Case Conceptualization Sam Dawson - Research Proposal Example

Running head: Sam Dawson case Case Conceptualization: Sam Dawson Affiliation Sam Dawson, A character in the movie " I am Sam", is mild mental retarded with Obsessive compulsive disorder and autism. The cognitive behavior therapy (CBT) for him incorporates self-instruction, modeling, problem solving and relaxation techniques. His communication, tendency to avoid fearful situations particularly that of losing Lucy, anger management, anxious behavior and socialization skills would be improved. The six sessions of CBT aim to gradually develop Sam into a competent social individual and parent to Lucy. The psychological techniques, mostly, address the issue of improving visible behavioral problems. The cognitive behavior therapy (CBT) improves both the visible defects in behavior as well as the thoughts of a retarded client. The components of the technique, to be used for Sam, are (Benson, 1986 as cited in Benson & Valenti-Hein, 2001) and as elaborated by Chapman, Shedlack and France (2006). These include: 1. Self-Instruction: The client is helped to phrase his/her own sentence and then encouraged to repeat it correctly. The correct repeats are given praise or some other reinforcer. The aim is to make patient understand his own words. 2. Problem Solving: In CBT, many potentially effective responses are presented and the patient is encouraged to select the best response. The problem solving steps involve identification of the problem, Identification of solutions, evaluate the solution and enact the best solution. The therapist gives one solution and asks the patient whether he can give any other solution. 3. Modeling: It is learning through observation. The therapist, someone favorite or a parent serves as a model. The model approaches a fearful object or situation and feels no anxiety or fear. The client is then asked to approach the fearful object either guided by the trainer or all by himself. His response is recorded. 4. Relaxation Training: It is a very important training to reduce anxiety as the mentally retarded particularly the dual diagnosed with OCD and Autism have high anxiety and distress levels (Russell, Mataix-Cols & Anson, 2005). The deep diaphragm breathing and progressive muscle relaxation (PMR), counting to ten or thinking about some pleasant event or pictures are used to accomplish reduction in anxiety. Throughout training, the therapist should use simple language, demonstrate the process, guide and when the patient does well he should be given positive reinforcer to motivate (Benson 1986; Chapman, Shedlack & France, 2006). TREATMENT SESSIONS: The sessions are divided as follows and each preceding session is reviewed in the next session: Session - I Introduction & Self-instructions: Sam is introduced to his training program of six sessions and asked -How does he feel about it To improve the communication of Sam, a variety of self- instruction statements are taught to him viz., self-affirmation (I can do it), self-control (breath deep and say relax). For people with limited vocabulary verbal or non-verbal picture prompts may be used. He is told to repeat the sentences. A correct response is praised to motivate him. Session- II Identify emotions and Situations: Initially the patients are taught to identify feelings of happiness, sadness and anger. The clients must first know when they are angry or sad to learn self -control. A known, preferably a favorite person acts as model and approaches a fearful situation without feeling any fear or anxiety. The trainer, then, puts a problem and clients find a solution. They enact it and receive feedback. As a result of such modeling the patient learns new behavior, fearful or avoiding behavior is reduced and already learned behavior is improved. Modeling reduces fear of meeting strangers, entering into stores or using escalators and self-injurious behavior (Benson, 1986 as cited in Benson & Valenti-Hein, 2001) and (Chapman, Shedlack & France, 2006). Session - III Social skills and Communication: Social Skills Training (SST) focuses on verbal as well as non-verbal parts of communication. The verbal parts are content of message while non-verbal are the eye contacts, distance that is to be maintained while talking. The success of SST is evaluated by pre- and post training comparisons of behavior, preferably persons other than the trainer must judge the patient. An Autistic has problem in adjusting in the society and community (Russell, Mataix-Cols & Anson, 2005). The deficits of Sociosexual skills are also addressed to prevent emotional stress and sexual abuse of mentally retarded and enhance community adjustment. The methods used may be any or a combination of stacking the deck (Foxx & McMorrow as cited in Benson & Valenti-Hein Benson & Valenti-Hein, 2001:111), The slides of life horizons (Kaplan, 1990 as cited in Benson & Valenti-Hein, 2001:111), Circles (Champagne, Walker & Hirch, 1988 as cited in Benson & Valenti-Hein, 2001:111) others include dating skills development. The training helps the client to understand a girl and boy behavior, know who are close and distant people and maintain corresponding behavior distances. The inclusion of it in the session is necessary for Sam to improve his social competence and assist in upbringing of Lucy with her foster parents. Session - IV Anger & Anxiety Management: The anger management will be dealt along with assertiveness training for Sam who gets severe anxiety thinking Lucy might be removed from him. Anger Management Training (AMT) aims to improve self-control of anger. The training employs a combination of cognitive behavior therapy methods (Benson & Valenti-Hein, 1986; Golden & Consorte, 2005). The real situations from work and home are preferred during AMT. It reduces violent behavior such as kicking and hitting others and destruction of property (Golden & Consorte, 2005). For example, The trainer asks: why did you hit him Client replies: He called me names! so I got angry and hit him. The trainer then asks: but that caused harm to you. Lucy was upset with you. The client replies: yes! The trainer tells him: next time someone makes you angry then you just walk away or ignore him and keep on doing your work. The client says: I will walk away, probably. The trainer says: Now, I say something that makes you angry and you just walk away. Assertiveness Training is to assert once rights comfortably without violating other's rights. The client is trained to differentiate between aggression and passivity. The anxiety is associated with comorbidity such as depression in mentally retarded (McLean, 1997). Sam would reduce his anxiety once he learns to assert well that Lucy belongs to him. Session - V Relaxation: The clients are taught relaxation through deep breath and PMR. The self-instructional training then teaches to discriminate between coping statements viz. Take it easy" or " be cool" and trouble statements such as "I won't let him get away with it" or "Who does he thinks he is" The stop-think-relax technique (Benson & Valenti-Hein, 2001). Since the mental age of Sam is only 7 years he may be trained by relatively simpler techniques also. As an example, Singh et al (2003) had used an easy to apply technique to attain self-control for anger. They trained their clients to focus on a neutral part of body such as soles of the feet whenever anger-arousing situation arises. The aggressive client learned to control the anger so well that he fulfilled his care provider's requirement of anger free living in the inpatient facility. Chapman, Shedlack and France (2006) have based their strategy on Benson &Valenti-Hein method (2001). The pictures tell the client to stop before showing the distressing emotion, think of an alternative and relax. In the cases of dual diagnosis such as Sam, anger and anxiety needs to be managed well so AMT remains a part of his sessions throughout. Session - VI Evaluation: Every preceding session is reviewed in the next session to evaluate progress of Sam. Since Sam is only mild retarded and there was no evidence of any neglect or cruelty by him towards. Moreover, his emotional relation with her is of superior level so she did not require placement away from Sam. However, the needs of a growing child, judgements about her education and discipline need to be addressed by a normal foster parent (Harris, 1998). The final assessment would be through reports of the trainer, foster parents and self-report by Sam to evaluate as to how Sam developed as competent individual and parent to assist in such a role REFERENCES Benson, B. A., & Valenti-Hein, D. (2001). Cognitive and social learning treatments. In Dosen, A. & Day, K. (Eds.). Treating Mental Illness and behavior disorder in Children and Adults with Mental Retardation. American Psychiatric Publisher. Chapman, R. A., Shedlack, K. J., & France, J. (2006). Stop-Think-Relax: An Adapted Self-control Training Strategy for Individuals with Mental Retardation and Coexisting Psychiatric Illness. Cognitive and Behavioral Practice, 13, 205-214. Golden, W. L., & Consorte, J. (2005, January 10). Training mildly retarded individuals to control their anger through the use of cognitive-behavior therapy techniques. Journal of Contemporary Psychotherapy (online), 13(2). DOI 10.1007/BF00946355. Harris, J. C. (1998). Developmental Neuropsychiatry: Assessment, Diagnosis, and Treatment of Developmental Disorders. United States: Oxford University Press MacLean, W. E. (Ed.). (1997). Ellis' Handbook of Mental Deficiency, Psychological , Theory, and Research. Mahwah, NJ: Lawrence Erlbaum Associates. 188-90. Russell, A. J., Mataix-Cols, D., & Anson, M. (2005). Obsessions and compulsions in Asperger syndrome and high-functioning autism. The British Journal of Psychiatry,) 186, 525-528. Singh, N. N., Wahler, R. G., Adkins, A. D., & Myers, R. R. (2003). Soles of the Feet: a mindfulness-based self-control intervention for aggression by an individual with mild mental retardation and mental illness. Research in Developmental Disabilities, 24(3), 158-169. Read More