Description
After reading through the case study, answer the following questions and be prepared to discuss in the live session (common themes from student responses will be brought into the live session):What individual and family strengths do you notice? What do you see as the presenting problem(s)?What information is missing? What questions do you have of the family in order to better understand their situation?What cultural factors do you want to be aware of and what potential issues of bias and/or overidentification might come up for you? What work will you need to do in order to view this family from a positive multicultural/social justice/feminist lens?What cognitive techniques would you try with Andrew? With his father?What cognitive theory–related homework assignments might be useful for FOC to carry out (share one or two)?What advantages and disadvantages do you see in using cognitive theory as the sole theory of choice?
Unformatted Attachment Preview
Case: Andrew Smith, 10 years old, Caucasian, male
Primary diagnosis: PTSD
Fourth session with the family
Current medication: guanFacine HCI (Guanfacine hydrochloride—Used to treat high blood
pressure and attention-deficit/hyperactivity disorder [ADHD]
Per his individualized education plan (IEP) at school, Andrew is functioning below average,
reading at a 3.2 grade level, writing at a 2.5 grade level, and performing math at a 3.5 grade
level. Based on the Reynolds Intellectual Assessment Scale, he scores average on overall
thinking, reasoning, and verbal processing. Nonverbal reasoning and the ability to briefly store
information and recall it is in the average range.
Both Andrew and father of child (FOC) completed the Child PTSD Symptom Scale, with client
reporting almost no issues and FOC reporting high acuity.
FOC’s consistent concern is around Andrew’s ability to demonstrate empathy and often states,
“What kind of a child am I raising?”
Andrew was admitted to the Mental Health Center of Denver’s Child and Family Services Day
Treatment program at the end of April 2017. During his time in the program, and as previously
reported from his past home-based therapist and school, Andrew struggles with engagement (i.e.,
impulsive and disruptive behaviors [bxs] in the classroom, such as talking out of turn, talking
back to teachers, fighting with peers, low to no mood awareness, and low to no self-regulation
related to PTSD).
The family’s goals are to improve family emotional connection and cohesion, and establish a
healthy family structure on a consistent basis. Andrew lives with his father (not his biological
father, but who adopted him and has full custody); his father’s significant other, who is
considered to be his stepmother (and whom he calls “mom”); and his three brothers (8, almost 7,
and 4 years old). Two of Andrew’s brothers are biological, but his youngest brother is his
(adoptive) father’s and stepmother’s son. Andrew’s two biological brothers have microcephaly,
but Andrew does not.
NOTE: Microcephaly is a birth defect where a baby’s head is smaller than expected when
compared to babies of the same sex and age. Babies with microcephaly often have smaller brains
that might not have developed properly.
Summary of History
It has been reported that Andrew’s biological mother locked Andrew in his room as a child with
his biological brothers for the entire workday when his father was at work (FOC was not aware
of this); the kids had no choice but to go to the bathroom on the floor. When FOC became aware
of this, he broke up with Andrew’s biological mother and sought custody of the children, at
which point she took all three children and was on the run with them for approximately seven
months. FOC is also suspicious of possible sexual abuse during this time because Andrew had
not been circumcised prior to his mother taking him and was circumcised upon his father getting
him back—it was reported to FOC that Andrew had an infection resulting in the need for
circumcision, and he questioned how Andrew would have developed an infection.
Andrew struggles with maintaining a normal sleep schedule; he has fears of being alone,
especially around the restroom and sleeping. FOC reported that he was initially afraid of his
stepmother being alone with him in the bathroom. Andrew still wets the bed with a pattern of it
increasing about every three months and then stopping for about two weeks. He also wets his
pants regularly at school and tries to hide it. Hygiene in general is a concern as Andrew
consistently comes to school smelling of urine and reports cleaning his bed up himself after
accidents. FOC reports that he has Andrew shower every other day. Andrew often wears dirty
and tattered clothes to school and is unwilling to change out of them (even when he has an
accident) to wear clean clothes that FOC has for him at school.
FOC is very logical and pragmatic in his approach to Andrew—however, he does not seem to be
able to view Andrew’s diagnosis the same way. FOC has expressed feeling that Andrew is
manipulative, nonempathetic, and consciously chooses to make poor choices. Thus far, FOC’s
primary form of discipline for Andrew has been for him to write sentences regarding his poor
behavior, which sometimes takes Andrew over two hours to complete (largely due to his
inattentiveness).
The current therapist has been working with Andrew and his father from a cognitive theory
framework, focusing mainly on psychoeducation around Andrew’s trauma history, adjusting
expectations/assumptions, and reinforcing a strength-based approach.
FOC is very talkative, so this has been a slow process as this therapist works to maintain a good
rapport with him, but little gets done during sessions since FOC rants about Andrew
continuously and often without pause.
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