homework due Saturday using the intervention of therapy role play !!! research paper 2-4 pages APA paper format with research

Running head: CASE STUDY OF DEENA 1

Intervention Paper: Case Study of Deena

Student Name

Southern New Hampshire University

CASE STUDY OF DEENA 2

Description of Intervention

In “Treatment of Reactive Attachment Disorder in Young Children: Importance of

Understanding Emotional Dynamics,” author Lin Shi of the Marriage and Family Therapy

program at Northern Illinois University, DeKalb, Illinois, describes an attachment informed,

three-stage treatment program. “The essence of attachment informed therapy lies in the provision

of a safe haven and secure base, that is, the rebuilding of human connections” (Shi, 2014, p. 4).

This intervention consisted of key elements as follows: the therapist working on the emotional

challenges rather than starting with behavioral; a commitment to a challenging, tiring, emotional

16 session program by the therapist; a committed, involved parent; access to funding, reduced

rates; and the three stages approach. The first stage is creating a “safe haven” space, in this case

study, a play therapy room, where the therapist and the child worked on attachment for sessions

one to three. Expected setbacks occurred in between sessions and at sessions as the child

absorbed the new surroundings, people, connections and began working on emotions. In the

second stage, the purpose is to facilitate mother-child attachment interaction, through the play

and guided by the therapist; this is for sessions 4 through 9. In between sessions, the foster

mother ensured she spent 10 minutes daily of one-on-one time with “Tom,” the 4-year-old boy in

her care. In the third stage, the purpose is to strengthen the mother-child attachment interaction

for sessions 10 through 16. The primary role is turned over to the mother.

Limitations or considerations to use of this intervention are as follows. “The most critical

pieces …were a committed therapist and parental figure, and a relatively stable living

environment” (Shi, 2014, p. 12). So, the committed, attachment-focused therapist is key, as is

the therapist’s own self-care due to the complexity and the emotional nature of the work, where

setbacks are to be expected, but are part of the child’s growth curve, too. The parent’s intimate

CASE STUDY OF DEENA 3

involvement and the parent’s own mental health, availability, secure sense of intimacy and

attachment are key. The ability to fund 16 sessions is a potential limitation. The last limitation is

where the foster child is in the foster system. If he/she is likely to be moved soon, that presents

another attachment “failure” on the system’s part, so this therapy would not be introduced then.

The child can become retraumatized and the chances of finishing the 16 sessions, with the

requisite parental support are slim.

Rationale

This intervention would be appropriate for Deena for the following reasons. She has been

diagnosed with RAD and PTSD, resulting from her first 18 months with her family of origin,

where neglect and abuse were constant. One example was her mother who used sedatives for

Deena as her babysitter. Another is how easily she gave up Deena, not arguing the decision for

Deena to be moved to foster care. Deena exhibits some key behaviors which the young boy did

in the case study: low frustration tolerance, language issues, low trust in herself, significant trust

issues with others, a struggle to connect, and emotional outbursts. When in treatment, Deena

would have a caring environment with parents who would likely be involved in treatment and do

the in between session work. Also, she finally seems to be in a foster family which is more

similar culturally and economically, a family who seems to want to work with her. She has

experienced “consistency of care” with this family and has been with them longer than any other

foster family. This is as opposed to the six other foster homes she has been in for short durations

in her 3 years of age, with the first 18 months in her own family of origin. Her therapist would

need to be committed, have good self-care, work from an attachment versus behavioral

perspective and know play therapy.

CASE STUDY OF DEENA 4

Explanation of Support

We would need a play therapy space, a “safe haven” we could create. We would need a

variety of toys, so Deena could choose what we played with as we got to know each other and

got closer over time. I would also need to be a therapist with some play therapy experience,

though the key is that I really understand attachment theory. This is so that I would have the

experience, patience, emotional tolerance and instincts to know when to move towards or away

from Deena, physically and emotionally. In the case study, only one parent was involved, the

mother; I’m not sure if that was by choice (e.g., mother as primary attachment figure) or not. In

Deena’s case, we have a mother, father and a young son. I would start with the mother since that

is what Erikson’s theory of development stages would say as well as attachment theories. The

mother and I would need to talk about her own family to ensure there were no significant family

attachment issues, and I would want to be aware of mental health conditions she might have, as

we partner together. I also would want to work with the father and the son on how to “be” with

Deena when she was at home, so to educate them on how to support the efforts and not

unintentionally sabotage the good work of the mother and the therapist. At some point, if Deena

could handle it, I would attempt to have all of her family in the therapy room together, which is

how it would be once she went home after therapy was done. I would set up a less frequent

schedule to maintain their progress as an aftercare program and to show Deena that attachments

can last, such as hers and mine.

Future Applications

I could see using this approach not only for young children with attachment disorders, but

for people of any age with trauma, or people with any language or verbal issues. The play seems

CASE STUDY OF DEENA 5

to be almost a diversion, to lower the frustration level with fun things to do. It allows the child to

relax and be more open to connecting, over time of course. I’ve read about wilderness programs

for adolescents, or therapy while walking because of the diverted focus, which allows people to

open up; plus, with nature, we know being outside is clearing and creative for the brain. I could

also see this type of treatment being handled in a residential center for adolescents, not a hospital

which sometimes would not be perceived as a “safe haven,” but a private center in the mountains

for example. The key part of this is that the therapist approaches the treatment not with a

behavioral lens, but with attachment disorder as the lens. I suppose that would be like a client

with PTSD not reliving the trauma during treatment but learning a safe way to talk about it, with

an adult version of play and creative therapy (art, nature, music, walking, painting, etc.).

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References

Shi, L. M. (2014). Treatment of reactive attachment disorder in young children: Importance of

understanding emotional dynamics. The American Journal of Family Therapy, 42, 1-13.

doi:10.1080/01926187.2013.763513