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Introduction

Cognitive behavioral therapy, or CBT, is an evidence based approach to treatment to aid a wide variety of disorders (Bohman, Santi, & Andersson, 2017). It is aim to promote to decrease symptoms and reduce behavioral issues through cognitive techniques like problem-solving, cognitive restructuring, and other typical behavioral techniques (Bohman, Santi, & Andersson, 2017). A CBT approach preferred for this case study is the use of coping skills and strategies. It can aid in reducing negative thoughts and approaches towards stressful situations.

Theory

The theory used to support our intervention is cognitive behavioral theory, or CBT. Based on this theory, it mentions how collaborating goal-oriented, problem solving and a way to modify maladaptive thoughts can influence positive changes in beliefs and behaviors (Taylor, 2011). The therapist would aid in teaching self-therapeutic strategies that can benefit the client when is needed (Taylor, 2011).

Evidence

The evidence for successful use of cognitive behavioral therapy (CBT) as an intervention for a wide variety of psychological issues is very strong (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). CBT has been adapted to the treatment of trauma and its use in the area of foster care has yielded positive outcomes (Hambrick, Oppenheim-Weller, N’zi, & Taussig, 2016).

Case Study

James is a 17-year-old male, currently in the foster care system. He was initially removed from the care of his parents because of the sexual abuse he endured from his father. He has lived with this childhood trauma for years and has had difficulty communicating and interacting with male authority figures. He often has outburst of anger and frequently lashes out (sometimes unprovoked) against the residential child care providers and supervisors. James realizes that these behaviors are detrimental to his relationships and wants to change. James has met with his psychologist who referred him to an occupational therapist to help with his coping skills. He is in agreement with the referral to Occupational therapy and this is the initial assessment.

Intervention Plan

Problem Statement

Client has difficulty effectively communicating to authority figures due to his lack of coping skills.

Long Term Goals

• Client will be able to hold a 30 minute conversation with and adult male in a position of authority without expressing maladaptive behaviors  independently by discharge.
• Client will be able to apply his learned coping skills by being able to accept advice from the residential supervisor without resorting to maladaptive behaviors by discharge.

Short Term Goals

• Client will be able to use progressive muscle relaxation techniques to reduce body tension and stress in 4 treatment sessions.
• Client will be able to identify stress inducing triggers independently  in order to manage his emotional response to authoritative figures in 1 month.
• Client will be able to successfully demonstrate appropriate coping skills in a role playing scenario with an authority  figure with no more than 3 verbal cues.

Intervention format

Individual

Description of Setting

Client will see the OT in the Residential house/activity room for therapy for 45 minutes at 4:00pm.

Supplies

No supplies

Agenda /Description

Set up safe learning environment (10 minutes)

• Re-visit the Jame’s goals
• Review steps taken toward the goals since last session
• Provide feedback on homework from last  session in recognizing stress triggers

Intervention of CBT (30 minutes)

• Work collaboratively with James to planning continued steps for goal attainment
• Practice deep breathing relaxation techniques
• Practice role-playing scenario with James’ where he is to identify triggers an self-regulate appropriately

Evaluate learning outcomes (10 minutes)

• Ask James to explain key events of the session
• Ask James to explain what was effective or ineffective
• Discuss how the client might handle a similar situation
• Ask James to practice the deep breathing relaxation techniques during the week whenever presented with stressful situations

SOAP

S: James reports that male authoritative figures make him feel “uncomfortable” due to his traumatic relationship with his sexually abusive father. James also reported that he feels as if all male authoritative figures are advantageous and condescending.

O: James was presented with a role playing scenario where he was to talk to an authority figure (the therapist) following a disagreement. The therapist presented different arguments to james and he was able to answer each point with minimal outburst. He was also shown deep breathing exercises where he was able to demonstrate knowledge of them and how to use them in the event that he is  triggered.

A: James was able to complete role playing exercises while displaying minimal negative behaviors. He was able to incorporate the coping techniques learned in previous therapy sessions as evidenced by his ability to take deep breaths in between answers, and keeping his voice level during the role playing exercises.  James was also able to complete deep breathing exercises without difficulty. James has shown significant progress from his first session and continuing therapy will be of great benefit.

P: James will benefit from attending three thirty minute session from OT bi-weekly for the next two months to address working memory and problem solving abilities. Will continue to monitor progress.

References

Bohman, B., Santi, A., & Andersson, G. (2017). Cognitive behavioral therapy in practice: therapist perceptions of techniques, outcome measures, practitioner qualifications, and relation to research. Cognitive Behaviour Therapy, 46(5), 391-403. doi:10.1080/16506073.2016.1263971

Hambrick, E. P., Oppenheim-Weller, S., N’zi, A. M., & Taussig, H. N. (2016). Mental health interventions for children in foster care: A systematic review. Children and Youth Services Review, 70, 65-77. doi:10.1016/j.childyouth.2016.09.002

Hofmann, S., Asnaani, A., Vonk, I., Sawyer, A., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy & Research, 36(5), 427-440. doi:10.1007/s10608-012-9476-1

Taylor, R. R. (2011). Cognitive behavioral therapy for chronic illness and disability. New York: Springer, 152.