Trauma-Focused Cognitive Behavioral Therapy Training, Case Study Example

  1. In terms of pyschoeducation and in regard to the first counseling session for Martin, I would try to find out how much Martin knows about the particular type of trauma he has been exposed.  I would approach this through a question-and-answer game.  In addition, I would reward Martin with points for answering questions correctly in order to encourage him and give him confidence.  For questions in which he partially answers correctly, I would also provide positive responses and some points, as well as praises for partially answering the question.  Furthermore, I would make sure to correct and respond with the appropriate answer in a manner suited for his age.  Examples of the questions I would ask are as follows: “What is violence?”, “What is physical abuse?”, “What is domestic abuse?”, “How often do things like this happen?”, and “Why does this happen?”.

In the case for Martin, he has witnessed domestic violence between his parents on several different occasions.  In addition, he continues to hear verbal abuse from his father in regard to his mother.  It is therefore important to begin to provide Martin with information so that he understands it isn’t his fault that he witnessed domestic violence between his parents.    Most importantly, Martin must be presented with information that violence is not the appropriate way to handle an argument.  In Martin’s case, he seems to do well with game playing.  A good plan of action would be to partake in a game playing role with Martin using action figures and show him how to respond to a disagreement, emphasizing the ability to control the situation in a non-violent manner.

  1. Techniques for stress management to help control Martin’s emotional thoughts would include controlled breathing, relaxation training, and thought stopping. Controlled breathing can help Martin cope with his stressful thoughts, whether at school, home or in his therapy sessions. This would also help Martin control his automatic functions, reduce his anxiety, and distract him from any anxious thoughts.  Once the breathing technique has been adapted and Martin has demonstrated proper body positioning, a relaxing word should be introduced while he conducts his breathing technique.  This will further help him deal with stress.

Relaxation training can also help reduce Martin’s stress by decreasing muscle tension.  This technique will show Martin how to relax his muscles when he recognizes tense feelings or stressful feelings.  A good method for teaching Martin since he is age 9 would be using the analogy of spaghetti noodles.  Explaining how spaghetti looks when it is cooked and uncooked and comparing that to muscle tension can give Martin a good representation of how his muscles should feel when he is tensed and relaxed.

Thought stopping can help Martin distract from any intrusive or stressful thought.  This technique should be implemented during the initial treatments because it will teach Martin that he can control his thoughts.  This type of treatment technique would be helpful to Martin because he was having trouble focusing on school work.  This technique can help him focus and not stress on any traumatic event that has occurred. For Martin, implementing some sort of verbal thought stopping technique, such as saying “go away”, when he has a stressful thought would work well, as well as teaching him to automatically think of a pleasant thought immediately when he recognizes a stressful thought.

  1. In order to teach Martin how to cope with his emotions and feelings, I would integrate the technique of “Feelings Identification”.  Feelings identification is a non-stressful technique that can help facilitate children in expressing their feelings with the therapist.  I would implement this technique during the first few sessions. To begin, the rationale for using the feelings identification would need to be explained to Martin in order for him to have an understanding of why it is important to express and identify his feelings with someone he trusts.  For Martin’s age and his past experience with his grandfather’s passing, it would be most appropriate to use the drawing technique to find out the types of feelings and emotions that Martin can identify.  For instance, Martin can draw the outline of a human figure, which is represented as his grandfather who died unexpectedly.  Different feeling labels would then be assigned a variation of colors.  Martin would then be instructed to color in the figure in proportions of how much of that feeling he has for his grandfather.  This same technique can be used to identify feelings towards his other family members.  Once Martin’s feelings are identified, an understanding of each emotion will be discussed through game playing techniques, such charades.  In addition to understanding what each emotion is, the intensity level of each emotion should be explained to Martin, as well as explaining how to use these feelings in different situations through role-playing techniques.
  2. Martin witnessed domestic violence towards his mother, as well as verbal abuse behavior from his father towards his mother; therefore, it is extremely important that Martin’s mother learns some stress management techniques for her, as well as techniques to help manage Martin’s behavior.

Thought stopping technique should be taught to Martin’s mother.  Martin’s mother has also experienced a significant amount of trauma related stress and therefore, most likely carries stressful thoughts.  In order to help Martin’s mother distract from trauma related thoughts or stress, thought stopping could help Martin’s mother not only deal with her own thoughts, but help Martin’s behavior in the process through the ability to regain focus.

Martin’s mother should also obtain an understanding of how to reinforce the feelings identification and expression skills that Martin is obtaining from the therapist.  Martin’s mother can implement feelings identification skills through labeling emotions and reinforcing Martin. For instance, Martin’s mother can learn to instruct Martin to label his emotions when in an argument with his siblings.  Reinforcing the behavior can be conducted through praising Martin when he expresses his emotions.

Martin’s mother should also be taught the use of active ignoring.  Active ignoring is directly ignoring types of behavior, such as mean statements made toward the parent, bad faces, eye rolling, mocking, taunting, or smirking.  This technique could help reduce certain types of behavior in Martin.  Martin’s mother, however, should be aware that the use of praise should also be used when Martin performs good behavior or responds well to negative situations.

Since Martin has been displaying behavioral problems at home and school, Martin’s mother should be taught to implement “time out” for undesirable behavior from Martin.  Providing a punishment to undesirable behavior will not only stop the behavior, but deny Martin of any attention, which could condone or bring attention to the behavior.

  1. In order to continue helping Martin deal with his trauma, the next steps would be to continue building the skills developed in the early sessions, such as feelings identification, feeling intensities, and emotion expression.  Teaching Martin how to practice these developed skills at home would be the first step in this process.  There are various things that can be offered, such as the Name the Feelings Worksheet, Rating Feelings Worksheet, emotional thermometers, and teaching Martin to write down situations that occur with different levels of emotions and how he responded to them.  These techniques can be reviewed in the following session and the therapist can help Martin create different strategies and praise him for completing the work and identifying his feelings.

In addition to continuing to help Martin deal with his feelings and emotions, it is important to follow-up and monitor Martin’s mothers progress in managing Martins behavior.  Therefore, during parent sessions, time should be set aside to review the skills and find out how the management is progressing.

References

Medical University of South Carolina.  (2005). TF-CBT-Web. http://tfcbt.musc.edu/