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JS is a 7-year-old Caucasian male in the second grade. He resides in two households with his divorced parents who share equal custody of him and his younger sister, age 5.
JS was referred by his teacher for bullying behavior that includes calling his peers names, wishing they were dead and hitting, chasing and threatening to hurt them. Teacher reports that at least two parents of peers have complained that JS has “stalked” their children, refusing to leave them alone and continuing to torment them with bullying behavior in spite of their efforts to avoid him. Teacher also reports JS refusal to follow directions/heed warnings, start or complete work, bullying/oppositional and conflict-seeking behavior and denial of personal responsibility. She reports that he continuously insists that he is being unfairly blamed, targeted and persecuted. Both parents report chronic lying and daily behaviors that include: refusing to follow their directions and teasing/hitting his sister. They deny incidents of “tantrums” and report that he seems “unperturbed” by negative consequences (that include occasional spankings), suggesting that his crying is an act designed to manipulate them. Both teacher and parents express worry that JS seems to lack empathy and that he has no friends. Parents both report that JS has difficulty falling and staying sleep, often awakening in the middle of the night. Finally, both parents and teacher report a drastic and short-lived improvement of his behavior after his mother recently threatened to send him to what he reported to the social work intern as a “boring school”, a place he described (based on his mother’s explanation) as “a faraway place where you can live with bad children and have to dig up your own food from the ground and you can’t see or call your parents and there is no TV or video games.”
Current (During time of Intake) and Historical Information
Parents report no complications at birth and that he met all age-appropriate physical/cognitive milestones. They report no problems with toilet training and that he developed and currently demonstrates all age appropriate activities of daily living. Teacher reports that the bullying behavior started in the previous year in first grade and that peers have been removed from JS’s class at the request of their concerned parents during this year and last. Parents report that behaviors at home and difficulty with sleep started when JS was about 4 years old. JS has complained of having no friends since kindergarten. Significant historical events:
- Mother’s diagnosis of stage-4 breast cancer that threatened her unborn child (JS’s sister) when he was three years old
- Parent’s divorce when he was 5 and a half years old
- Deaths of paternal and maternal grandfathers (at age 5 and 6)
JS’s father reports that when JS was age 2-3 years, his mother was “mostly absent” as she received cancer treatment and that as baby and mother survived. JS’s father reports that his wife felt he had not adequately met her physical and emotional needs during her health crises, which combined with her excessive alcohol consumption, precipitated the decline of their marriage. Both parents report that JS witnessed at least two incidents of domestic violence that resulted in police intervention at the home. JS reports that both parents “fall asleep” sometimes after drinking “grown up drinks”. During interviews, both parents engaged in critical, blame-placing pattern going back and forth with each other. JS reports same pattern of interaction during custody-related-drop-offs. Both parents are devout Roman Catholics and their church is an important spiritual/social resource from them/JS. Father reports that JS “seemed unphased” by the deaths of his grandfathers (with whom he had close relationships) but suggested that their family’s religious beliefs “might be a support”. JS received therapeutic services for 4 months following his mother’s move into a separate household when he was 6 years old and he received 9 months of school-based social work services that consisted of weekly 30-minute sessions during the prior year.
Clinton Elementary School
The Elementary School Social Work program services all of the elementary school schools in the South Orange/Maplewood school district. Last year I was assigned to Clinton Elementary School located in Maplewood, NJ. The school is an ELL/ESL magnet school therefore most of the students who are new to the district and/or need assistance with English as a second language are automatically sent to Clinton. The grades include Kindergarten to 5th grade. My initial observation is that of a large population of Caucasians. There is also a strong presence of African American, Asians, and very little Latinos. There are also a large number of students who are multiracial. With regards to social economic status, some children live in the higher income location of South Orange while other students live in the mid to low income location of Maplewood. There are also a few children in special education classes and one student who is physically disabled.
My role as social work intern was to support and work together with students, parents, teachers, on-site social worker, as well as the intern/s we are paired with at the appointed school. Individually, my role was to support the school social worker by providing individual social/emotional skills-based services to students K-5. I also conducted group sessions with students covering various topics from play groups, to friendship groups, and divorce groups. In terms of working with the families of the students, my role was to assist in creating behavioral plans with the parents that would meet their needs as well as the students. The key goal with families was to communicate with them in order to achieve the best results for the student. Additionally, my role with the school community was to continue supporting the idea of normalizing the services available at the school which is available to every single student.
My work as a social work intern was impacted by the agency in that students could only be treated thought a framework of “skills-based” social work protocol of a school setting. Individual sessions were limited to no more than 30 minutes, once a week (unless otherwise discussed by administrators and/or recommended by teachers). Additionally, in this specific school setting not every teacher was trained to work with students who have specific social and emotional needs. Therefore, my work with JS was limited when working with his teacher because although she was cooperative she was untrained making her unable to reinforce skills we worked on during sessions.
John Bowlby’s Attachment Theory discusses the idea that early relationships in a child’s life that are both warm and satisfying lead a child to develop a more positive social and emotional ability which allows them to build positive relationships with others (Butcher & Gersch, 2014). For example, Walsh (2013) discusses avoidant attachment in a child and describes it as a parent/infant attachment in which a child is not disturbed when the caregiver is present or not, in this attachment style a child may seek to be close to the caregiver even though the caregiver may reject them. This attachment style forms a child into an individual that suppresses certain feelings of distress in order to not go through an overwhelming experience again (Walsh, 2013). From an attachment theory perspective, the nature of JS’s presenting problems could have been the results of abrupt and extended separation from his mother (associated with her cancer treatment) from age 2-4 which may have interfered with normal/healthy attachment. In other words, JS may have not been able to have his emotional needs met during this specific period of time causing him to develop an avoidant attachment. Additionally, the trauma of losing his mother at a critical developmental time may have disrupted his ability to develop trusting relationships, which in turn, may be driving his antisocial behavior (bullying).
Attachment Theory Intervention Model
JS is a 7-year-old Caucasian male in the second grade. He resides in two households with his divorced parents who share equal custody of him and his younger sister, age 5. When JS was between the ages of 2-3 years, his mother was “mostly absent” in order to receive stage-4 breast cancer treatment. The attachment formed between JS and his mother were assessed to determine JS’s attachment style in an effort to implement the most appropriate interventions that would allow us to set reach the set goals.
The goals of treatment from an attachment perspective for JS were to build interpersonal competencies and reduce reactivity in order to target JS’s anger, anxiety, and low self-esteem.
Internalized symptoms and behaviors were addressed by working on attachment needs, self-esteem, and emotion regulation. This was done through the use of two interventions: play therapy and mindfulness.
Schultz (2016) describes child play therapy as a form of therapy that provides a child with a secure environment which allows the child to freely express themselves by guiding their own experience through decision making. In an effort to improve JS’s self-esteem, child play therapy was used as it allowed JS to experience a safe, non-verbal (at times), symbolic language for communication/disclosure. JS was able to identify with toy trucks, animal figures, and colorful stones which allowed for discovery/expression of “self”. Additionally, during certain sessions JS found himself having to problem solve specific “toy malfunctions” such as having to reposition them individually. Cultivating the ability to make his own decisions as well as being in a safe non-judgmental environment allowed JS to feel more secure about the decisions he made. Using child play therapy was used as an intervention because the physical office space allowed for such intervention to be provided and it was also an intervention that could be continued with JS’s social work intern for the following school year.
Iacona & Johnson (2018) describe mindfulness as a state of awareness of one’s presence through activities such as breathing, thoughts, emotions, and sensations, all of which occur in a non -judgmental environment. In an effort to improve JS’s state of awareness when in difficult and complex bullying related situations mindfulness exercises were practiced during every session. For example, for the first 4-5 sessions, JS was asked to “Name one thing you are proud of and one thing you are grateful for”. This exercise allowed JS to process daily thoughts and have a more positive outlook while being in school. JS eventually began to implement the exercise into his daily routine with the help of his teacher. Using mindfulness as an intervention was chosen because research shows that some outcomes of practicing mindfulness result in decreasing anxiety, stress, and hostility (Iacona & Johnson, 2018). Additionally, mindfulness was used as an intervention because it fell under the category of what the agency considered “school based social skills” and it was a transferable skill that could continue to be worked on by the social work intern who would work with JS the following school year.
According to Walsh (2013) Cognitive Theory discusses the idea that an individual’s way of thinking is developed through environmental experiences, which are then evaluated in order to decide how to act. The theory also argues that “emotions” are psychosomatic reactions to feelings felt throughout the evaluation process. For example, an occurrence produces a specific way of thinking about that occurrence which then leads either to a feeling or an act (Walsh, 2013). From a cognitive theory perspective, JS’s exposure to environmental factors such as domestic violence and continued exposure to parental conflict may be correlated with some internalized and externalized symptoms and behaviors. All of which resulted in JS’s rigid thinking pattern which include multiple cognitive distortions. Therefore, JS believes that peers are mean, anticipates rejection and responds defensively. JS reports his behavior is necessary “to control” or “punish” others for being mean. Addresses conflicts but stating “they started it” (argues that conflicts always start with others) and practices a lot of self-victimization.
Cognitive Theory Intervention Model
JS is a 7-year-old Caucasian male in the second grade. He resides in two households with his divorced parents who share equal custody of him and his younger sister, age 5. Parent’s divorced when he was 5 and a half years old. JS’s parents report that JS witnessed at least two incidents of domestic violence that resulted in police intervention at the home. JS reports that both parents “fall asleep” sometimes after drinking “grown up drinks”. During interviews, both parents engaged in critical, blame-placing pattern going back and forth with each other. JS reports same pattern of interaction during custody-related-drop-offs. JS’s experiences of his evaluation and emotion and/or actions to specific situations were assessed to determine JS’s cognitive thought process in an effort to implement the most appropriate interventions that would allow us to set reach the set goals.
The goals of treatment from a cognitive perspective for JS were to increase pro-social behaviors and reduce antisocial behaviors.
Pro-social behaviors were addressed by working on fostering healthier social perceptions and by teaching emotional/behavioral regulation skills. This was done through the use of two interventions: bibliotherapy and Dialectal Behavioral Therapy worksheets and role-plays.
Heath, Prater, & Dyches (2011) describe bibliotherapy as a form of reading a carefully selected book that applies a specific lesson to be learned in order to build on the story’s message. In an effort to improve JS’s pro-social behaviors, bibliotherapy was used in the format of social stories that discouraged bullying and celebrated/modeled kindness with his peers. Research has shown an improved emotional investment and insight of personal situations when using bibliotherapy with a client (Heath et al., 2011). For example, during bibliotherapy sessions, JS was able to describe specific bullying behaviors that he was responsible of, as the story continued, JS was able to identify his role in similar life situations and expressed remorse and followed along with alternatives to bullying behavior. Bibliotherapy was used as an intervention because it fell under the category of what the program considered “school based social skills” and the school was able to provide with books related to bullying accessible through the school library.
Ziraki and Hassan (2017) describe Dialectical Behavioral Therapy (DBT) as a cognitive-behavioral approach which allows a therapist and the client to set specific goals that are important to the client (in JS’s case important to his pro-social behavior in school) by minimizing unwanted behavior (in JS’s case hurtful and harmful behavior – e.g. bullying) and replacing the behavior with behaviors that have positive effects in the client’s life. According to Ziraki and Hassna’s (2017) research, there is a significant difference between individuals who bully and receive DBT versus those who do not receive DBT– individuals who receive DBT are more likely to hold higher tolerance of distress and are able to regulate their emotions which reduces behaviors that are impulsive and caused by angry thoughts and feelings. In JS’s case, DBT was used as an intervention in order to teach emotional/behavioral regulation skills. This was done through DBT worksheets provided by my supervisor that allowed JS to practice soothing skills. For example, a breathing star worksheet was used during every session in an effort to teach JS how to breathe when he would find himself upset or angry (ready to bully a student). Additionally, distress tolerance was taught to JS through the use of role plays both in individual and group sessions. DBT was used as an intervention because it allowed me as social work intern to experiment with DBT and explore different therapeutic alternatives for JS in an effort to help fill his toolbox of essential skills.
Assessment of Intervention Approaches
The above information provided for JS’s case were real-life theories and interventions that were put in place in order to support JS during the 2017-2018 school year. From the attachment theory perspective, a strength for JS’s case was that our assumption of his attachment style allowed for us to explore with JS specific unmet needs that needed to be addressed. Using attachment theory, we are able to measure his unmet needs which included desire for food/sweets, ability to enjoy therapeutic activity without distraction of craving/reward, increase eye contact, and positive mood/affect. The tool used to measure his unmet needs were session notes and parent/teacher reports. A weakness to this approach was that although we determined a specific attachment style based on the information provided, it is our understanding that both parents had more information that they were not willing to provide us with – specifically pertaining to JS’s mother’s involvement with JS before she left the household for medical treatment. In other words, there is a possibility that the attachment style may be different, and we will never know.
Furthermore, from the cognitive theory perspective, a strength for JS’s case was that we were able to determine specific cognitive distortions and related them to his behavior based on detailed experiences JS went through as reported by both parents. Using, a cognitive theory approach allowed us to reduce cognitive distortions and improve JS’s ability to reframe specific thoughts. A weakness to this approach was that although certain cognitive distortions and behaviors were either reduced or reframes JS’s thought process was not visible. JS’s would report his feelings through words, play, and art but it was unclear as to whether or not his changed behavior was due to our interventions or physical and emotional maturation.
SJ’s progress based on the interventions – before the school year was completed, SJ did not make much progress in terms of his bullying behavior and emotion regulation. SJ continued to emotionally and physically bully his classmates. During play therapy, SJ began to refuse any play initiation unless he would be provided with sweets/rewards. SJ was able to demonstrate knowledge of calm-down mindfulness exercises but was not able to use them in real-life situations. In terms of his cognitive distortions, SJ was able to improve his word phrasing from “always” to “sometimes”. SJ was able to cite specific examples of kindness during bibliotherapy and role playing however he was unable to put them in action. Finally, JS’s distress tolerance slightly improved as he was able to accept changes in schedules and was able to accept limits.
- Butcher, R. L., & Gersch, I. S. (2014). Parental experiences of the “Time Together” home visiting intervention: An Attachment Theory perspective. Educational Psychology in Practice,30(1), 1-18. doi:10.1080/02667363.2013.867254
- Heath, M. A., Ph.D, Prater, M. A., Ph.D, & Dyches, T. T., Ed. D. (2011). Portrayals of Bullying in Children’s Picture Books and Implications for Bibliotherapy. Reading Horizons,51.2, 119-138.
- Iacona, J., & Johnson, S. (2018). Neurobiology of Trauma and Mindfulness for Children. Journal of Trauma Nursing, 25(3), 187-191. doi:10.1097/jtn.0000000000000365
- Schultz, W. (2016). Child-Centered Play Therapy. Reasons Papers,38(1), 21-37.
- Walsh, J. (2013). Theories for direct social work practice (pp. 88-89). Stamford, CT: Cengage. Chapter 5.
- Walsh, J. (2013). Theories for direct social work practice (pp. 171-197). Stamford, CT: Cengage. Chapter 8.
- Ziraki, F. P., & Hassan, T. (2017). Investigating the Effectiveness of Dialectical Behavior Therapy in Clinical Symptoms, Anger Control and Emotional Regulation of Bully Children. International Journal of Clinical Medicine,08(04), 277-292. doi:10.4236/ijcm.2017.84027
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