Olivia Benson’s Clinical Case Study and Treatment Plan
Author’s Note: This is my final paper for my Therapeutic Techniques and Counseling class. We had to write a case study on a fictional character and then create a realistic treatment plan for them. This piece contains in-depth descriptions of PTSD, its symptomology, Olivia Benson’s symptoms, and her trauma. Trigger warnings abound for abuse, alcoholism, sexual assault, and kidnapping. If you need something lighter from me, my Disney publication is here:
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Olivia “Liv” Margaret Benson is a 54-year-old single mother from New York City. She was raised as an only child by her mother, Serena, in New York City. However, she later discovered she had a half-brother, named Simon. Olivia and her mother had a toxic and abusive relationship. She is a product of rape. The circumstances of her birth both meant that her mother’s rapist was not in her life and that Serena was traumatized. Serena’s trauma led to her becoming an alcoholic and being physically and verbally abusive to her only child. This trauma affected Olivia in the beginning of her career. As a teenager, Olivia was deeply in love with and engaged to one of her mother’s students. When Serena found out, she attacked her daughter with a broken liquor bottle, forcing Olivia to flee the apartment. Despite her addiction and abusive behavior, Serena maintained a successful career as an English professor for much of her adult life and was extremely intelligent. So too is her daughter. Olivia speaks five languages-Hungarian, English, French, Spanish, and Italian. She uses this skill frequently at work. Ms. Benson is a highly decorated and passionate police captain at the New York City Police Department (NYPD), She has been a police officer for 22 years. In that time, Ms. Benson has worked her way up from detective to squad captain (“Olivia Benson, 2022).
After college, Olivia trained at the NYPD police academy. She was hired onto the force in 1992. In 1999, she began working as part of Manhattan’s Special Victims Unit (SVU), dealing specifically with violent personal crimes such as rape, child abuse, domestic violence, and incest. This is her passion, and she is phenomenal at it. Her work has led directly to a fulfilling career, strong and loving friendships, the adoption of her only son, Noah Benson, and a deep and abiding passion for victims’ advocacy work. However, it has also been difficult to handle and has led to the development of Post-Traumatic Stress Disorder (PTSD) (“Trauma-Informed Care in Behavioral Mental Healthcare” 2014).
Serena Benson-Olivia’s mother died early on in her career. Her best friend, Alex Cabot, had to go into witness protection, which caused Olivia and the rest of the squad to believe she was dead for months. For all of her life, Olivia was under the impression that she was an only child. However, she later discovered she has a half-brother, Simon. While she attempted to build a bond with Simon, he was repeatedly involved in criminal activity. Eventually, Olivia set a boundary and decided she could not have him in her life. Simon was murdered soon afterward. She initially blamed herself. However, the most traumatic events for Olivia remain her experiences of sexual assault.
In 2008, Olivia went undercover at Riker’s Island to investigate a rape case involving inmates. While undercover, Olivia was sexually assaulted by a correctional officer and subsequently developed PTSD. One of her close friends Finn was undercover with her and rescued her (Wolf, Goffman, et. al, 2008). The following year, she began experiencing flashbacks, nightmares, hyper-vigilance, and other symptoms and began attending group therapy for rape survivors (Wolf, Denoon, et. al, 2008). Olivia also experiences dissociative episodes (Wolf, Leight, Martin, et, al 2013).
In 2011, one of the survivors Olivia had previously advocated for made her the temporary guardian of her son, Calvin. Calvin and Olivia bonded for several months until his mother revoked Olivia’s guardianship and sent Calvin to live with his grandparents (“Olivia Benson”,2022)
In 2013 and 2014, Olivia worked on the case a serial rapist/murderer named William Lewis, Lewis liked to kidnap, rape, and torture his victims (Wolf, Leight, & Martin et. al, 2013). She became wrapped up in the case and made it her mission to stop Lewis. He eventually broke into her Manhattan apartment, and kidnapped, drugged and tortured her for several days. Olivia was eventually rescued by her squad. Although Lewis tried to assault her, he failed (Wolf, Leight, & Martin et al, 2013). Olivia suffers from flashbacks, sleep disturbances, hypervigilance, occasional nightmares, and panic attacks (Wolf, Leight, & Martin et al, 2013). Her symptoms affect both her work and her personal life. Her trauma involving serial rapist/murderer, William Lewis lasted for a total of seven emotionally taxing and intense Manhattan SVU cases (Raga, 2020). I believe Olivia’s trauma to be complex, given her history (Raga, 2020). She saw another therapist regularly prior to seeking treatment with me
In 2014, Olivia became the legal guardian of Noah Porter, who was abandoned in a house used for sex trafficking as an infant. His biological mother was a trafficking victim. Olivia formally adopted Noah the following year (“Olivia Benson”, 2022). She seems to be a doting and compassionate mother who would do anything for her only son (“Olivia Benson”, 2022).
While on a day out with his biological grandmother, Noah’s biological grandmother, Shelia, kidnapped him. Olivia had to rescue him and subsequently arrest Shelia. This obviously made Olivia’s hypervigilance that much worse (“Olivia Benson,” 2022).
For the first 12 years of her career at SVU, Olivia’s partner was Detective Eliot Stabler. She has called Eliot “the most stable man in her life” and was devastated when he left the SVU squad. She has some strong romantic feelings for Eliot but has never acted on them. She and Eliot are still extremely close and remain best friends. After Eliot left, she and Detective Nick Amaro were partners for a few years.
Olivia has dated several men over the years, including co-workers. While she’s had some loving and caring relationships, her work often gets in the way of the rest of her life. Olivia is close with several work friends, including Amanda, Sonny, Finn, and Kat. Her squad has become a loving “found family”, and they trust each other immensely. She is still close with several former co-workers including Rafael, Alex, and Miranda. Through these close friendships, she is supported and finally feels a sense of trust and safety among this “chosen family” her NYPD squad has built. They know the trauma she has endured and fully support her seeking mental healthcare services.
I am recommending Dialectical Behavioral Therapy for Liv. DBT is highly recommended for survivors of trauma, and I believe it will be immensely helpful as she continues to heal. In a 2013 study, Bohus and his colleagues found that 40% of women with PTSD resulting from sexual abuse responded well to DBT treatment specifically geared toward PTSD versus a control group (Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N., Schmahl, C. & Steil, R. , 2013).
I am recommending DBT instead of something similar such as behavior therapy or cognitive behavior therapy (CBT) because I do not think those treatment modalities would be appropriate for Liv. Behavior therapy focuses on what can be done to change a client’s behavior. CBT focuses on how thoughts lead to behavior. Both tend to break down existing coping mechanisms, That is not appropriate for Olivia, She needs to build coping skills and build up her ability to tolerate distress. Breaking down existing coping mechanisms without helping her build healthy ones is totally irresponsible.
My plan for Olivia includes both individual DBT and trauma-focused talk therapy and DBT-focused group therapy. DBT stands for Dialectical Behavioral Therapy. DBT was developed by Marsha Lindham in 1993 as a treatment for borderline personality disorder (BPD), However, this therapy has widespread applications for the treatment of multiple diagnoses, and is particularly effective for trauma survivors (Tull, 2020).
DBT has four core elements: distress tolerance, mindfulness, emotional regulation, and interpersonal effectiveness (McKay, Wood, & Brantley, 2007). Distress tolerance will give Olivia the ability to calm herself down in the moment. Mindfulness will help her build on positive experiences and stay in the present moment. Emotional regulation will help temper the often-overwhelming emotions that accompanies PTSD, Interpersonal effectiveness addresses the way PTSD can affect relationships with loved ones. These skills also include what is called “radical acceptance” which involves fully and totally accepting things as they happened.
Distress tolerance involves teaching a client to self-soothe by helping them create a personal distraction plan and figure out what pleasurable activities they are willing to do to help themselves relax and distract and ground themselves. Distress tolerance helps people “cope better with painful events by building up resilience and giving…new ways to soften the effects of upsetting circumstances (MCKay, Wood, & Brantley).” These “pleasurable activities” can be anything from talking to a friend to booking a vacation, and anything else the client can think of that they can do or think of in the moment to mitigate distress (McKay, Wood, and Brantley, 2007). Distress tolerance skills are helpful for both mitigating self-destructive behaviors and helping clients ground themselves. Grounding techniques are helpful in helping clients to stay present in the moment. This will be helpful for Olivia’s dissociative episodes and flashbacks (Wolf, DeNoon, et al, 2008). Olivia also experiences dissociative episodes (Wolf, Leight, Martin, et, al 2013).
Mindfulness, also known as meditation, can be helpful in mitigating many unpleasant symptoms of PTSD (McKay, Wood, & Brantley 2007). Studies have shown it to be helpful for depression, anxiety, and chronic pain (McKay, Wood, & Brantley, 2007). This can be helpful for grounding clients and helping the client stay “in the moment.” Mindfulness can help people “…experience more fully the present moment while focusing less on painful experiences of the past or frightening possibilities of the future. Mindfulness also builds “tools to overcome habitual negative judgments (McKay, Wood, & Brantley, 2007).”
Emotional regulation will teach Olivia how to temper and manage overwhelming emotions. Emotion regulation helps people recognize emotions without being overwhelmed by them. “The goal is to modulate … feelings without behaving in reactive or destructive ways (McKay, Wood, & Brantley, 2007).” This could help Olivia get control of her emotions in high-stress situations. She is not an angry person by nature. However, she has a long history of becoming emotionally involved in cases. To the point that she will volunteer for dangerous undercover work because she so strongly believes in getting justice for victims (Wolf & Goffman, 2008). At one point, Olivia’s PTSD was triggered after the first assault. She had a flashback and subsequently held a suspect at gunpoint (Wolf & McCreary, 2008).
Interpersonal effectiveness helps develop “new tools to better express … beliefs and needs, set limits, and negotiate solutions to problems-all while protecting … relationships and treating others with respect (McKay, Wood, & Brantley, 2007).” Interpersonal effectiveness works on personal relationships, which can be greatly impacted by PTSD.
My goals for Olivia are for us to determine which of her symptoms are most distressing and why. I also want to know what she finds comforting. This will help determine what her triggers are and how we can best lessen their impact. This can also help us to begin understanding what distress tolerance skills would work best for her. Distraction and grounding techniques vary from person to person. I would encourage her to keep a journal and stay connected with her close-knit work family and continue group therapy. I would also suggest she work on her relationship with work as it is a consistent trigger for her. Given how consistently she is triggered, it might be time for her to seek justice for survivors of violent crimes in a safer way.
In DBT therapy, the therapist acts as a guide and a teacher, guiding clients through each skill one step at a time. This helps clients become more familiar with the implementing a new set of skills
This treatment follows the APA Ethics Code guidelines. (American Psychological Association, 2022). DBT is an intense form of therapy that often involves worksheets, workbooks, and other materials. As such, everything is thoroughly explained to each client, and clients are encouraged to ask questions and have a direct approach to this form of therapy. Every step of DBT is thoroughly explained and consented to (APA Ethics Code 4: 01).
Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N., Schmahl, C., … & Steil, R. (2013). Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: a randomised controlled trial. Psychotherapy and psychosomatics, 82(4), 221–233.
McKay, Matthew, PhD, Wood, Jeffrey C. PsyD.& Brantley, Jeffrey, MD. (2007). The Dialectical Behavioral Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & Distress Tolerance. New Harbinger Publications
Raga Pippa. (2020). Was Olivia Benson Ever Raped? A Timeline of Her Trauma. 7 February 2020. Distractify. www.distractify.com https://www.distractify.com/p/was-olivia-benson-raped
Trauma Informed Care In Behavioral Healthcare PTSD Diagnostic Criteria (2022). www.ncbi.nlm.nih.gov https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/
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