Pamantasan ng Lungsod ng Maynila Intramuros, Manila

Practicum II TREATMENT PLAN

In partial fulfillment for this semester under the subject Practicum II

Christine Anthea C. Gonzales

05 March 2014

I.

Identifying Information Name: Sex: Chronological Age: Birth: Address: Contact Number: Present Working Impression: Referring Physician: J. Conol Male 9 years, 7 months and 10 days July 24, 2004 Paraaque 0910922**** Post Traumatic Stress Disorder secondary to Physical and Sexual Abuse Anne Kristine Silang, MD

II.

Personal Background Family History and Domestic Environment Mr. Conol is the only child of Lourdes (44) and Lorenzo (46). His mother and father were separated years ago hence he is now currently living with his mother alone in Paranaque. Her father physically and sexually abused him when he was about 4-5 years old. His mother admits that when Mr. Conol was 1-2 years old he was also maltreated by their former housemaid. His mother is a social worker. His father no longer lives with them thus he is compelled to go with his mother at work therefore having absences in school or he is left alone at home with neighbours watching over him. His mother disciplines him only by giving a sermon and asking his compliance to a good behaviour. Her mother stated that she never beats her son. Significant Health History Mr. Conol was born normal and was hospitalized before due to Pneumonia. He also experienced having measles at the age of 2 and mumps when he was 5 years old. He also has no apparent hearing, sight and speech problems. Furthermore he has normal eating habits though sleep patterns are irregular. He is currently undergoing special services under rehabilitation medicine which are psychotherapy and play therapy. Behavioral and Emotional History Mr. Conol is an obedient and caring child. He has special attention and love for his mother. He immediately listens when he is being lectured. When asked about on his father, he keeps quiet most of the time and was indifferent though he is aware of his resentment and fear towards his father. Furthermore, whenever Mr. Conol gets into a fight at school, he does not accept defeat and tends to get even. He is easy to be pushed over by his classmates and therefore does not have friends to consider except at home with his cousin and his best friend.

Social and Educational History He was enrolled at San Antonio Elementary School as a Grade 3 student despite of being intimidated by his classmates he still looks happy and as if like nothing had happened. He is mostly preoccupied playing with his toys and watching the television. Also, he was often being intimidated by his classmates therefore leading him to arguments and immediate physical aggression.

III.

Key Points An exposure to a traumatic event during which someone feels fear, helplessness or horror thus re-experiencing the event through memories and nightmares. (American Psychiatry Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV-TR), 2000). The following criterion is positive in Mr. Conols case: 1. The person experienced and witnessed an event that involves actual threat to the physical integrity of self. 2. The persons response involved fear, helplessness and horror. 3. Recurrent and intrusive distressing recollections of the event shown by his repetitive play. 4. Recurrent distressing dreams of the event. 5. Efforts to avoid activities, places or people that arouse recollections in the trauma. 6. Markedly diminish interest or participation in significant activities. 7. Efforts to avoid thoughts, feelings or conversations associated with the trauma. 8. Difficulty staying asleep. 9. Irritability or outbursts of anger.

IV.

Diagnosis Based on the evaluation it suggests that Mr. Conol has adequate adaptive skills and intellectual capability as evidenced by the tests. His intellectual capacity is of average level. His psychological functioning still manifests feelings of anxiety, fear and emotional isolation among his relationship among his peers. It is highly likely possible that he may show problems in coping, functioning and even performing capably in his community. His personality profile reveals that it is likely possible that he may show problems in interacting and establishing good rapport with his friends and colleagues. He displays characteristic restriction and numbness of emotional responsiveness was seen that may hinder his socio-emotional growth. With these observations, the evaluation would agree in diagnosing Posttraumatic Stress Disorder.

V.

Treatment Plan A. Goals Relive emotional trauma to relieve emotional suffering. Improve social and interpersonal relationships that may aid in repressed emotions. Ease the tension and anxiety brought about by his condition. B. Counseling Approach Rational Emotive Behavior Therapy (REBT), a Cognitive Behavior Therapy is to be used as a counseling approach. REBT is to be used for Mr. Conol in order to minimize emotional disturbance and self-defeating behaviors by learning that life can be bearable and that even suffering is honorable. Teach him to deal with self-statements so that negative assumptions about the trauma are to be corrected, modifying his thinking and minimize irrational beliefs. Stress to him that he is presently disturbed by events and still acting upon self-defeating view of his self. A-B-C framework is also a useful tool for understanding the clients feelings, thoughts, events and behavior (Wolfe, 2007). Disputing the belief that was from the existence of an activating event, hence leading to an emotional consequence that has an effect on the individual therefore creating a feeling or emotion. Also, Play Therapy is to be used for a more child-friendly approach that will help in regulating his decision-making skills and coordination with his feelings and Family Therapy for maintenance at home that will be invoked by family members on his emotion and behavior that can influence cognition to improve his behavior. C. Intervention Program/Treatment Methods These techniques are also encouraged in Mr. Conols case: Role Playing. This has emotive, cognitive and behavioral components. He is advised to create disturbances facilitated by the practitioner and rehearse certain behaviors to bring out what he felt in the situation in order to work through underlying irrational beliefs about oneself that are related to unpleasant feelings. Shame-attacking Exercises. Emotional disturbance related to self as shown by guilt, anxiety and depression. Aimed to self-acceptance and to help him work on his behaviors and thinking so that he will no feel ashamed or humiliated. Recommendation: Mr. Conol is advised to continue his schooling in a more social-friendly environment as much as possible as it would improve his interacting skills.

He is also advised to continue his Play Therapy session to improve his coordination and associative skills that might be helpful in dealing with situations that needs interaction. Games and puzzle activities with another playmate may be utilized in this therapy. He is advised to undergo behavioural modification techniques to improve stress management relating to explosive emotions and aggressive tendencies. Engagement into interactive activities with other children or people should be promoted to help improve his socialization skills and interpersonal relationships. Training and support of the family, particularly Family Therapy must be used in his home to improve his behavior. As a parent, encourage and support him regarding his views in life. Add more advices and in relation to his preferences in life. The caregivers are also encouraged to let him do his work independently including decision-making activities and activities that may include socializing with others to cut back on individual acts (i.e. playing on his own, video games, etc.)

Note: This is a 10-week therapeutic process. Changes in timeframe depends on the progress that client will show.

Prepared by:

Christine Anthea Gonzales Psychology Intern Rehabilitation Medicine, UP-PGH Pamantasan ng Lungsod ng Maynila