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Clinical Considerations for Conducting Child-Parent Psychotherapy with Young Children with Developmental Disabilities Who Have Experienced Trauma
No full textChild-Parent Psychotherapy (CPP) is an evidence-based treatment for children age 0-5 who have experienced at least one traumatic event and/or are experiencing mental health, attachment, and/or behavioral problems. Harley, Williams, Zamora, & Lakatos (2014) use a case study approach to examine the utility of CPP for working with children with developmental disabilities. They share specific ways in which the model can be tailored for this population. In this commentary, we reflect on their work with James, a 14-month old Latino boy with global delays related to a stroke he suffered after surgery for a congenital heart defect, and Juan, a 6 year, 2 month old boy diagnosed as autistic who has also experienced multiple traumas. We highlight interventions that address core CPP goals and discuss the need to address four key topic areas when conducting CPP with children with disabilities: 1) the importance of addressing risks that present within the caregiver-child relationship, including caregivers’ unresolved grief; 2) the potential for the caregiver or child’s history of trauma to contribute to challenges in the child and caregiver’s functioning; 3) the importance of working as part of an interdisciplinary team to coordinate care and better address the complex needs of families; and 4) the importance of applying a socio-cultural lens in every aspect of the work.
A Reconceptualization of Pseudohallucinations in the Case of "Kate"
No full textIn the case study of "Kate" (Shapiro, Bussing, & Nguyen, 2014), we discussed a case of a 16-year-old adolescent who initially presented with auditory hallucinations and secondary delusional thinking. A more thorough examination of the underlying dynamics of the patient and family pointed away from a diagnosis of a psychotic disorder, and the consideration of "pseudohallucinations"—conversion disorder symptoms in the form of psychiatric symptoms—was felt key by the treating child psychiatrist in tailoring treatment for Kate and her family. We discussed potential definitions of "pseudohallucinations" and used a psychodynamic formulation as a conceptual framework to provide treatment in the form of cognitive-behavioral therapy, psychodynamic therapy, and family therapy. Kate improved during the course of treatment, and thankfully avoided long-term treatment with antipsychotic medications. In response to three thoughtful and stimulating commentaries on the original case study by Pienkos (2014), Westerman (2014), and Mertin (2014), we discuss other ways in which Kate's case can be conceptualized, and we further explore the phenomenon of non-psychotic hallucinations. We focus on the main thematic elements in these commentaries, namely, Kate’s struggle for autonomy and independence as a main driver in symptom formation; the theoretical approach to the case; and the continued focus on the hallucinatory experiences
A DRBEM For Time-Dependent Infiltration from Periodic Irrigation Channels in a Homogeneous Soil
No full textIn this paper, a problem involving time-dependent water flow in a homogeneous soil is considered. The problem involves water infiltration from periodic identical trapezoidal channels. A governing equation of the problem is the Richard’s equation, which can be studied more conveniently by transforming the equation to a Helmholtz equation using the Kirchhoff transformation with dimensionless variables and a Laplace’s transform. A dual reciprocity boundary element method (DRBEM) is employed to solve the Helmholtz equation numerically. Results obtained are found to be physically reasonable.
"Cool Kids" in Denmark: Continuing Reflections on a Cognitive-Behavioral Therapy Group for Anxious Youth
No full textThis paper responds to a commentary by Perini, Wuthrich, and Rapee (2013) on two case studies on cognitive behavioral therapy for anxious children and their parents using the "Cool Kids" treatment program (Lundkvist-Houndoumadi & Thastum, 2013a; Lundkvist-Houndoumadi & Thastum, 2013b). In our response we address the following topics: including fathers in the therapy; a stepped-care approach to treatment; treatment of non-responders; parental anxiety as a predictor of treatment response; combining group and individual formats; and inclusion of students in the treatment.
Considerations for Modifying Exposure and Response Prevention: The Cases of Mr. H and Angela
No full textExposure and response prevention (ERP) is considered the gold standard treatment for obsessive-compulsive disorder (OCD). However, when comorbidity or other clinically relevant issues arise, the standard ERP protocol may require modification. Golden and Holaway's (2013) case of "Mr. H" and Pontes and Pereira's (2013) case of "Angela" offer excellent examples of clients presenting with these clinical challenges. Our commentary addresses some of the concerns raised by these authors by bringing in the emerging field of Distress Tolerance (DT) research. Using examples from the authors’ cases, along with relevant research, we suggest that clinicians who wish to modify ERP consider the proposed alterations carefully by simultaneously thinking more broadly and more specifically about the psychopathology present. In addition, we stress the necessity of various forms of continual outcome monitoring
A "Cool Kids" Cognitive-Behavioral Therapy Group for Youth with Anxiety Disorders: Part 1, The Case of Erik
No full textThis case study involves a 12-year-old boy, Erik, with cognitive difficulties, who also suffered from multiple anxiety disorders (specifically, he met the diagnostic criteria of Generalized Anxiety, Specific Phobias, Social Phobia, and Separation Anxiety). Erik and his family were treated for 10 sessions over three months with the "Cool Kids " cognitive-behavioral therapy (CBT) program developed by Ronald Rapee and his colleagues (Rapee et al., 2006). The treatment took place in a university training clinic in Aarhus, Denmark. CBT was conducted in a group format, with both children and their families taking an active part, and included cognitive restructuring, gradual exposure, child management training, and skills training in areas such as assertiveness. Results show that therapy effectively reduced the child’s anxiety symptoms, as measured by the Anxiety Disorder Interview Schedule for Children and Parents (ADIS-IV P/C) and by the Spence Children's Anxiety Scale (SCAS). Additional quantitative and qualitative data indicate an overall positive therapeutic outcome, which was maintained at 3 months and 15 months after the conclusion of treatment. A primary aim of the case study was to investigate the mechanisms of change leading to success in Erik's case, focusing on the role of parental inclusion in the therapy and the necessary accommodations made to the child’s cognitive developmental level. For example, through parents’ engagement in therapy, it was possible to alter their expectations and behaviors, with Erik’s mother learning how to be less overprotective and control her own anxiety, functioning as a positive role model for her child. Furthermore, the present study stresses the significance of accommodating the treatment to the child’s cognitive developmental level, such that Erik’s cognitions were initially challenged successfully through gradual exposures and only later addressed with cognitive restructuring, aided by the treatment given to his parents and Erik’s advancing cognitive maturation
Sara, A Social Phobia Client with Sudden Change After Exposure Exercises in Intensive Cognitive-Behavior Group Therapy: A Case-Based Analysis of Mechanisms of Change
No full textThis case study deals with Sara, a 37-year-old social phobic woman who suffered from a primary fear of blushing as well as comorbid disorders, including obsessive-compulsive disorder, generalized anxiety disorder and spider phobia. The client was treated in an intensive, one-week group cognitive-behavioral therapy program in an educational university clinic in Aarhus, Denmark. She achieved a remarkable and durable change in her longstanding social phobia after two in-session behavioral experiments conducted during the third and fourth days of the program. After treatment, the client was interviewed about her sudden gain, and she read and commented on the case study report. The primary aim of the study was to investigate the micro-level mechanisms of change for this particular client, and thereby illustrate the prospects of pragmatic case studies in meticulous process research focusing on one of the most intricate problems in psychotherapy: how does treatment work
The Pragmatic Case Study Method for Creating Rigorous and Systematic, Practitioner-Friendly Research
No full textPsychotherapy case studies have the capacity to link directly to the work of practitioners because these studies are grounded in the same type of setting in which clinicians function, that of the single case. Not surprisingly, then, case studies have played a most important role in the development of a wide range of therapy models, like psychoanalysis, behavioral therapy, and client-centered therapy. However, until recently, case studies as a method of research have fallen into disuse because they have been viewed as subjective and journalistic. This situation has changed with the growth of the philosophical movement of postmodernism, which has encouraged pluralism in the social sciences, and in turn stimulated new approaches to the case study as a serious method for psychotherapy research. This paper reviews one such approach, the pragmatic case study method, which is grounded in the fast-growing "mixed methods" model in the social sciences that seeks new ways to integrate qualitative and quantitative research designs and data. This paper begins with an overview of the growing variety of types of psychotherapy research, indicating where case studies fit in and describing a new design that integrates the use of pragmatic case studies with randomized clinical trials. The paper then lays out the basic structure of the pragmatic case study, in the context of viewing therapy as a complex adaptive system and, in a related fashion, as an example of Peterson's (1991) "Disciplined Inquiry" model of professional practice. The paper next provides a more concrete idea of the pragmatic case study by summarizing guidelines for writing such a case study for this PCSP journal, and by describing the structure of a specific example of a pragmatic case study published in the journal, the case of Caroline by Ueli Kramer. Finally, the paper describes how the pragmatic case study can be integrated with other types of case study designs
Advances and Controversies in the Application of a Modified Version of Cognitive Behavior Therapy for Social Anxiety Disorder
No full textIn their comprehensive case study, Jensen, Hougaard, and Fishman (2013) examined the micro-level mechanisms of change for a socially anxious client who underwent one-week of intensive group-based cognitive behavioral therapy (CBT) and experienced rapid symptom improvement. Our commentary focuses on two key components in the cognitive model of social anxiety, which this study highlights - the role of safety behaviors and interrogating the social environment, as well two topics that are applicable to anxiety treatments in general - integrating acceptance-based strategies into CBT and novel approaches in treatment delivery. We highlight what can be learned from Jensen and colleagues’ case study by incorporating both empirical research and our own clinical anecdotes.
Values-Focused Exposure and Response Prevention in the Treatment of Comorbid Schizophrenia and Obsessive-Compulsive Disorder: The Case of "Mr. H"
No full textWe describe a subgroup of individuals with comorbid diagnoses of paranoid schizophrenia and obsessive-compulsive (OCD) disorder. It is proposed that traditional exposure and response prevention (ERP) may need to be altered given the unique characteristics of this subgroup. We suggest that providers may approach treatment for OCD from within the context of a patient’s delusion. The case study of "Mr. H," a veteran of the U.S. military diagnosed with schizophrenia and OCD, is described. We propose that attenuating or eliminating obsessions and compulsions may not result in the achievement of a goal stemming from a delusional belief, but may contribute to an increased sense of mastery and independence