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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 original house therapeutic approaches for medicine were finally chosen by the therapist with the application of three interventions within each approach. The approaches included; Cognitive Behavioral approach, narrative Based Therapeutic approach, and a Psychoeducational Therapeutic approach. These purposely chosen constructs were applied to the Peterson house principles and with their help the Peterson house was able to aid 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 department located within the college district of Philadelphia. It is a high end department that specializes in helping families and individuals with problematic behaviors and circumstances. Much of the clientele within the Summit department could be determined mid to upper class. The department is primarily funded by direct cost from clients who are seeking extremely mighty PhD. And Masters level clinicians to aid with their house issues and by underground 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 aid for their son's behavior. Mr. Peterson worries that if David's behavior continues, many may think that David is a real trouble maker; thus effecting his academic 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 between 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 beyond doubt 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 calculate he is at the Summit Point department is because his mom & dad just want to turn him. Both, Mr. And Mrs. Peterson want David to just behave at school and at home in order for him to acquire a good education 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 development 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 write back 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 determined 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 man that makes references to having hobbies; such as playing tennis, biking and shopping. Mrs. Peterson does not declare 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 mental illness or supreme behavior problems. David attends high school within the tenth grade at Highland High School. David does not reconsider 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 medicine plan (see shape 1.1) consist of one original goal and intermediary objectives straight through a Cognitive arrival to aid 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 aid David and his house with these objectives and goal with no progress. I believe that with the current data I can construct suggestions, and inform my custom by linking new strategies and intervention objectives from house therapeutic approaches to aid in solving David's difficulties.
Goal: To decrease David's problematic behaviors
- Send home weekly develop report
- When David receives poor behavior reports he is grounded from skate boarding and other activities he enjoys
Figure 1.1
The current suggestion and decision to link house therapy approaches to this condition is to aid with necessary issues. In retrospect, the interventions although practical, located 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 develop reports for review. It was also founded that the use of negative reinforcement strategies was not efficient 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 data I believe that it would be wise to now couple a unavoidable reinforcement plan that would aid with promoting good behavior and expanding self esteem. I feel that suggesting the use of strategies to aid 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 medicine plan did not allow David to touch for himself the roles of others or allow him to identify view and feeling patterns. I believe that with the comprehension of David's personality and his unavoidable brain and sensitivity, utilizing strategies that aid with view identification may be beneficial. The newly suggested medicine plan is as follows;
Goal One: To decrease David's problematic behaviors
- To increase David's awareness of how his behavior affects others
- To aid David in identifying thoughts, feelings, behaviors, beliefs
- To aid David's parents with better parenting and relationship skills
Figure 1.2
Strategies for turn - Cognitive Approach
During session consulation I would ask David, how he view 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 arrival intervention that I learned at the University of Michigan School of social Work may be efficient (Personal Communication, R. Tolman, October, 2006). I would advise 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 finished with a negative consequence for David. The condition I would ask of David must have ended with him mental that he should have responded differently. I would ask him to express to all of us his detailed story from beginning to end. After he expressed his story I would ask David and his parents if there were more unavoidable 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 comprise the newly agreed upon unavoidable 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 during the interaction, except for the expanding of the unavoidable 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 unavoidable response attached to his interaction. His father would play the teacher, and at the end David would hopefully begin to understand both roles of those involved. It is hypothesized that this role reversal may turn David's perceptions.
The second intervention that I believe would be helpful in allowing David to identify his thoughts and feelings and how they consequent his behavior would be to use during 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, inspecting the known data about David's love for drawing and optical acuity. I would advise to David to express a time when he was disrespectful or acting out against his parents or teachers. That exact lesson 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 during this lesson and address either or not they were unavoidable or negative, or either they were realistic or distorted; at the center 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 unavoidable 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 beneficial to use a third cognitive approach. I feel that it may be beneficial for the Peterson house to use 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 amount 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 beneficial for assisting in cognitively reconstructing the house systems perception and expectations of David's behavior.
Narrative Approach
It could be suggested that in an effort to speak about the behaviors within sessions one should seek to sell out 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 beneficial (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 efficient intervention, especially for David who has been indicated as having low self esteem and has been identified as perhaps being the scape goat within the house system.
After a standard expression of dissimilar perspectives over a amount of sessions, as the therapist I would advise 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 unavoidable statements of affection for David and let him know that they validate his feelings. This would lend to decreased fault looking and negative reciprocity (Lawson & Prevatt, 1999). This process I believe would aid David in reducing his feelings of isolation and heighten his commitment to working against the externalized problems.
Furthermore, a third intervention that may be efficient 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 unavoidable 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 efficient inspecting the educational level of the parents and David, as well as the families strengths and potential to use qoute solving and communication concepts (Becvar & Becvar, 2000). inspecting the suspected scape goating behaviors of Mr. And Mrs. Peterson, I feel that teaching Mr. And Mrs. Peterson better 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 communication 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 inspecting their educational level and willingness to learn.
Another intervention I would implement to heighten communication with the educational principles would be to teach parents how to implement a home/school communication principles (Foley, 2007). This principles includes maintaining a chart that is marked by teachers and parents to indicate behaviors, moods, and activities that were completed during the day (Foley, 2007). The construction of this principles creates efficient communications between school staff and parents (Foley, 2007). As the therapist I would ask the Petersons to construct this principles as instructed and then within one session rate 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 consequent straight through and consistency about the communication principles would be very important.
Due to the educational levels of the Peterson family, as a therapist I would advise interventions such as parental skills groups within the community or the use of parenting resources and educational programs within sessions. It is hypothesized that the Petersons would welcome any educational data about more efficient parenting. Recommending web sites, books (Love and Logic) and therapeutic games to heighten a child's communication and self esteem would be inherent interventions for the Peterson family. These psychoeducational interventions would aid with the third objective of the medicine plan, about the need to acquire greater parenting and relationship skills.
Conclusion
The mystery I identified within the first medicine plan was that only one arrival 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 sell out David's negative behaviors the interventions should be creative, associated to qoute solving objectives and address the entire house system.
I believe that utilizing a cognitively based arrival would be an leading 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 view identification, David will be able to purposely insert unavoidable thoughts straight through cognitive restructuring (Becvar & Becvar, 2000). Gaining parental involvement with journaling may also be a breathtaking intervention, inspecting that Mr. And Mrs. Peterson are writers and may give entertaining and creative reflections.
What may be a concern is that David's parents could identify externalizing a qoute straight through a narrative approach, as a way of David not taking full responsibility for his behavior. inspecting their past negative reciprocity of his behaviors and the parents' attitudes and expectations, it would be leading 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 arrival would seem to be an efficient approach. This arrival I feel would aid the Petersons in gaining necessary communication skills and greater parenting strategies for David. I feel that communication construction strategies would aid with what David stated as "no one listens to me." inspecting the Petersons earnings level, community affect and unavoidable attitude towards education, suggesting that they gain involvement in a parenting and or communications group would be an perfect intervention strategy.
I feel as the Petersons therapist that the utilization of these three approaches and selecting them agreeing to their exact condition and house dynamics that they will prove to be more effective. I feel that these approaches comprise all the elements that are needed to heighten the skills and sell out the problems that were chosen by the Peterson family.
Note to Reader: All participants in this narrative and the department 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 social Workers; The Notes.
Lawson, D. M., & Prevatt, F. F. (1999) Casebook in house Therapy. Belmont; Ca:
Wadsworth Publishing.
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