My client currently receives cognitive behavioral therapy, however, how we can we assist her to change the way that she thinks, when her each day of her life is filled with a negative encounter? Cognitive behavioral therapy alone is not enough, this client and other clients like her need for trauma sensitive information, and family issues to be addressed. If the family does not know how to express themselves, or have never grieved or coped with recent losses or instances, then TF-CBT would be able to assist with building and utilizing appropriate coping skills, and with learning about how to grieve appropriately.
This type of therapy aims to teach the children and families how to deal with their problems appropriately and to get them to accept the reality and commit to change. Within this therapy, the therapist or social worker may use different strategies or interventions like Acceptance Commitment Therapy to help the family as well. This therapy is highly recommended for children who have experienced traumatic life events, as it being rated as the best practice for use with this population.
As far as cultural diversity, TF CBT has been studied using African and European American families, and has recently been adapted for Latino families and for the hearing impaired. This services is currently being adapted for families of other countries. Psychosocial assessment Psychological functioning The client has a mild intellectual disability concerning her speech, which causes her to stutter and at times and have a difficult time forming the words that she would like to say. Due to her communication disorder, she attends a special education school, and moderately struggles with assignments.
The client did not present with or have a history of any psychotic features and is always oriented to person, place and time. The client has a history of impaired judgment, which could be a result of environmental factors as well as her communication disorder. The client realized that attempting to run out into traffic was impulsive and that she should not have done that, but has a history of reacting impulsively and not utilizing appropriate coping skills, which signifies impaired insight.
The client does not appear with any memory impairment and is able to accurately recall things from her short term and long term memory, but unable to give reason for actions and usually says that she “blacks out”. The client uses AWOLING, aggressive behaviors, and suicide threats as her coping mechanisms. The client has run away on numerous occasions and returns saying that she had sex with older men and hoped to get raped and die. The client also admits to smoking marijuana and doing drugs, but has tested negative for her drug screens. Emotional Functioning
This client has a hard time expressing herself and usually presents as evasive, guarded, agitated or defensive. The client usually uses negative emotions as a defense mechanism, and continuously reports wanting to get raped and killed because she has not been able to cope with being raped by her sibling in the past. Due to the client being abused and neglected, she doesn’t know how to respond to individuals who are caring, and who try to listen to her and help her cope. (Diller, 2010), believes that foreign experiences usually create unfamiliar emotions, which causes the reaction of confusion, pain, anger, fear and guilt.
The client may use anger to protect herself from unfamiliar emotions or from getting hurt again. The client has a long history of destructive behaviors, including tearing off wall paper, and punching holes in walls. The client too has a long history of assaultive behaviors: assaulting staff and peers, and just being verbally aggressive. During the crisis visit, the client had an appropriate affect. Also, despite her unwillingness to confide in her support team, the client was able to express her feeling of embarrassment, betrayal and self-hatred that she felt after being mocked by her teacher.
The client had a break through. Social/Behavioral Functioning The client reported that she has a difficult time making and maintaining friendships due to her being in a group home setting, however gets along with her housemates and “some of the staff”. The client reported that she often follows her friends, so if they suggest that they AWOL then she will do it and reminisced about a time that her friend wanted to jump out of a window at school and admitted to following her, “but didn’t know why [she] followed her”.
It is evidenced that the client is usually socially passive. The client has a history of running away so she smokes marijuana, and reports that some of the “other girls” suggest that she does it to feel better. The client reported that she feels less stressed after smoking. The last few drug test has tested negative for substance abuse; however the client could be smoking synthetic marijuana. Brain Mechanisms In the previous section, it was discussed how the client is usually uncooperative, and guarded, and will usually be extremely brief throughout her therapy sessions.
It does not go unnoticed that the client has a hard time trusting people who claim to be concerned with her best interest—yet she still gets bullied by a teacher. That could describe one reason while this client continuously presents with emotional and behavioral disturbances. However, the client was raped by her brother at the age of 5, sexually assaulted by her cousin at the age of 10, and physically and emotionally abused by her mother—who struggled with substance abuse and psychiatric issues. The clients father was incarcerated for over 10 years of her life, so she does no know him.
There are extreme effects that traumatic experiences can have on the brain, especially when the experience happen in early childhood years (Ziegler, 2015). Traumatic experiences usually warrant emotional and behavioral issues, and sometimes mental issues. The client doesn’t know how to cope, and from a young girl, her brain seems to immediately go into the fight or flight response, which is actually expected if one does not receive treatment after a traumatic incident (Farmer, 2009). The client has an extensive history of fighting staff and peers, as well as running away.
It is believed that females usually bottle up their feelings by removing themselves from stressful situations, or disassociating themselves (Ziegler, 2015). As far as brain development goes, there are long term affects that interferes with brain development, which could also explain the emotional and behavioral issues that this client presents with. It was briefly discussed that the clients mother has substance abuse issues, and her own psychiatric history, which are genetic factors that also influences brain development.
Due to the history of abuse and neglect from the client’s parents, it would be appropriate to assume that the client did not have a secure attachment with her parents or any care giver, which could limit the neurons in the limbic area of the brain, which teaches one how to feel and form a temperament (Rolls, 2015). In the early years, the brain relies on connections and bonding in order to form synaptic connections, which is important when forming personality.
The brain will continue to develop with or without appropriate stimuli, however my client has unconsciously learned her own ways to cope and regulate her emotions; that explains why she has hard time regulating her behaviors, and with responding with an appropriate affect. DSM 5 Diagnoses The client has been diagnosed with Disruptive Mood Dysregulation disorder, with psychosocial and contextual factors that includes academic or educational problems, and high expressed emotional level within the family.
During the current crisis visit, the client’s mood was triggered, however, that is not always the case. This client has a history of displaying characteristics of an angry, irritable, or agitated mood almost every day. The mood is not situational, depending on the environment, because the child displayed these behaviors while living with her mother, living in the residential setting over the last three years, while at school, and on outings.
The severity is documented by her ripping off wall paper, assaulting staff, breaking mirrors, threatening to jump out of windows and run into traffic, AWOLING, assaulting peers, being verbally aggressive, and having spontaneous outbursts at least three times a week and consistently put on a 1:1. Intermittent Explosive disorder was looked at, but was ruled out because individuals diagnosed does not present with a negative mood majority of the time and on a daily basis (Coccaro, 2012). Treatment Plan
The presenting problem for this treatment plan would focus on my client’s behavioral issues, and include her and her mother. The goals are for the family to incorporate skills learned through therapy that could help them manage stress, and verbally converse about what they are feeling and how they think that their feelings affect their lives: whether negatively or positively. This form of therapy typically ends after 16 sessions, so the mother and child would have a session bi-weekly for an 8-month time span.
There will be goals and issues that will be discussed that references the early years of the client’s life, what they each remember, and what could have been changed to make things better. Attachment will be discussed, the absence of the client’s father and the affect that the absence has had on both the mom and the client, the behavioral issues will be discussed and the mother perspective, as well as her own behaviors will be discussed. The client’s molestation will be discussed, love will be discussed and what it means to each individual.
In Cognitive Therapy, Piaget discussed how some children are exposed to high risk factors because their environment was not conducive for successful growth or brain development, this therapy will work through the traumatic experiences and encourage greater cognitive functioning, by helping the family change their thoughts about their pasts and to cope appropriately. The biggest break through will be communication, because neither the client or the mother has fully processed their life stressors and instead, has been avoiding them. Discussion
Through the literature and multiple interventions that I have learned about, I have a different perspective of these children and youth. I see the community complaining about these youth being housed in their neighborhoods, I hear people saying that these children just need a good whooping, I hear people saying these kids are too grown, but I rarely, or I don’t think that I have heard anyone say, hey what happened to you, instead it is usually what’s wrong with you. We should focus more on brain development, because it gives us a lot of information about what happened to these children and youth, and helps explain why they are acting out.
Acting out may be the only thing that they know how to do, or know that acting out will get them the attention that they yearn for. I was able to take a look at the client’s current treatment services and past services, but it is unsure if anyone is talking about what happened to the client in the past, which I doubt, because the behaviors that the client presents with may be overshadowing her past. I feel like the client is asking to talk about her trauma when she yells: I want to get raped and die, knowing that she was molested by her brother at a young age. giver (Cohen,
