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Answer the following questions. Please include information from the class, including the readings in your answers.Please see notes in bold on the bottom of this page-these are notes which need to be implemented into questions a and b. Also these two questions carry most of the points. The following client sees you in your office: A Puerto Rican family with a 12 year-old boy (Luke) comes to see you in your clinic complaining that Luke’s motivation in school is low and that he is excessively impulsive. He was recently suspended for three days for saying he was going to rape a girl at school. Prior to this, he has been found viewing “extreme” pornography on several occasions. His parents have put security on the computer to prevent access to indecent material, but he has figured out ways to get around this. He has explosive anger when confronted. While he has not been violent toward anyone, he will yell and make threats of violence toward his parents and others. Because he is big for his age, he can be intimidating. In addition, his grades have been failing to barely passing. He has a history of struggling academically since he began school and has been required to spend more time on assignments than other students. However, it became worse when he entered the sixth grade and a permanent substitute teacher was assigned to his class. It is a result of the suspension that his parents would like to work on both his anger and impulsive pornography viewing. In addition, recently, his mother found a note in notebook in his room in which he has detailed drawings of sex acts with names of girls at his school under them. It is perceived by the family that the new teacher is unfairly singling out Luke for minor behaviors, as well as his academic difficultly. The teacher is an ex-Chicago police officer and is “rigid” in classroom discipline. She holds high standards for the class. It is seen that she is unwilling to compromise or “attempt to understand Luke’s situation.” Luke has several classmates who appear to look up to him. He has a stoic presentation that frustrates the teachers during disciplining, but seems to earn him respect from other students. Luke lives with his biological parents and 17-year-old brother. Luke’s parents have been to marital counseling and have had a difficult marriage for several years. (Their arguments concern the father’s lack of motivation in their relationship. While he appears to have strong emotional feelings for his wife, he does little initiation of activities, both in taking her out or initiating intimacy in the home. Despite the wife expressing much anger at this, he does not change. He believes that she is too pushy and negative. A recent fight: he took a week off from work. She wanted to spend time together and do things. He built her a patio so she could enjoy being outside. She was upset and he thought when she got use of it, she’d be thankful) Luke’s mother stays at home and his father is a truck driver for a local balery. His hours are early, from 3 am to 11 am. He is very tired when home during the day and mostly sleeps and watches TV. His mother wants “more of a family life” and pushes him to spend more time with their sons. He makes fleeting efforts, but has low energy and rapidly discontinues the effort. His mother has lupus and pulmonary hypertension, and is frequently symptomatic. Luke shows no interest in other activities. He is large and, in the past, has shown interest in sports. Recently, he had an opportunity to play football, but chose not to without explaining further. His mother believes that this was done to “spite” her so she kept pushing him to do it. This just got him angrier and he threatened violence to get her to stop. In the home, fights between his mother and Luke occur daily in an effort to get him to study and do his homework “properly” (he can be sloppy and careless in his efforts). It is stated that Luke would play his game system all day if he could. The video games and the TV are frequently taken away from him as a result of his not stopping using them when asked to finish the homework. Luke sees everything as being taken away from him and when positive reinforcements were suggested he stated, “it wouldn’t matter, they’d also be taken away.” He is close to failing this grade, but he does not show anxiety. He appears apathetic. With regard to the pornography viewing, he only is known to do this on the computer (the family has only one placed in a central area of the house) and at night when his parents are sleeping. He provides little information about this behavior and appears embarrassed. He stated it started over a year ago when an older friend showed him a website and he has been visiting these sites regularly since. He states that he knows it makes his mother upset, but he gets “urges”. He reports he often thinks about it when bored or stressed, but the urge is very strong at night, particularly when he hears snoring and he knows his parents are asleep. His parents have said they have found him looking at extremely graphic and violent images and are very disturbed by the excessiveness this activity. When asked what he would like out of therapy, Luke just shrugs and says, “I am only here because I have to be here”. Based on this limited information, do the following: One Paragraph each question! a) Make a formulation of his impulsive behaviors and problematic anger behavior from the cognitive-behavioral perspective, including suspected causal and maintaining variables. Include a discussion in how operant conditioning is relevant to development and maintenance, include evidence that you have read material. What further information do you need for this formulation? b) Create a treatment plan using specific treatment strategies and discuss why you chose this plan and these strategies. Because motivation for therapy may be low, also discuss how you would compensate for that weakness. c) Treating adolescents who come involuntarily in individual sessions can be difficult. How can dialectical (include a discussion of what dialectics are) strategies be useful in these contexts? Give an example of a dialectical strategy (not behavioral or cognitive) and apply it to this case. d) Make a brief formulation of the marital distress (ie. 3 formulations). Because you know very little about this case, this formulation is expected to be brief and speculative. e) Unrelated to the above case: Briefly explain the cognitive formulation of positive symptoms of schizophrenia (delusions and hallucinations) and compare and contrast it to the cognitive formulation of personality disorders (not Linehan’s model). Note, only one paragraph. Here are notes on Anger and Impulse: ANGER-Compliance vs power= less emotion and stay focused on value being thought. Gain authority with consistency. Generalization; vary the setting of the operant. Incidental modeling: how we show problem solving, frustration management. Children: random disruption of perceived reward. Pervasive Anger: Event trigger-something happened, perceived injustice. Attribute to unfairness, blamable, intentional. Changes in Physiology-anger continues. Anger vs Frustration: Anger-you have someone to blame. Frustration is similar to disappointment. IMPULSE-being interested in immediate consequences rather than in long run. Provide immediate gratification despite the known consequences. Urge to engage is classically conditioned. Voluntary behavior is reinforced. Repetition of behavior maintains the learning by repeated connection to the context and then generalizing it. Lack of motivation to stop or lack of skills to stop urge (overcome urge)

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