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Theory of Change

Magaly Soto-Sanchez

MFT 596

Contextual Factors

  • Age: 16
  • 10th grade
  • Sex: Female
  • Sexual Orientation: Heterosexual
  • Latina
  • SES: Low Income
  • Bilingual
  • Raised Catholic but not practicing

Presenting Problem

Student referred herself to counseling services due to feeling depressed and holding in a lot of anger. Student shares that she has been through changes in her life and has had a hard time dealing with it. Student shares that her parents recently separated. Student shares that she is close to her mom and has an "okay" relationship with her dad. Since her parents separated student lives with mother in a room that they rent out from a friend of her mom. Student explains that she feels sad, emotional, and angry with everything going on.

Diagnosis

F43.20 Adjustment Disorder, unspecified

Z59.9 Unspecified Housing and Economic Problem

Z63.5 Disruption of Family by Separation or Divorce

Ethical and Legal Considerations

Ethical and Legal Considerations

  • Clinician made sure to get parent consent before starting services with student
  • Clinician went over informed consent, confidentiality, and limits to confidentiality with parent and student
  • Clinician must be aware of any countertransferance issues that may come up for clinician

CBT and SFT

Theory

Cognitive behavioral therapy is based on the cognitive model: the way we perceive situations influences how we feel (Nichols & Davis, 2017). In addition, CBT involves uses psychoeducation, skills training, and mindfulness. Adding ‘relaxation’ and/or ‘mindfulness’ elements to CBT appears to further contribute positively to the effectiveness of interventions for aggression problems (Deffenbacher, 2011).

Solution focused therapy focuses on the client's strengths in order to influence their perspective to find solutions to their problems (Nichols & Davis, 2017).

Goal

  • Decrease feelings of anger by increasing use of healthy emotional expression using positive coping strategies from 0x a week to 2x a week.

Goal

Interventions

  • Psychoeducation on cognitive triangle
  • Introducing types of communication and practicing "I" statements when talking to family members
  • Exploring coping skills and implementing ones that work
  • Using scaling questions to assess where student is and focusing on areas that have been having a positive impact
  • Exception questions to help student find solutions to past problems and apply them to current ones

The Change Process

Clinician: Last week you mentioned that you were at a 6? How about this week?

Clt: I don't know, maybe I'm at a 8 this week.

Clinician: What made it an 8?

Clt: I had a good weekend. On Friday we won our softball game and Saturday I was able to go to the beach and play volleyball.

Clinician: That's great to hear. It sounds like your enjoy playing different sports.

Clt: I do, I've always been part of a team and if I am not, I work out.

Clinician: What about it do you like?

The Change Process

The Change Process

Clt: I like that my team knows each other and we know how to run plays during softball games.

Clinician: Communication between team members is key when it comes to playing

Clt: Yeah! I remember when we started our season, the girls didn't really know each other and we would lose games! Like 2-14, it was bad. But now that we know each other more and talk, we play better

Clinician: It's awesome that you're able to reflect on the growth your team has made. How do you think communication can help with how you've been feeling?

The Change Process

The Change Process

Clt: ...I think it can help if I can share my feelings with my mom. I've been so angry about a lot of things and I've always kept them to myself, it leads to my mom and I having arguments. If I just talked to her about how I feel everything maybe she will understand.

Clinician: It could be just like what happened with the team. You and your mom will communicate and become closer in order to deal with the things that are going on.

References

Deffenbacher, J.L. (2011). Cognitive-behavioral conceptualization and treatment of anger. Cognitive and Behavioral Practice, 18, 212–221.

Nichols, M. P., & Davis, S. D. (2017). Family therapy: Concepts and methods (Eleventh Edition ed.). Hoboken, NJ: Pearson.

References

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