A Re-evaluation of Unit 4’s Case Study

A Re-evaluation of Unit 4’s Case Study

PS115 Unit 8 Assignment: A Re-evaluation of Unit 4’s Case Study

The original case study provided for this essay outlined a clinical contact between the Psychologist, Dr. Williams, his patient, 15-year-old Juan; who suffers from cystic fibrosis, and his parents. The information presented briefly describes the encounter; Dr. Williams conducted an intake interview with the family where Juan’s anger issues where outlined, he did not address Juan directly and ignored the parents when they suggested speaking with Juan’s primary physicians. Dr. Williams provided the parents with standard behavioral intervention, without explanation. Additionally, there was a follow up appointment scheduled one week from the initial contact, which was not kept by Juan’s family.

Some of the issues that I feel need to be addressed with Juan and his family as it relates to the case study revolves around my perception regarding the inadequate amount of information gained during the diagnostic intake; I would have involved Juan more in the process as it is his behaviors we are planning on treating. Additionally, I would have begun the consultation process with Juan’s other providers, through obtaining a consent to treat and a release of information; these would allow me to contact his primary care physician, any specialists regarding his Cystic fibrosis and case management professionals that may be involved in the family’s life.

I would have explained to Juan and his parents that there are a number of biopsychosocial stressors incumbent in individuals who suffer from chronic and terminal illnesses; and therefore, children of Juan’s age who have cystic fibrosis, are at a higher risk of suffering from psychological and behavioral issues, such as anxiety anger and depression (Drotar, 2006). I would have begun to develop a behavioral intervention plan with the family, and like Dr. Williams, provided the family with a standard behavioral intervention to start at home. Unlike Dr. Williams however, I would have explained that this standard intervention was a means to collect information to develop a treatment plan tailored to Juan’s specific needs. How Juan responds to this initial behavioral intervention plan will provide me as the provider, invaluable information, such as if there were particular triggers for the anger such as defiance, where Juan doesn’t like to be told what to do or does not get his way, or if there were any environmental factors that resulted in these negative behaviors. For instance, does the anger only present itself at home, or does it show more often in environments where Juan is exposed to social factors, like at the Mall or school (if in this case, he attends mainstream education). This would allow me to ensure that Juan would receive the most effective treatment based on the evidence collected, my clinical judgment and the preference of Juan and his family as this is an example of the psychological principle known as evidence-based practice.

Expanding on this principle, I would consult with Juan’s primary health care provider and Medical specialists, to determine any biological factors that could be exacerbating his anger issues. Those who suffer from chronic pain tend to demonstrate excessive anger and disengagement when their wishes are not met (Govern, 2002). Cystic fibrosis can cause complications that result in chronic pain. By speaking with Juan’s other providers, we can incorporate any biological factors that may be present into the treatment plan; it may be necessary for the treating doctor to prescribe or re-evaluate Juan’s medication to provide more comfort for pain, which in turn may relieve some of the negative behaviors Juan is experiencing. The case study also outlines that Juan suffers from “other birth defects,” If some of these are neurological or developmental, then this information would play a critical factor in the development of Juan’s treatment plan. If Juan had developmental disabilities such as cerebral palsy, which could affect thinking and reasoning, Autism, which affects interpersonal skills or any number of other disorders, then the treatment plan would need to be adjusted to factor in these determinants. Other professionals that I would consult with include any case management or social workers that may be involved with Juan and his family. I believe that it would be prudent to develop an overview of Juan’s home life from sources other than the patient and his immediate family. I would like to know factors such as his family dwelling, how many live in the household? are the other family members that suffer from cognitive or physical disabilities within the home? How is Juan’s relationship with his parents from a professional standpoint? do both his parents work? Or do his patents have any legal or financial complications that could be affecting Juan’s behavior? The answers to these questions are essential, as it gives me, the provider more pieces to complete the puzzle.

When developing Juan’s treatment plan I would likely administer assessments to determine the best course of treatment moving forward; one such assessment that I would employ would be the State-Trait Anger Expression Inventory-2, Child & Adolescent (STAXI-2 C/A). This assessment is designed to assist the clinician in distinguishing between temporary anger states, and more enduring conditions (Spielberger, 1988). Providing the clinician, a snapshot of Juan’s thought process as it relates to his anger issues. My primary rationale for adopting this specific inventory is that I would be able to, with some degree of accuracy, identify if Juan’s anger profile correlates to any health issues; which in Juan’s case would be clinically significant. Dependent on the information obtained through these consultations, in addition to initial clinical contacts between myself and Juan, results of any assessments that I conduct, and the wishes of the family, medication, in addition to psychotherapy may be an option to address the negative behaviors exhibited by Juan; if this where the case I would refer Juan to a psychiatrist to determine if psychopharmacological intervention would enhance the efficacy of treatment.

One possible treatment modality that I would employ in treating Juan would be Dialectical behavioral therapy or DBT. DBT is a cognitive behavioral treatment that utilizes both individual psychotherapy and group therapy in order to promote the development of coping skills. Although initially designed to treat chronically suicidal patients with Borderline Personality Disorder (BPD) it is now being adopted as a treatment for an array of other disorders, which includes some of the symptoms presented by Juan (Chapman, 2006). My rationale for employing this specific treatment modality is because of the possibility that the presenting symptoms that Juan is experiencing is related to Oppositional Defiance Disorder (ODD), which shares many of borderline personality disorders traits. As mentioned, DBT employs both individual psychotherapy and group therapy, which in my belief will address some of the psychosocial stressors outlined previously in this essay. DBT promotes mindfulness, which would allow Juan to focus on what is happening in the present, and not what is going to happen, which could divert any thoughts that Juan may be having about his future prospects as it relates to his cystic fibrosis. Other key concepts of DBT include distress tolerance and interpersonal effectiveness (Chapman, 2006). These concepts will teach Juan how to cope with stressful situations when he cannot change that situation, abstract thinking and evaluation techniques will be employed for this purpose. The interpersonal effectiveness will teach Juan how to ask for something he wants and say what he wants to say while maintaining respect for others and not becoming irrational when the answer received is not favorable to him. The final concept that DBT promotes is emotional regulation, this will provide Juan with the skills necessary for reducing his emotional vulnerability and decreasing emotional suffering, allowing Juan to change the emotions he wants to change (chapman, 2006). This is important as the one emotion that is outlined in the case study is anger, being able to manage the emotional factors that cause Juan’s anger will be beneficial for the management of his presenting symptoms.

Inevitably, when Juan’s progress reaches a certain point, the frequency of the therapeutic interventions conducted by me as the primary therapeutic provider will decline, yet merely ending treatment would be detrimental to the therapeutic process and Juan’s success. It is therefore essential that I establish a well-defined aftercare program to promote patient success. I would refer Juan to a wraparound program, such as those provided by the various advocacy programs available for children and young adults with chronic illness; and ensure that a Memorandum of Understanding is established between myself and that advocacy agency to facilitate relevant communication regarding Juan’s progress. A wraparound program will be beneficial, as it provides support for Juan in various social settings, such as in-home and any educational establishment he may be attending on a regular basis. The majority of wraparound programs of this type provide support for family members of patients, this would benefit Juan by giving intervention advice for his parents and address any concerns they may have in the continuation of Juan’s care. I would still meet with Juan on a regular monthly basis; so that I can to monitor for any decomposition in his mental state and should such become evident, we would adjust his treatment plan, increasing clinical contacts and intensifying treatment as necessary.

References

Drotar, D. (2006). Psychological Interventions: Cystic Fibrosis. In, Psychological interventions in childhood chronic illness (pp. 203-219). Washington, DC, US: American Psychological Association. doi:10.1037/11412-010

Chapman A. L. (2006). Dialectical behavior therapy current indications and unique elements. ,3(9). 62–68. Retrieved from

Govern, P. (2002). Study links anger to pain. Reporter. Retrieved from: http://www.mc.vanderbilt.edu/reporter/index.html?ID=2374

Spielberger, C. D. (1988). Manual for the State-Trait Anger Expression Inventory. Savannah, TN: Psychological Assessment Resources.