This paper includes a brief analysis of the intervention aimed at addressing the needs of a rape victim. The 14-year-old African American female exhibited delinquent behavior and depression symptoms. The therapy included elements of CBT, motivational interviewing, and play therapy. The major goals of the treatment were achieved and the girl reveals a positive attitude towards the treatment and its effects. However, there are certain limitations as the child still feels she has no control over her life. Although the caregiver received certain training on addressing issues that may occur, additional treatment might be needed in the future.
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The target child (TC) is an African American female at the age of 14. The TC was raped by her maternal grandfather, and the child was placed with her paternal grandparents. The paternal grandmother addressed the corresponding facility reporting that the TC exhibited delinquent behavior and tended to alienate everyone. The child is diagnosed with post-traumatic stress disorder (PSTD). The significant goals of the treatment are reducing depression symptoms and reducing delinquent behavior of the TC.
It is necessary to note that PTSD is often associated with depression symptoms and delinquent behavior. Schottenbauer, Glass, Arnkoff, and Gray (2008) state that people suffering from PTSD often have a feeling of alienation, hostility, and depression. Depression symptoms include feeling helplessness, loss of interest in anything, sleep changes, irritability, self-loathing, anger (James & Gilliland, 2012). This psychological state often leads to delinquent behavior (Baldwin et al., 2014).
Such behavior is often a result of the child’s desire to avoid unpleasant memories and distress though sometimes they are trying to receive certain status among their peers, which is also a compensation for their lowered self-esteem (Cohen, Berliner & Mannarino, 2010). The TC is likely to exhibit delinquent behavior to avoid unpleasant memories. This behavior is also a result of depression symptoms that include anger, irritability, sleep problems, etc.
It is necessary to note that the intervention consists of several components and techniques. It includes CBT, motivational interviewing, as well as elements of play therapy. Researchers state that the effectiveness of CBT in treating depression and PTSD has been acknowledged (Lau, Hilbert & Gregory, 2013).
This approach is goal-oriented, and it helps the client to address the issues he/she faces. This approach enables the therapist to focus on the client’s relationships with the therapist and other people (Schottenbauer et al., 2008). It also helps the client accept the situation instead of trying to avoid the memories and thinking about it. The treatment helps in addressing delinquent behavior, as the client understands that such behavior does not help to address the problem and is associated with numerous negative effects (James & Gilliland, 2012).
Importantly, this type of treatment also includes interaction with parents or caregivers who are trained to address the issues they might face (Gospodarevskaya & Segal, 2012). During sessions, caregivers obtain the necessary parenting skills. Therefore, it is possible to note that CBT is a complex and flexible approach that is effective in treating people suffering from PTSD. The holistic approach of the treatment helps the client integrate effectively into the community.
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As for another component of the treatment, it is possible to use motivational interviewing. This approach is especially beneficial when the therapist needs to address certain resistance of the client (Glick, 2014). Although it was developed as a technique to treat addiction, it is very effective when there is a need to change the behavior of the client. One of the major goals of the approach is to motivate the client to change his/her behavior.
Finally, play therapy can also become a component of the treatment in the present case. James and Gilliland (2012) stress that this type of treatment can help the client (especially a child or adolescent) to address the issues without even making any effort. The client finds solutions and tends to adopt desired behavioral patterns during the play.
Method and Design
The present study is longitudinal, and it will last six weeks. It is a quantitative design. A study-design measure consisting of 13 items can help identify and evaluate the outcomes of the treatment. Two measures should be taken to evaluate the treatment (baseline and secondary). As has been mentioned above, the TC is a 14-year-old African American female that is now living with her paternal grandparents. She has issues with her biological mother. The TYC exhibits delinquent behavior and has developed depression symptoms.
The 13 items mentioned above focus on TC’s ideas and attitudes towards her experiences, treatment, and relationships with others. The measurement also includes TC’s reflection on the way she can control things in her life.
The data were collected during discussions with the TC and her grandmother. The therapist recorded the discussions. The recorded discussions were periodically analyzed to evaluate the progress of the TC and the effectiveness of the treatment.
Data Analysis and Findings
The treatment can be regarded as effective as the therapist managed to achieve significant goals. TC’s depression symptoms decreased, and the behavior was changed. It is possible to note that the TC has adopted a healthier view on the experience (see fig. 1). Thus, the TC is now able to effectively deal with her feelings she can talk about her experience with the therapist or close ones, she also understands the way she feels about the experience, her self-esteem has increased.
At the same time, it is necessary to note that some goals were not reached. The girl does not still feel comfortable with the choices she makes, which shows a lack of control. At that, she admits that she feels there is this lack as thinks she cannot control her life. Importantly, TC’s baseline perceptions exhibited certain traces of healthy behavior. For instance, she acknowledged that the crime happened, she did not feel anger, did not put the responsibility on herself. It shows the TC’s readiness to deal with her psychological trauma effectively.
It is possible to note that motivational interviewing and play therapy was especially important for the TC’s ability to deal with her feelings and raising her self-esteem. The use of motivational interviewing and the CBT was beneficial for the development of the proper relationships (and creating rapport) between the TC and the therapist. The significant goals of the treatment were achieved as the TC’s depression symptoms decreased significantly and her behavior became appropriate.
Importantly, the results of the intervention show that it can be effectively used in similar cases. The therapist can use this approach when helping the client to deal with feelings and raising self-esteem. However, it is necessary to note that this treatment is insufficient for developing the client’s ability to take control of the client’s life.
On balance, it is possible to note that the treatment was successful as the major goals (reducing depression symptoms and delinquent behavior) were achieved. At the same time, there are certain limitations. Hence, there is a risk of relapse as the TC is still unable to take control over her life and the choices she makes. This suggests that she still feels quite insecure and can lead to the development of depression symptoms or delinquent behavior in the future. Of course, the treatment included training of the caregiver, which may help her to address the issues that may occur in the future. However, this may be insufficient for the TC.
The intervention had to be more focused on helping the TC to take control over her life and be more comfortable with the choices she makes. Motivational interviewing could focus on this goal, and the TC could acquire the necessary skills. It could also use play therapy with a specific focus on the control in the TC’s life.
Irrespective of these limitations, it is necessary to note that the treatment has proved to be effective as it addressed the main goals set. The TC is quite strong and has the stamina to cope with the problems she had to face. At the same time, if the TC or her caregiver will address professionals, the treatment will have to address the need to acquire skills to take control over one’s life.
Baldwin, D.S., Anderson, I.M., Nutt, D.J., Allgulander, C., Bandelow, B.,… Wittchen, H.U. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 28(5), 1-37.
Cohen, J.A., Berliner, L., Mannarino, A. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems. Child Abuse & Neglect, 34(15), 215-224.
James, R., & Gilliland, B. (2012). Crisis intervention strategies. Belmont, CA: Cengage Learning.
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Glick, J.L. (2014). Case study 1-7 effective interventions for adolescent conduct disorder in residential treatment. In C.W. LeCroy & E.K. Anthony (Eds.), Case studies in child, adolescent, and family treatment (pp. 110-130). Hoboken, NJ: John Wiley & Sons.
Gospodarevskaya, E., & Segal, L. (2012). Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children. Child and Adolescent Psychiatry and Mental Health, 6(15), 1-15.
Lau, J.Y.F., Hilbert, K., & Gregory, A.M. (2013). Anxiety and depression in young people: Developmental considerations. In P. Graham & S. Reynolds (Eds.), Cognitive behavior therapy for children and families (pp. 7-22). New York, NY: Cambridge University Press.
Schottenbauer, M.A., Glass, C.R., Arnkoff, D.B., & Gray, S.H. (2008). Trauma focused CBT for children with co-occurring trauma and behavior problems. Psychiatry, 71(1), 13-34.