Patient
"Lisa" is a 35 year old, single woman. She was admitted to the inpatient Trauma Program two weeks ago and is now considered stable enough for day treatment.

Diagnosis
Axis I - Major Depression, Post Traumatic Stress Disorder
Axis II - Borderline Personality Disorder

Referral
Lisa was referred for treatment in the Day Program by her psychiatrist as a transition between the structure and safety of inpatient treatment and outpatient therapy at home.

Barriers to Treatment
Lisa is fragile and at risk for possible self injury. She is dependent upon external support, lacking in ego strength, and fears potential acting out during periods of stress.

History
Lisa was in outpatient treatment for six years. This is her fifth inpatient confinement. She was first diagnosed with major depression followed by bipolar mood disorder, then borderline personality disorder, before receiving the posttraumatic stress diagnosis two years ago. Lisa is quite dependent on her outpatient therapist who she sees three times per week, and who is becoming exhausted by the demands of treating this labile and needy patient.

Course of Treatment
An integrated team approach, consisting of the psychiatrist, masters level therapists, case manager, direct care staff and Lisa, developed a treatment plan which focused on correcting cognitive errors, building ego strength and emphasizing her responsibility for her own behavior. The patient received individual therapy three times per week and was able through that modality to improve her functioning to the point that she was ready for discharge. Self esteem was especially helped by group therapy, which improved Lisa's self confidence and problem solving abilities. Cognitive therapy groups helped Lisa recognize distortions in her thinking. Anger management groups helped Lisa learn to release her anger in healthy ways rather than to turn it inward. Life skills calss and trauma education group increased Lisa's knowledge of her defenses and coping strategies and improved her general level of functioning. The program's "no self harm" policy motivated Lisa to maintain her safety and built confidence in her ability to do so.

Discharge
The Trauma Program's confrontive, yet supportive style, offered Lisa a chance to move from supervision to independence. It helped her find and use the strength within her to set and meet treatment goals and to begin setting and working toward real life goals. Lisa's outpatient therapist and psychiatrist were regularly informed of her progress. Upon her return home, Lisa was scheduled to see her outpatient therapist twice weekly. With the help of Trauma Program staff, limits were set on phone calls between therapy sessions. Lisa enrolled in college part-time and began working a few hours each week.

The above patient information is a composite of patients treated in the program.