Psychotherapy for post-traumatic stress disorder in a young rape survivor: A case study

Abstract

This paper describes the psychodynamic psychotherapy of a 20-year-old African woman with post-traumatic stress disorder (PTSD). ‘Mphumi' entered therapy a year after her father's friend had repeatedly raped her. The paper documents the process of therapy and uses the case material to examine theoretical issues relevant to the treatment of PTSD. First, Horowitz's (2001) theory is used as a basis for arguing that a histrionic personality style predisposed her to an extreme degree of denial and dissociation, which prevented her from processing the trauma at a cognitive or emotional level and contributed to the entrenched PTSD. It was only after she had suffered a breakdown, which necessitated hospitalisation, that her resistance to processing the trauma was overcome. Second, the case material is used to show how other significantly disturbing events earlier in her life shaped her response to the rape and to examine the extent to which effective processing of the current trauma calls for the acknowledgement and working through of earlier traumas and losses. Finally, the case narrative shows how the treatment of PTSD is of necessity a slow, complex process which takes into account the individual's unique history, idiosyncratic vulnerabilities and socio-cultural context.

Keywords: post-traumatic stress disorder, psychodynamic psychotherapy, rape, South Africa

Journal of Psychology in Africa 2005, 15(2): 177–184