Case Study Development and Theoretical Explanation - Coursework Example

? Case Study Development and Theoretical Explanation Case Study Sophia is a 9-year-old girl who has been refusing to walk to school, 7 months after discovering about a tragic incident in which her 13-year-old cousin was severely attacked by a dog in a neighbor’s gated back yard. After learning about the occurrence, Sophia, who lives with her parents and 6-year-old sibling, began to avoid participating in leisurely activities in the park where local residents walk their dogs. Sophia’s parent’s insistence always followed a tantrum or an outburst even though; she visited the park every weekend and walked to school every day with a group of friends before the tragedy occurred. The gradual change in Sophia’s behavior was witnessed by her mother but she could not associate it with a specific event. In the past, Sophia had only kept a hamster as a pet and the family did not raise any other pets since the animal died. 2 weeks ago Sophia attended a friend’s birthday party where she was introduced to his stepfather’s German Shepherd and this meeting instantly provoked a negative reaction from Sophia’s side as she froze then began to cry inconsolably when the seemingly friendly dog was brought closer to her by the owner who contemplated that the child would eventually overcome her initial fear. Since, the incident Sophia has been refusing to walk to school with a group of friends and her visits to the park where owners walk their dogs have become inexistent. Sophia, who was always a friendly and sociable girl, does not have a medical or family history of physical illness. Her maternal uncle, however, reportedly suffers from schizophrenia. Symptoms Sophia’s symptoms of unrelenting terror and fear of dogs first emerged 7 months ago when she was informed of the tragic incident in which a dog attacked her cousin. Later, a friend of Sophia’s who accompanied the young girl during the walk from the school reported that Sophia began to tremble, scream, panic before running in the opposite direction when she saw an old woman approaching in her direction with a dog. Such an instantaneous reaction has been classified by Spiegel and Spiegel (2008) as a symptom of dog phobia. Another symptom that can be observed in the case of Sophia is that of anxiety, which surfaces once an individual is forced to face the stimulus which is causing the phobia (American Psychiatric Association 2000). At the birthday party, the young girl was brought in close proximity with the German Shepherd as the owner only considered the child’s responses as initial fear, however, the short distance between Sophia and the dog only heightened the extent of her anxiety, fear and helplessness in escaping the situation which generated the physical response of freezing followed by crying. Diagnosis An examination of the subject’s symptoms coincides with the diagnostic criteria for 300.29 Specific Phobia as per the recommendations of the American Psychiatric Association (2000) in DSM-IVTR. This criterion outlines a list from A-G. Sophia’s association with criterion A of DSM-IVTR has been reinforced on several occasions in which the subject displayed an extreme fear of dogs when faced with the stimulus in various environments. Consequently, the subject’s reaction or response was instantaneous and marked by the onset of anxiety when the stimulus was brought in close proximity, for example, when she was walking home from school and panicked upon witnessing a dog or froze immediately then began to cry when a German Shepherd approached her at a party. The American Psychiatric Association (2000) notes that in the case of specific phobia the individual is often aware of the irrationality of the fear however, children do not appreciate this observation which is an observation that stands validated for the subject. Accordingly, criterion D postulates that a subject also chooses to avoid a scenario in which contact maybe made with a stimulus. In Sophia’s case, the child has been refusing to participate in leisurely activities at the park because there is a heightened possibility that she might be exposed to the stimulus. Consequently, these observations declare that a fear of dogs has indeed been interfering in the subject’s daily routine by hindering the continuation of academic and leisurely activities. The 7 month duration of these events fulfills criterion F and as per the recommendations of criterion G of DSM-IVTR the specific phobia can be classified under the subtype of Animal Type (American Psychiatric Association 2000). Selection of Theoretical Orientation – Cognitive The theoretical orientation which has been selected to advance the assessment and treatment of the case is cognitive. The key concepts that are associated with this theoretical consideration include the execution of Cognitive-behavioral therapy (CBT). According to Davis III, Ollendick and Ost (2009), recent progress with regards to cognitive therapy involves the amalgamation of various key concepts such as psychoeducation, participant modeling, reinforcement and in vivo exposure therapy within the context of the concept to successfully and effectively treat specific phobias in adults and children. This theoretical orientation allows a mental health counselor to work with an individual in a systematic and organized manner to address anxiety disorders including specific phobias. Interpretation of Subject’s Symptoms A cognitive theoretical orientation encourages the application of pertinent tools, techniques and measures to critically examine a subject’s symptoms. McKay and Storch (2008) state that a behavioral avoidance task (BAT) permits therapists to understand the causes of emergent symptoms and to identify the stimulus that maybe triggering certain responses. The application of this tool in the case of the subject would allow a therapist to quantify two important variables: the subject’s heart rate and the subjective anxiety (McKay and Storch 2008). Henceforth, if this method is administered on the subject and the beats per minute (BPM) experience a significant rise once the subject is exposed to the dog, then the onset of these symptoms would establish that the subject avoids the stimuli due to certain reasons that are later examined through the cognitive-behavioral function analysis. Through the cognitive-behavioral function analysis, the symptoms of the child can be assessed within the context of three dimensions which include: the ramifications of the subject’s behavior of avoidance, the negative cognitions of the child regarding dogs and the extent to which varying scenarios or extent of exposure to dogs may cause the subject to display different degrees of fear, anxiety and panic (McKay and Storch 2008). This observation essentially asserts that when Sophia is faced with a situation where she is exposed to a dog in close proximity, her level of fear stands at dissimilar stages. For example, when introduced to the German Shepherd at a birthday party the subject froze before crying rather than running in the opposite direction because the level of fear and anxiety was at its peak. On the other hand, when the child saw the dog making its way in her direction she was able to make a quick decision of running in the opposite direction because the danger expectancy during the incident was lower which enhanced the subject’s belief that she would be able to cope with the situation. This is also known as self-efficacy (McKay and Storch 2008). Treatment of Subject Even though, conclusions of researches such as the one conducted by May et al. (2013) have highlighted the limitations of CBT in treating anxiety disorders it should be noted that this theoretical orientation has proven to be the most effective in addressing the phobias that are experienced by children. As stated previously, CBT is marked by the initiation of structured sessions to effectively assist the subject’s diagnosis. McKay and Storch (2011) note that the progress of sessions when the subject being treated is a child must take into account various factors that are not considered in the treatment of adults who are experiencing a specific phobia. The first session which could be scheduled to last for approximately an hour could commence by gradually introducing the subject with the possibility of interacting with a dog. At this point a therapist must comprehend the various scenarios that could emerge in terms of the reaction of the child (McKay and Storch 2011). The next step involves bringing a small dog in one end of the room and relating the positive characteristics of the animal to the child, steadily the clinician must began by petting the dog and encouraging the child to do the same. McKay and Storch (2011) define this step as participant modeling. Throughout the process, the clinician must discuss with the subject, her fears and anxieties or the possible terrible circumstances that the subject believes might occur if the dog is brought closer. Accordingly, the clinician should address these fears separately, for example, by placing his/her hand close to the mouth of the dog if the child fears being bitten and suggesting that dogs do not like to bite, once no reaction is shown by the stimuli (McKay and Storch 2011). Consequently, these behavioral experiments must continue with larger breeds of dogs by selecting a stronger breed in each session. A highly significant consideration that should be acknowledged during the course of the sessions is that the length of treatment is variable and cannot be specified for one subject on the basis of past experience (McKay and Storch 2011). References American Psychiatric Association (Ed.). (2000). diagnostic criteria from dsM-iV-tr. Amer Psychiatric Pub Incorporated. Davis III, T. E., Ollendick, T. H., & Ost, L. G. (2009). Intensive treatment of specific phobias in children and adolescents. Cognitive and behavioral practice,16(3), 294-303. May, A. C., Rudy, B. M., Davis, T. E., & Matson, J. L. (2013). Evidence-Based Behavioral Treatment of Dog Phobia With Young Children Two Case Examples.Behavior Modification, 37(1), 143-160. McKay, D., & Storch, E. A. (Eds.). (2009). Cognitive-behavior Therapy for Children: Treating Complex and Refractory Cases. Springer Publishing Company. McKay, D., & Storch, E. A. (Eds.). (2011). Handbook of child and adolescent anxiety disorders. Springer. Spiegel, H., & Spiegel, D. (2008). Trance and treatment: Clinical uses of hypnosis. American Psychiatric Pub. Read More