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The Peterson house on May 5th 2007 took the initiative to gain therapeutic services for their troubled son David. Throughout the therapeutic process, all house members became actively involved. Three customary house therapeutic approaches for treatment were eventually chosen by the therapist with the application of three interventions within each approach. The approaches included; Cognitive Behavioral approach, record Based Therapeutic approach, and a Psychoeducational Therapeutic approach. These purposely chosen constructs were applied to the Peterson house ideas and with their help the Peterson house was able to assist their son David with his behavior issues.
Agency Context
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The current agency, in which the Peterson house sought assistance, was the Summit Agency. Summit is an inner city branch settled within the college district of Philadelphia. It is a high end branch that specializes in helping families and individuals with problematic behaviors and circumstances. Much of the clientele within the Summit branch could be considered mid to upper class. The branch is primarily funded by direct payment from clients who are seeking extremely considerable PhD. And Masters level clinicians to assist with their house issues and by private donations given by local university professors and staff.
Presenting Problem
The presenting qoute agreeing to the Peterson house has been clarified by Mr. And Mrs. Peterson as the behavior of their 16 yr. Old son David. For the last two months David has been acting out in school and been disrespectful at home. Rule breaking, disrespecting teachers, and detentions have remained consistent parts of David's behaviors. This type of behavior for the Peterson house is unacceptable and has resulted in the Peterson house seeking assistance for their son's behavior. Mr. Peterson worries that if David's behavior continues, many may think that David is a real issue maker; thus effecting his schoraly life and possibilities of going to college in two years. Mrs. Peterson is involved about her son and wants his negative behaviors to cease. She feels that when he acts out in school this causes tensions within the household; especially in the middle of herself and her husband. Both Mr. & Mrs. Peterson seem to agree that they argue more and have greater difficulties on the weeks and days in which David gets in the most trouble. In sessions, David makes statements like, "I don't care about school, because you guy's don't indeed care about me." David, in session seems angry. He seems to be very sensitive and seems to desire more attention and time with his parents. He states that he believes no one listens to him and that the only reason he is at the Summit Point branch is because his mom & dad just want to change him. Both, Mr. And Mrs. Peterson want David to just behave at school and at home in order for him to fetch a good schooling and be regarded as a good young man. David states that if his parents would not work so much, he may have some time with them, and not feel so lonely. David also states that when his parents are angry, they seem to take things out on him; thus production him more frustrated and angry.
Demographics
Mr. Peterson is a 50 year old white male. Mr. Peterson is an educated man with a PhD in literature from the University of North Carolina, for which he takes great pride. Mr. Peterson could be described as having an opinionated egocentric personality, quick witted, and some how seems to rejoinder with some type of literary quote within every response to house and friends. Mr. Peterson does not emphasize a religious preference or identity and could be considered one who maintains an upper middle class life style. Although Mr. Peterson has published a few literary works, none have been significantly successful, and this seems to be a source of pain and loss of self esteem for Mr. Peterson.
Mrs. Peterson is a 46 year old white female. Mrs. Peterson also graduated from the University of North Carolina with a PhD in literature. Mrs. Peterson seems to be a smart, pleasant someone that makes references to having hobbies; such as playing tennis, biking and shopping. Mrs. Peterson does not enounce a religious preference, but does say she believes in God. Mrs. Peterson has published two novels and takes great pride in their success.
David is a sixteen year old white male. He has no history of thinking illness or paramount behavior problems. David attends high school within the tenth grade at Highland High School. David does not think himself to be a religious person, but does love the most recent Eminem Rap Cd, loves to skate board, draw, and enjoys watching nightmare movies. David does seem to be a sensitive young man, and at times makes efforts to express his feelings and clearly express any noticeable changes to pictures and other items within my therapeutic office; thus indicating a heightened sense of observational ability.
Treatment Plan
The current treatment plan (see figure 1.1) consist of one customary goal and intermediary objectives straight through a Cognitive advent to assist in modifying David's current behavior issues. Thus far, over the past month and a half I have met with the Peterson house every week and attempted to assist David and his house with these objectives and goal with no progress. I believe that with the current facts I can form suggestions, and edify my practice by linking new strategies and intervention objectives from house therapeutic approaches to assist in solving David's difficulties.
Goal: To decrease David's problematic behaviors
- Send home weekly improve report
- When David receives poor behavior reports he is grounded from skate boarding and other activities he enjoys
Figure 1.1
The current recommendation and decision to link house therapy approaches to this condition is to assist with considerable issues. In retrospect, the interventions although practical, settled much of the responsibility and process upon David rather than a house oriented intervention. It was found that many times David would not even bring home his weekly improve reports for review. It was also founded that the use of negative reinforcement strategies was not productive due to David's already tattered self image. After supplementary interactions with parents it was discovered that they rarely complimented David on what he does right, and they admitted to criticizing him at times. With this facts I believe that it would be wise to now couple a obvious reinforcement plan that would assist with promoting good behavior and expanding self esteem. I feel that suggesting the use of strategies to assist with David's parents in regards to their relationship and the scape goating behaviors David describes may be beneficial. I believe that David's parents would also advantage by gaining parenting skills and education. The prior treatment plan did not allow David to palpate for himself the roles of others or allow him to identify thought and feeling patterns. I believe that with the comprehension of David's personality and his obvious brain and sensitivity, utilizing strategies that assist with thought identification may be beneficial. The newly suggested treatment plan is as follows;
Goal One: To decrease David's problematic behaviors
- To growth David's awareness of how his behavior affects others
- To assist David in identifying thoughts, feelings, behaviors, beliefs
- To assist David's parents with great parenting and relationship skills
Figure 1.2
Strategies for change - Cognitive Approach
During session discussion I would ask David, how he thought his behavior at school made others feel and what impact his behavior had on others. After his response I feel that the "Critical Moment" Cognitive Behavioral advent intervention that I learned at the University of Michigan School of communal Work may be productive (Personal Communication, R. Tolman, October, 2006). I would suggest that a role play should be utilized with David and his parents. I would ask David to identify any time or condition in which he interacted with a instructor negatively and when the interaction ended with a negative consequence for David. The condition I would ask of David must have ended with him thinking that he should have responded differently. I would ask him to express to all of us his detailed story from starting to end. After he expressed his story I would ask David and his parents if there were more obvious responses David could have utilized that were not disrespectful. David and his parents would have good ideas about what David's response could have been and they would share these ideas. After sharing their ideas, I would ask that David play the role of the teacher, and I then ask his father to play the role of his son David. I would ask David's father to make sure that in his response, as he acted like David that he would contain the newly agreed upon obvious response. As both would act out the role play, David would state the words of his instructor within the past interaction and his father would do his best to repeat what David had stated was spoken while the interaction, except for the expanding of the obvious statement that David should have said. After the role play, I would ask a role reversal. This time David would play himself, stating what his father had stated with the obvious response attached to his interaction. His father would play the teacher, and at the windup David would hopefully begin to understand both roles of those involved. It is hypothesized that this role reversal may change David's perceptions.
The second intervention that I believe would be helpful in allowing David to identify his thoughts and feelings and how they succeed his behavior would be to utilize while the session a dry erase board in order to draw the "circle of identification" (Becvar & Becvar, 2000). This circle could indicate the process of thoughts, feelings, and behaviors. I feel that the utilization of this type of intervention may work well, considering the known facts about David's love for drawing and optic acuity. I would suggest to David to express a time when he was disrespectful or acting out against his parents or teachers. That specific part would be the focus in which we would identify his thoughts, feelings and behaviors to that circumstance. As a therapist I believe that as we identify his thoughts and feelings while this part and address whether or not they were obvious or negative, or whether they were realistic or distorted; at the town of David's response could lie schemas about himself and others that may not be salutary or functional for his life. It will be the goal of this intervention to address those negative schemas that may be assisting in negative responses, and purposely inserting obvious collaborative thoughts created within our sessions.
Due to suspected negative reciprocity and the improvement of negative schemas within the house system, about David's consistent behaviors, it would seem to be useful to utilize a third cognitive approach. I feel that it may be useful for the Peterson house to utilize a thought, feeling, and behavior journal for all members in the house (Becvar & Becvar, 2000; Lawson & Prevatt, 1999). It would be expressed to the house that on each page of the journal there should be two headings; "What did David do today", and "How did I feel about what David did today." I believe that this could allow the house over a estimate of sessions to come to a realization of how they are perceiving their son, and how David perceives himself in a qualitative manner. Identifying these schemas, thoughts, and feelings may be useful for assisting in cognitively reconstructing the house systems perception and expectations of David's behavior.
Narrative Approach
It could be suggested that in an exertion to speak about the behaviors within sessions one should seek to reduce parental "problem saturation" about discussions of David's behavior (Lawson & Prevatt, 1999). It could be hypothesized that due to the constant commentary and negative perceptions that David's parents have expressed about his behaviors, utilizing an externalization technique would be useful (Lawson & Prevatt, 1999). As the therapist I should ask two sets of questions; questions relating to how house members feel about David's behavior and after a series of questions about the families reactions to David's behavior I would ask the parents if there was ever a time in which David did not act disrespectful or behave in a negative manner (Prevatt & Lawson, 1999). All house members could then begin to identify the negative behaviors as external events in which they could seek to collaborate and work against (Prevatt & Lawson, 1999). This would seem to be an productive intervention, especially for David who has been indicated as having low self esteem and has been identified as maybe being the scape goat within the house system.
After a thorough expression of separate perspectives over a estimate of sessions, as the therapist I would suggest to the parents to write a letter to their son. Within the letter I would ask them to express their commitment to helping David. I would express to the parents to write obvious statements of affection for David and let him know that they validate his feelings. This would lend to decreased fault finding and negative reciprocity (Lawson & Prevatt, 1999). This process I believe would assist David in reducing his feelings of isolation and enhance his commitment to working against the externalized problems.
Furthermore, a third intervention that may be productive would be for myself as the therapist to write a final letter of prediction (Lawson & Prevatt, 1999). This letter would be written in a way that expressed a strengths base perspective and a obvious message of hope in regards to house commitment and David's behaviors.
Psychoeducational Approach
As the therapist I would pursue concepts and processes consistent with educating the Peterson family. I would identify concepts that may be productive considering the educational level of the parents and David, as well as the families strengths and capability to utilize qoute solving and transportation concepts (Becvar & Becvar, 2000). considering the suspected scape goating behaviors of Mr. And Mrs. Peterson, I feel that teaching Mr. And Mrs. Peterson great ways of communicating their own problems rather than projecting them upon David would be beneficial. I believe speaking with Mr. And Mrs. Peterson about active listening skills, practicing the transportation ball technique (speaker holds the ball / listener waits their turn) would allow the Petersons to work on their listening skills. I feel that this would work well for the Petersons considering their educational level and willingness to learn.
Another intervention I would implement to enhance transportation with the educational ideas would be to teach parents how to implement a home/school transportation ideas (Foley, 2007). This ideas includes maintaining a chart that is marked by teachers and parents to indicate behaviors, moods, and activities that were completed while the day (Foley, 2007). The construction of this ideas creates productive communications in the middle of school staff and parents (Foley, 2007). As the therapist I would ask the Petersons to form this ideas as instructed and then within one session evaluate the process and express the ideas to David. Emphasizing also to David that good reports will bring good rewards. Educating Mr. And Mrs. Peterson about succeed straight through and consistency about the transportation ideas would be very important.
Due to the educational levels of the Peterson family, as a therapist I would suggest interventions such as parental skills groups within the society or the use of parenting resources and educational programs within sessions. It is hypothesized that the Petersons would welcome any educational facts about more productive parenting. Recommending web sites, books (Love and Logic) and therapeutic games to enhance a child's transportation and self esteem would be possible interventions for the Peterson family. These psychoeducational interventions would assist with the third objective of the treatment plan, about the need to fetch greater parenting and relationship skills.
Conclusion
The mystery I identified within the first treatment plan was that only one advent was utilized and it was not an eclectic process with at least three approaches and multiple interventions. I believe that the eclecticism should be a priority due to the nature of the qoute and multiple systems involved. I felt as if in order to reduce David's negative behaviors the interventions should be creative, associated to qoute solving objectives and address the whole house system.
I believe that utilizing a cognitively based advent would be an important part in identifying the negative beliefs and schemas David may have about himself as the roots of his low self esteem. By expanding David's abilities in negative thought identification, David will be able to purposely insert obvious thoughts straight through cognitive restructuring (Becvar & Becvar, 2000). Gaining parental involvement with journaling may also be a overwhelming intervention, considering that Mr. And Mrs. Peterson are writers and may give tantalizing and creative reflections.
What may be a concern is that David's parents could identify externalizing a qoute straight through a record approach, as a way of David not taking full responsibility for his behavior. considering their past negative reciprocity of his behaviors and the parents' attitudes and expectations, it would be important to emphasize the significance of such a perspective.
David stated that his parents do not listen to him. Also admitted by his parents, they tend to argue more when David gets in trouble. The chosen Psycho educational advent would seem to be an productive approach. This advent I feel would assist the Petersons in gaining considerable transportation skills and greater parenting strategies for David. I feel that transportation construction strategies would assist with what David stated as "no one listens to me." considering the Petersons wage level, society work on and obvious attitude towards education, suggesting that they gain involvement in a parenting and or communications group would be an excellent intervention strategy.
I feel as the Petersons therapist that the utilization of these three approaches and selecting them agreeing to their specific condition and house dynamics that they will prove to be more effective. I feel that these approaches contain all the elements that are needed to enhance the skills and reduce the problems that were chosen by the Peterson family.
Note to Reader: All participants in this record and the branch are fictional: any relation or relationship to real circumstances is clearly coincidental.
L. J. Riley Jr. Bsw, Llmsw
______________________________________
References
Becvar, D. S., & Bacvar, R. J. (2000). house Therapy; A Systemic Integration. (4th edition). Needham Heights; Ma: Allyn & Bacon Publishing.
Foley, S. (2007) Psychological Testing for communal Workers; The Notes.
Lawson, D. M., & Prevatt, F. F. (1999) Casebook in house Therapy. Belmont; Ca:
Wadsworth Publishing.
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