger issues." Rhonda states that she is looking for a counselor who can "handle my past and actually knows how to help me get over it." Rhonda then proceeds to tell you she had 19 surgeries before the age of 10 to resolve a genetic heart defect. She reports that she continues to be under the care of a cardiologist because her heart condition will continue to be an issue throughout her life. Rhonda reports experiencing significant anxiety whenever she drives by a hospital or has to go into a hospital to visit friends. FAMILY HISTORY During the first 10 years of Rhonda's life, she was sexually abused by a neighbor. Rhonda reports that she was also sexually abused by her sister during the same period and continuing until her sister moved away to college. Rhonda was 16 years old when the sexual abuse from her sister stopped. Rhonda disclosed to her mother the abuse she experienced from the neighbor and her sister shortly after the neighbor was charged for sexually abusing another child in the neighborhood. Rhonda's mother stated that she did not believe Rhonda's sister had abused Rhonda because "I'm a good mom and I would know if anything like that was happening under my roof." However, her mom did believe Rhonda's disclosure of sexual abuse by the neighbor, but felt that there was no need to report Rhonda's abuse when the neighbor, who had already being charged for abusing a different child in the neighborhood, would be going to jail in any case. Rhonda states that her relationship with her mother has been "hot and cold" ever since Rhonda disclosed the abuse. She also reports that she is unsure whether her father is aware of the abuse she endured from the neighbor and her sister; Rhonda never disclosed this information to him directly, but she suspects that her mother would have told him. The family never discussed Rhonda's disclosure of sexual abuse, and Rhonda doesn't know whether anyone ever confronted her older sister about the abuse. To date, Rhonda has never talked with her sister about it, and avoids most family gatherings that she expects her sister will attend. Rhonda states that she regularly gets high if she finds herself at family gatherings that her sister is attending. Rhonda reports that she continues to have flashbacks of different episodes of abuse. She identifies her heart surgery scars as a trigger. She states that when her scars are touched by anyone, including herself, she gets flashbacks of the sexual abuse by her neighbor because his large hands would brush over her scars when he was fondling her breasts. She also identifies the smell of a particular lotion to be a trigger of the abuse she endured from her sister. She states that she is still unable to tolerate the smell and texture of any lotion and has never bought a bottle of lotion as an adult.

CURRENT FUNCTIONING Rhonda is currently unemployed but is looking for a job. She reports that she has a difficult time maintaining employment because she moves around a lot. When asked what causes her to move around a lot, she reports that she has had a few relationships (six in the last year) that did not work out well and that she was living with each of them at the time of the breakups. Rhonda states that she is currently "trying on" being a lesbian because she believes that "women are more understanding than men, so maybe a woman would get me better and not leave me." Rhonda reports that she struggles to manage her money or maintain any relationship, stating that "most people in my life end up leaving me." When asked what she has been working on with previous counselors, Rhonda states that she has been working on different coping skills. In the past, Rhonda would burn herself or get high when her trauma was triggered. She states that she now tries to engage in deep breathing and relaxation techniques, but "they aren't as effective as burning myself." Rhonda does report a history of suicidal ideation and identifies that she typically will feel suicidal when her romantic relationships are ended by the other person. Although Rhonda reports a history of suicidal ideation, she reports no attempts to take her life. Rhonda is attending counseling as compliance with probation. She is currently working on her substance abuse issues with another counseling agency. Rhonda is coming to your agency with the hopes of working on her past sexual trauma. She states that she believes sexual trauma is the root of her anger, relationship problems, and substance abuse issues. She believes that if you can just "make the bad stuff in my past go away" she will be able to get off probation and stay out of trouble. Questions (use relevant citations where necessary) 1. What are your diagnostic impressions? 2. Based on your diagnostic impressions what is your diagnostic conclusion? In other words, what is the complete DSM 5 diagnosis? 3. What therapeutic interventions would consider using with Rhonda? Why? 4. As a vocational rehabilitation counselor, what are some challenges you might experience in working with Rhonda, to help her attain gainful employment? 5. What reasonable accommodations will this individual need to maintain employment? Extra credit Question (5 points) - do your research before answering this question. Cite your references appropriately. 6. Based on your current state laws and professional ethical code, what are you legally obligated to do in term of reporting the past child sexual abuse? What are you ethically obligated to do in terms of reporting the past child abuse?