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Case-Based Treatment Plan

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Case-Based Treatment Plan

Child and Adolescent Counseling

Abstract
Catie is a 7 year old girl experiencing troubles getting along with her peers and siblings. After completing the history intake the therapist does some working hypothesis of what may be the causes of Catie’s misbehavior and therefore he creates a treatment plan based on the Child-Parent Interaction Therapy, according to which both parents and the child improve their communicational skills through play therapy.

Case-Based Treatment Plan In this paper the case of Catie, who is a 7 year old girl, is going to be examined. Through the first phone contact with her mother, the therapist gathered some basic information about the present situation in Catie’s life. The mother mentioned that she is divorced with her husband for a year now and she lives with her three daughters. Catie is the middle child, as she has an older sister, who is 10 years old, and a younger sister who is 4 years old. The mother also mentioned that she works full time but after the divorce she has depressive symptoms and anxiety. As fas as Catie is concerned, the mother is lately concerned about her daughter’s social behavior. She started showing social awkwardness with her peers and siblings, she cannot make easily friends and she is either distant and isolated or she gets into conflicts. She considers herself lost between her two sisters, as the older one seems to be the “good child” and the younger one as the little girl needing protect and attention. The relationship between parents was described by the mother as “fairly good”, and the father spend time with his daughters every Wednesday afternoon and every other weekend. What was also mentioned is that Catie has a good relationship with her both parents. As a therapist and due to the fact that the information given by the mother are not quite sufficient in order Catie’s behavioral profile to be complete, additional information should be gathered, as well. As the parents are divorced, mother should furtherely define the exact period of Catie’s presenting problem and father should also give information on how Catie behaves when she spends time with him and her sisters and what kind of arrangements have been made between parents concerning the upbringing of their children before and after the divorce. Moreover, it would be essential to know from both parents their social environment and background, the family structure and the relationships among family members before divorce and under which circumstances the parents finally got divorced. Catie’s siblings should also be interviewed in order to examine their point of view towards their sister’s behavior and their roles in the family. It would also be essential for the therapist to have a conversation with Catie’s school teacher in order to gather information about her school performance and her behavior in the classroom. Finally, coming in contact with the child itself in the therapeutic session, it is important the therapist to create a familiar environment for Catie in order to feel safe to express herself giving information in order to examine her perspective of the situation. Taking all these information into consideration, some questions are raised concerning if there are any conditions under which this behaviour is not apparent, what kind of communication does actually Catie have with her parents, what kind of interests does she have or if she is taking any leisure activity in her free time. Additional to that, it could be important to know how her mother treats her in comparison with her two sisters and the reason she is behaving like that, wondering if she feels neglected and as a result she misbehaves in order to get attention from the people in her environment and especially her parents. Therapist’s working hypothesis is configured based on the fact that Catie seems to have a low self-esteem as she puts herself in comparison with her sisters, as they get better attention by their parents and they manage to have better skills than her according to the history intake, and the fact that her mother experiences depression and anxiety may affect Catie to misbehave. At this point, considering the dynamic interplay between maternal affect and children's behavior, it is possible that children with mothers experiencing symptoms of depression may lead children in irritable and aggressive behaviors (Cummings et al., 2000, Downey and Coyne, 1990). The negative changes in maternal functioning may reinforce children's behavior problems (Sheeber, Hops, Andrews, Alpert, and Davis, 1998). Based on this hypothesis, a possible diagnosis for Catie’s behavior could be Dysthymic Disorder. According to the American Psychiatric Association (2000) in DSM-IV-TR, dysthymic disorder in children may be expressed by irritable and aggressive rather than depressive mood and the minimum duration of this disorder has to be approximately one year. Consequently, the therapeutic plan is formulated with weekly sessions for approximately 15 sessions. Based on the fact that Catie manages to get along with her both parents a suitable treatment technique for the therapist to follow would be Child-Parent Interaction Therapy (CPIT), which is a manualized, evidence-based practice for children with disruptive behavior disorders ages two through seven (Zisser and Eyberg, 2008, Eyberg and Child Study Lab, 1999, Hembree-Kigin and McNeil, 1995, Eyberg and Robinson, 1982). It is based on established parenting, social learning, and attachment theories and consists of two phases: Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI). In CDI, some of the goals are the strengthening of the relationship among parents and the child by training parents in the use of nondirective play therapy skills, which are mainly support social interaction and increase positive parent behaviors, such as praise. The PDI phase additionally to the CDI skills introduces of unambiguous parental commands, limit-setting, and consistent follow-through with consequences (e.g., timeout) to increase compliance and decrease disruptive behavior. During this therapeutic approach parents develop child-focused relationship skills and also learn effective discipline skills. Moreover, Child-Parent Interaction Therapy includes a didactic component to introduce, model, and role-play skills, coaching sessions in which the therapist uses modeling, reinforcement, and selective attention to shape the parent’s skills during live interactions with the child, coding of parent-child interactions in most sessions to guide and evaluate treatment, and homework assignments between sessions that intend to expand treatment effects to the home environment. Catie, even though there were not clear information at the initial description of her history by her mother, seems to have good communication skills which she is unable to develop and express due to her current condition. Moreover, she has a positive relationship with her parents, which might have positive effects by their interaction through therapy. She might have also other interests either in school or outside it, such leisure activities, or feelings for her sisters which are covered by her depressive mood and feelings of being neglected or inferiority. Based on those strengths mentioned, three therapeutic goals would be set for Catie to achieve in order to decrease this disruptive behavior. The main goal is Catie to increase her understanding of her own feelings, thoughts, herself and others and how she operates in different situations. A second goal is to improve her relationship with her parents and her siblings and start feeling equally towards them and therefore to be able to join together in activities. Finally, Catie will be suggested to start up a leisure activity after school, such as sports, through which she will be able to come in contact with other peers, and therefore to develop her communicational skills. In conclusion, in all therapeutic processes the therapist sets some discharge criteria, which can have either negative or positive effects. For example, the child might show a continuous unwillingness to come to therapy or he might not manage to reach all the therapeutic goals have been set at the duration of the treatment. Moreover, if parents are part of the therapy and they do not come either on time or at all for several times, then the therapeutic process comes to an end. On the other hand, when the child manages to achieve the goals set and develop all the skills required in order to be part of his social environment, then the therapist is no longer required an the therapy has a positive ending. In Catie’s case a suggested closure activity at the last session would be the therapist to put her in front of her parents as they are her mirror and then they try to copy exactly what she does in slow movements, though, at the same time. This kind of play therapy could be considered as a form of nonverbal communication, where the child feels free to interact and come even closer to his parents and the parents are also ready to understand better the emotions and the feelings of their child without any verbal expression of herself towards her parents.

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial treatments of conduct disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27, 180–189.
Cummings, E. M., Davies, P. T., & Campbell, S. B. ( 2000). Developmental psychopathology and family process: Theory, research, and clinical implications. New York, NY: Guilford Press.
Downey, G., & Coyne, J. C. ( 1990). Children of depressed parents: An integrative review. Psychological Bulletin, 108, 50– 76.
Eyberg, S. M., & Child Study Lab. (1999). Parent–Child Interaction Therapy: Integrity checklists and materials.
Eyberg, S. M., & Robinson, E. A. (1982). Parent–Child InteractionTraining: Effects on family functioning. Journal of Clinical Child Psychology, 11, 130–137.
Gallagher, N. (2003). Effects of Parent–Child Interaction Therapy on young children with disruptive behavior disorders. Bridges, 1, 1–17.
Sheeber, L., Hops, H., Andrews, J., Alpert, T., & Davis, B. ( 1998). Interactional processes in families with depressed and non-depressed adolescents: Reinforcement of depressive behavior. Behaviour Research and Therapy, 36, 417– 427.
Thomas, R., & Zimmer-Gembeck, M. J. (2007). Behavioral outcomes of Parent–Child Interaction Therapy and Triple P–Positive Parenting Program: A review and meta-analysis. Journal of Abnormal Child Psychology, 35, 475–495.

References
Zisser, A., & Eyberg, S. M. (2008). Parent–Child Interaction Therapy and the treatment of oppositional children. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapist for children andadolescents (2nd ed., pp. 204–223). New York: Guilford Press.

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