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