Week 2 Discussion Response to Classmates

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Please no plagiarism and make sure you are able to access all resource on your own before you bid. Main references come from Balkin, R. S., & Kleist, D. M. (2017) and/or American Psychological Association (2014). You need to have scholarly support for any claim of fact or recommendation regarding treatment. I have also attached my discussion rubric so you can see how to make full points. Please respond to all 3 of my classmates separately with separate references for each response. You need to have scholarly support for any claim of fact or recommendation like peer-reviewed, professional scholarly journals. I need this completed by 09/05/19 at 6pm.

Expectation:

Responses to peers. Note that this is measured by both the quantity and quality of your posts. Does your post contribute to continuing the discussion? Are your ideas supported with citations from the learning resources and other scholarly sources? Note that citations are expected for both your main post and your response posts. Note also, that, although it is often helpful and important to provide one or two sentence responses thanking somebody or supporting them or commiserating with them, those types of responses do not always further the discussion as much as they check in with the author. Such responses are appropriate and encouraged; however, they should be considered supplemental to more substantive responses, not sufficient by themselves.

Read your colleagues' postings. Respond to your colleagues' postings by explaining whether you agree with your peer’s choices to use the intervention they reviewed based on your understanding of the research.

1. Classmate (M. Chr)

Presenting Problem

For this discussion and the final project, there was a selection of different case studies that could be chosen from. I personally chose the case study of Chloe which hit home to me because I teach first grade currently and she is in that age group.  Chloe is a young girl who is eight years old. She is currently in the system because of an sexual abuse situation that happened to her starting at five years old at the hands of her birth mother because her birth mother exploited her for drugs (Walden University, n.d.). She is very skeptical of adults and gets such bad separation anxiety that she will bite her nails until they bleed (Walden University, n.d.). She also isolates herself and the anxiety espisodes usually last half an hour then she is recentered (Walden University, n.d.). Thus, because of the isolation and anxiety, her schooling has suffered a decline (Walden University, n.d.).  She was referred to me by her foster mother. 

I would certainly say that there is a presenting issue that Chloe is facing. The main issue I see her facing is what I mentioned in the first paragraph which is the social isolation due to being sexually traumatized. The sexual trauma that she has experienced can directly tell us why she is isolating herself, and considering that it was done by adults after her mom left her with them, it is also no wonder to me why I see her also facing anxiety towards adults for a certain amount of time. The thirty minutes could also be indicative as to how long the abuse lasted each time. Thus, with me understanding what the presenting issue is, I now need to come up with a proper intervention to help.

As I just mentioned, I now need to choose an intervention best suited for Chloe. The intervention I have chosen for Chloe is Cognitive Behavioral Therapy (CBT) mixed with play/art therapy. However, I think there are statistics that I need to keep in mind which is that eighteen percent of females will have experienced sexual abuse (Allen and Hoskowitz, 2016). Thus, with the experience of sexual trauma, there are certain side effects that will usually appear such as dissociation, post-traumatic stress syndrome, and anxious behaviors (Allen and Hoskowitz, 2016). This is important information because these are the exact signs that Chloe is exhibiting. The way this intervention would work is that I would start off very unstructured. Meaning I would allow her to guide the session, and she would select what is played with or drawn (Allen and Hoskowitz, 2016). Then it would move to me having her do select activities an example being a sand tray (Allen and Hoskowitz, 2016). Then the CBT portion would be sprinkled in which is where I focus on her cognitive thinking about the situations she presenting though play to where I help reshape her thinking to help her cope with what has happened to her (Allen and Hoskowitz, 2016). 

Empirical Evidence

When searching for the right research article for the intervention I chose, I knew that there were certain aspects that I needed to make sure that I had included in my search in order to come up with the best possible article for my needs. The first search that I typed in, which was interventions for students who have experienced sexual abuse, yielded no results. Thus, this told me that I needed to utilize different words in my search bar. I then tried a different approach by changing the word students to children and that yielded the results I needed. Thus, it matched what I put into the search bar to where I was able to find the right article for my needs which was titled Structured Trauma-Focused CBT and Unstructured Play/Experiential Techniques in the Treatment of Sexually Abused Children: A Field Study With Practicing Clinicians. It was also what I expected to find because I knew from my crisis and trauma class last term what to look for or what was common to find when it comes to this particular type of trauma. As far as the actual content of the article, it was what I expected to find based on the title. It was a study that was conducted using CBT and play therapy to help children who have experienced sexual trauma with an introduction that discussed the process of structured and unstructured intervention and statistics (Allen and Hoskowitz, 2016). 

However, with this study, I also  needed to make sure that I analyze the results. In the study, they utilized different models. The first two models did not integrate the interaction piece. Thus, there was not as much of an improvement or success between the two models, although the second one saw a slight improvement over the first one. The third model was the most improved to help with anxiety due to the fact of adding that interacting pieces. The third model pieces included both CBT and play therapy, pretreatment anxiety, number sessions completed (this was higher than both models  one and two), CBT usage , and play therapy usage. Also with the third model, there was more of a usage with play therapy than CBT. Thus, this tells me that utilizing both as I intended would be the most successful with keeping in mind that I need to make sure that I am following more along the lines of the third model if I want her to be the most successful. The best part about these models is that they all go with the presenting problem of anxiety which is exactly what I want to help Chloe with. 

Case Conceptualization

Thus, I would say that this particular article did not change my perception of the intervention. I have known that play therapy gives me an indication of where the child's anxiety might be, and where her their thoughts might be especially in this case with Chloe being anxious around adults  and being left places at first (Walden University, n.d.).However, I will say that I would be very strategic as to the implementation based on the information given as the article stated that there is not much empirical evidence for the play therapy portion. However, as I mentioned the results indicated that utilization of both CBT and play therapy together achieves the greatest results. This means that I would possibly think before I gave this intervention, but I think ultimately I would give this intervention to Chloe based on the contents of the article. 

Resources:

Allen, B., and Hoskowitz, N. (2016). Structured Trauma-Focused CBT and Unstructured Play/Experiential Techniques in the Treatment of Sexually Abused Children: A Field Study With Practicing Clinicians. Retrieved from https://journals-sagepub-com.ezp.waldenulibrary.org/doi/full/10.1177/1077559516681866?

Walden University. (n.d.). Final Project Case Studies. Retrieved from https://class.content.laureate.net/d47ae92955aafd40eb7fcbd70a23abaa.html#section_container1.

 1077559516681866.pdf 

2. Classmate (L. Lan)

Presenting Problem:

I chose to focus on Case Study Two (Jim) as my goal is to work with adolescents as a school counselor (Walden University, n.d.).  I’ve worked with students who have experienced loss in the past and it is not always obvious that bereavement is at the source of their presenting problems. In the case of Jim, his social isolation, altered peer relationships, decreased engagement in academics,  substance use and his poor relationship with his parents began after the sudden loss of his sister (Walden University, n.d.).  In exploring interventions that would support Jim, I focused on grief interventions.  I came across several different approaches to treating adolescents who have experienced unexpected loss in their families. I was interested in a particular treatment called “Parent Guidance Intervention” (Horsley & Patterson, 2006) because it integrates the entire family in the healing process and encourages communication amongst family members as a way to support the grieving child. In reading this article, I learned that “the ability to cope with sibling loss is further compounded if the death occurs during adolescence” (Horsley & Patterson, 2006), therefore an effective intervention is even more important for teenagers and young adults. According to the article, “A sudden death leaves the survivor feeling out of control, and with the possibility of great anger which may need to be released. This anger is often expressed through high-risk behaviors such as drug use and sexual activity in order to block out thoughts and feelings associated with the sibling death” which aligns with some of Jim’s behavior of substance abuse (Horsley & Patterson, 2006).

Empirical Evidence

This article discussed the importance of open communication among family members following the unexpected loss of a sibling/child. According to Horsley & Patterson (2006) this sort of communication helps to honor the deceased child and also helps the surviving children to continue on with normal adolescent development. The Parent Guidance Intervention Method “is designed to provide parents with bereavement support and education around their surviving child’s psychological and developmental needs, help adolescents maintain a connection with their parents following a sibling death, and allow for the adolescent to grieve and resolve the loss” (Horsley & Patterson, 2006). The subjects of this study consisted of 5 adolescent participants and their parents. Each adolescent had lost a sibling unexpectedly in the past 12-24 months and each reported that they had received messages to “ignore or postpone their grief” in an effort to remain strong for their parents (Horsley & Patterson, 2006). Treatment consisted of the researcher meeting "once a week for three sessions with the subjects and/or their parents. Sessions lasted 90 minutes" and lasted 21 weeks (Horsley & Patterson, 2006). All adolescent subjects reported an increase in communication surrounding their deceased sibling during the intervention and post intervention phase. According to the results, all five subjects also demonstrated an improvement in targeted communication behaviors such as sharing their thoughts and feelings about the deceased sibling at an increased rate.  

Case Conceptualization

I was unfamiliar with this intervention prior to reading this article. The findings of this study were interesting in that it seems that this intervention improved communication between parents and children who’d lost a child/ sibling. What this study did not discuss is the impact of this communication on the surviving child’s behavior (beyond increased communication). For example, how does the Parent Guidance Intervention impact an adolescent’s ability to maintain positive peer relationships or how does this intervention affect academic engagement, which are presenting problems that Jim is facing. 

Before jumping into this intervention, I would need to know more about its impact beyond improved familial communication. I would also like to see a study conducted with a larger group of subjects, as five subjects is a rather small pool from which to draw conclusions. This would also be a difficult intervention to employ as a school counselor – it seems more conducive to the work of a family therapist, given the work with parents as well as students. 

References

HORSLEY H; PATTERSON T. The effects of a parent guidance intervention on communication among adolescents who have experienced the sudden death of a sibling. American Journal of Family Therapy, [s. l.], v. 34, n. 2, p. 119–137, 2006. 

Walden University. (n.d.). Final Project Case Studies. Retrieved from https://class.content.laureate.net/d47ae92955aafd40eb7fcbd70a23abaa.html#section_container1

https://content.ebscohost.com/ContentServer.asp?T=P&P=AN&K=106114481&S=R&D=rzh&EbscoContent=dGJyMNXb4kSeprI40dvuOLCmr1Gep7dSrq%2B4TLGWxWXS&ContentCustomer=dGJyMPGss0q1qK5IuePfgeyx43zx

3. Classmate (K. Scu)

Presenting Problem

The case study I have selected is case study 2, which is about Jim, a 14-year-old Caucasian male.  Since the death of his sister he has been having a difficult time coping.  In this case study I have noted he is going through a traumatic experience, which is causing him to turn to, substance abuse and experiencing social and behavioral changes that are negative with friends and at school.  The case study also states there is family history of alcoholism and no family connection/cohesiveness during the grieving process.  The mental health issue he is experiencing is traumatic grief and posttraumatic stress disorder.  After reviewing this case, I believe early psychoeducation and trauma-focused cognitive-behavioral therapy will help Jim.  

Intervention 

If Jim came to my office, I would support him immediately and help him understand what he is experiencing.  I would explain the steps of grief, to help him normalize what he is feeling, which may help him remove the negative behaviors that have taken place.  It is important to make sure he receives continued support by using psychoeducation and trauma-focused cognitive-behavioral therapy (TF-CBT) to help him express his emotions.  I will also keep the parents in mind, in which trauma-focused cognitive-behavioral therapy can be used to help the family come together to support each other during this time as well.      

Empirical Evidence 

Jim’s parents have not been supportive during this time and believe he is just going through a phase.  Regal (2014) states many people will experience trauma when an incident is a shock, and the loss and grief is combined with lack of support and help.  According to this article, Jim should have received support after the death of his sister to help him understand his emotions and how to react to what he is experiencing.  When people do not receive early support, Dyregory and Regal (2012) states traumatic events “lead to high psychic distress, posttraumatic stress disorder, or complicate grief reactions for significant number of those affected” (p. 271).  

When comparing my intervention to the article, it was not too much different from what I expected, but it did change my perception.  After reading the article I learned that early intervention, such as encouraging the person to engage in early emotional expression needs to come natural and one should not encourage them to detail verbal expression of emotions (before 6 hours after event) (Dyregory & Regel, 2012).  But I did learn that trauma-focused cognitive-behavioral therapy was a positive approach for traumatic experiences, which will help Jim.  Ramirez de Arellano et at. (2014) states that TF-CBT can be used to help clients develop coping skills, relaxation skills, affective modulation skills, and cognitive coping skills. As soon as I read the first two sentences of case, I immediately thought he should have received a first-aid approach after the car accident.  I also learned I must respect the fact that Jim may not want to talk about the incident, but rather just help him find ways to cope (Dyregory & Regel, 2012).     

Case Conceptualization 

Based on this article, I will still use early intervention, combined with psychoeducation and TF-CBT. I will remember that I should respect the fact that my client may not want to talk about the car accident involving his sister.  According to the article, Dyregory and Regel (2012) states a practitioner can advocate early interventions following traumatic events, but we must caution and use good judgement on the use of specific interventions, when the client has experienced a shocking traumatic event.  I must also remember that not all people will respond to interventions of my choice and that psychosocial support is supported by 30 years of research, which is a major protective factor after a traumatic event (Dyregory & Regel, 2012).   

Dyregrov, A., & Regel, S. (2012). Early Interventions Following Exposure to Traumatic Events: Implications for Practice From Recent Research. Journal of Loss & Trauma, 17(3), 271–291. https://doi-org.ezp.waldenulibrary.org/10.1080/15325024.2011.616832 

Ramirez de Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence. Psychiatric services (Washington, D.C.), 65(5), 591–602. doi:10.1176/appi.ps.201300255

Regal, S. (2014). Early interventions following traumatic bereavement. Sudden Best Practice Guidance. Retrieved from https://www.suddendeath.org/assets/docs/guidance_reports/sudden-guidance-14-early-intervention.pdf 

File  Trauma-Focused.pdf (246.973 KB) 

Required Resources

Balkin, R. S., & Kleist, D. M. (2017). Counseling research: A practitioner-scholar approach. Alexandria, VA: American Counseling Association.

  • Chapter 2, “The Research Process”

Heath, P. J., Brenner, R. E., Vogel, D. L., Lannin, D. G., & Strass, H. A. (2017). Masculinity and barriers to seeking counseling: The buffering role of self-compassion. Journal of Counseling Psychology, 64(1), 94–103. http://dx.doi.org/10.1037/cou0000185 

Note: You will access this article from the Walden Library databases.

Document: Final Project Case Studies

Document: Final Project Worksheet

Week 10 Assignment Rubric

Required Media

Laureate Education (Producer). (2017k). Purpose of research [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 15 minutes.

Accessible player  --Downloads-- Download Video w/CC Download Audio Download Transcript 

Credit: Provided courtesy of the Laureate International Network of Universities.

Walden University, Course Guides. (n.d.). COUN 6626/6328S Research methodology and program evaluation: Library media. Retrieved October 25, 2018, from https://academicguides.waldenu.edu/coun6626/assignmentresources/week2discussion
Please review the resources listed to guide you as you search for articles related to your intervention.

· Finding Databases

· Finding and Selecting Appropriate Journals

· Finding and Selecting Appropriate Articles

· Database Features

· Parts of a Research Article

Optional Resources

Rosenthal, H. (2017). Encyclopedia of counseling (4th ed.). New York, NY: Routledge.

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  • Please no plagiarism and make sure you are able to access all resource on your own before you bid. Main references come from Balkin, R. S., & Kleist, D. M. (2017) and/or American Psychological …