The client in this case study will be referred to as Tory throughout this paper in order to maintain client’s confidentiality. On December 29th, 2016, Tory attended her first session with this therapist. Tory came to therapy because she overly cries and throws tantrums. The client’s mother described Tory as a person with a “difficult behavior”. Tory’s mother mentioned during the first session that the client gets easily angry and does not follow directions.
In occasions, Tory becomes physically aggressive towards her parents. About 3 years ago, Tory burned her leg with boiling water. The client’s other believes that after burning her leg, Tory’s behavior deteriorated. Moreover, the client’s parents are currently divorcing. They recently made the choice to divorce. The client was not told about the divorce. Tory’s parents decided to avoid each other at home, until February 2016. On February 2016, the client’s father moved out to another home. In this paper, this writer will talk about the use of filial therapy with Tory’s family.
This paper will contain the client’s demographic/identifying information, Biopsychosocial history, diagnostic impressions, treatment plan, interventions, outcome, and clinical onsiderations. Analyzing the application of filial therapy with this case study will help to demonstrate an effective intervention that can be used with clients sharing similar demographics or clinical history as this case study. Demographic/Identifying Information Tory is a 9 years-old female who was born in the United States (US). She is currently living in Kent, Washington. As of February, 2016, Tory lives with her mother and her 4 years-old sister. The client stays with her father over the weekends. Her parents are in their mid 30s. They identify themselves as heterosexuals. Biopsychosocial history
In regards of the client’s family history, Tory was born to a Mexican couple who met and married in the US. Tory’s family identifies as Catholic, regarding their religious beliefs. The client is the oldest daughter of two daughters that the couple had. Tory’s mother believes that Tory becomes jealous of her younger sister because of the attention that Tory’s younger sister gets. During the first session with this therapist, Tory’s mother mentioned to the therapist that she is planning on separating from Tory’s father because she has a new partner. During the sessions that this therapist had with the client, this herapist observed that Tory had a closer relationship with the father than with the mother.
The attachment style that Tory and her father had was secure attachment. Firestone (2013) defined secure attached children as children who see their parents as a secure base from which they can venture out, and independently explore the world. During various sessions, Tory made sure that her father accompanied her into the session room. In addition to Tory’ family history, this section of the paper will also present Tory’s medical history. The client’s parents did not report any current or past medication prescribed to the client.
At the age of five, Tory was in the kitchen when boiling water fell over her leg. After her second- degree burn, Tory’s behavior changed, according to her mother. Tory’s father reported to this therapist that Tory does now want to wear clothes that can show her legs. Also, Tory’s parents have a difficult time to get Tory to shower. Besides her family and medical history, this section of the paper will introduce Tory’s educational history. She is currently studying at Millennium Elementary School. Tory’s parents did not report any cognitive disability or especial classes that Tory attends.
The client’s father entioned to this therapist that Tory does not have a similar defiant behavior at school as she does at her home. Tory has been able to build friendships at her school, and treat her teachers respectfully. Diagnostic Impression The client’s reported symptoms are: getting angry easily, irritable mood, constant tantrums, excessive crying, not following her parents’ directions, traumatic distress regarding her experience burning her leg, and often arguing with her parents. During the client’s intake, Tory was diagnosed with Oppositional Defiant Disorder. However, the client meets the criteria for another diagnosed.
Based on the report of the client’s parents and assessment, the client’s DSM-5 diagnosis is: 296. 99 Disruptive Mood Dysregulation Disorder. The therapist at the intake of the client focused on the narrative of the parents about the client not following directions. However, this diagnosis dismisses the constant tantrums, anger outbursts, and excessive crying. Disruptive Mood Dysregulation Disorder is characterized by severe and recurrent temper outbursts are out of proportion in intensity or duration to the situation (American Psychiatric Association, 2013). Thus, this diagnosis better fits the lient’s presenting problem than the diagnosis given to Tory during the intake. Treatment Plan When the therapist asked the client’s parents about the goals that they have for treatment, they stated that their goals of treatment is for Tory to follow their directions, and not have constant tantrums.
Based on the report of the client’s family and their desire for treatment, the goal of treatment for the client is that the client’s tantrums will decrease in intensity and duration, and Tory will be able to follow directions in a more effective manner. In order to achieve the goals of treatment, the bjectives of treatment are the following: The client will learn at least two coping skills to help her regulate her anger and loss of temper; the client will use at least one of her meaningful activities to help her manage her anger and irritability. the client will learn at least one skill to help her cope with her traumatic experience; the client’s parents will learn at least two parenting skills to help the client emotionally regulate when she has an anger outburst or throws a tantrum; and, the client’s parents will learn at least one parenting skill to do limit setting with the client. Interventions
In order to attain the objectives set for treatment, this therapist has been using filial therapy, involving Tory’s parents in the healing of the client. Tory is struggling to emotionally regulate, and express her emotions in a healthy manner. Landreth (2012) recommended using filial therapy to help children’s emotional adjustment. With Filial therapy, Tory’s parents would learn to assist Tory to emotionally regulate in times of distress. Filial therapy empowers parents to be the agents of change for their children (VanFleet, 2014). Tory’s parents would learn the appropriate skills to fill confident about helping Tory.
This therapist decided to do filial therapy with the client present. This therapist wanted to introduce the skills of filial therapy while applying them with the client. Throughout this section, this therapist will discuss the interventions that occurred with Tory. Analyzing the interventions will help to understand the techniques that the therapist used to help the client emotionally regulate, and empower Tory’s parents with appropriate skills. First Session During the first session, Tory and her mother were present in the room. The client was upset and yelled to her mother when er mother was talking with the therapist.
Tory was angry about hearing the reasons that she was brought in to therapy. The therapist explained to the client’s mother the benefit of play therapy for children. Play therapy helps children to cope with their difficult emotions, and to find solutions to their problems (Schaefer, 2013). The therapist talked about the efficacy of play therapy to help children emotionally regulate and express their emotions in a healthy manner. This therapist also mentioned to the mother that play therapy would help Tory to problem solve and gain mastery.
After her mother left the room, Tory covere her face, and did not want to engage with the therapist. Tory just gave short answer responses to the therapist, and did not want to do play therapy. The therapist reflected back on how scared and upset Tory was feeling. According to Ray (2011), reflecting content and feelings validates the children’s perceptions of their experience and clarifies children’s understanding of themselves. The therapist showed Tory that he understood her experience. At the end of the first session, Tory uncovered her face, and told the therapist that she wants to come back.