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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
In Practical Psychotherapy With Adolescents, Dr. Alice K. Rubenstein demonstrates her approach to working with adolescent clients. Because of the complexity of their lives, adolescents often have difficulty describing their feelings and identifying the source of stressors. Dr. Rubenstein helps adolescent clients to identify their feelings and the factors contributing to the problems they are dealing with, and then helps brainstorm possible solutions. In this session, Dr. Rubenstein works with a 15-year-old boy with behavioral difficulties, family conflicts, and academic problems. She helps him find ways to reduce the tension with his father and address some of the problems he is having at school because of his recently diagnosed attention-deficit/hyperactivity disorder. This video features a client portrayed by an actor on the basis of actual case material. Precipitating Events The client, Jason, was referred to Dr. Rubenstein after a confrontation with a teacher in study hall that resulted in his suspension from school. The teacher had attempted to verbally discipline Jason, who was restless, talking loudly, and generally disrupting others who were trying to study. After several attempts to help him settle down by speaking to him from her seat, the teacher approached Jason and gently placed her hand on his arm. Jason stood up and impulsively pushed her arm away; the teacher lost her balance and fell. This was not the first time Jason had exhibited behavioral problems at school. Since he started junior high, his problems included disrupting classes repeatedly by "clowning off" and by being chronically late to class. Until sixth grade, his native intelligence had allowed him to maintain his grades, despite his difficulty concentrating in school and completing homework. In seventh and eighth grades, however, his grades declined; he began getting his first D's in some classes, and he failed one subject. Jason's mother blamed Jason's behavioral and academic problems on the marital separation, which had occurred when Jason was in seventh grade, and on Jason's father's rigidity and lack of empathy for Jason's pain. She admitted, however, that she couldn't "handle" Jason, so she agreed to the father having custody of him. Jason's father, in turn, blamed Jason's problems on his mother's history of coddling him. After the incident in study hall, the vice principal suspended Jason from school, with his return conditional on results of a psychological evaluation. The vice principal, who had previously worked with Dr. Rubenstein, gave Jason's father her phone number as well as the names and numbers of several other psychologists. Jason's mother was informed of the study hall incident, suspension, and recommendation for psychological evaluation. Jason's father was reluctant to make the appointment for the evaluation. He saw psychological treatment as "too much talk and not enough action" and as a continuation of the mother's coddling. However, Jason's mother was enthusiastic about the idea. Jason insisted that he was not willing to see a "shrink," blaming the study hall incident on one of his friends and insisting that everybody was overreacting. After being home alone for 2 days on suspension, Jason was bored and lonely. Jason's father did not like leaving him home alone while he was at work because he didn't trust Jason. After 2 days, Jason's father called the school to try to convince them to let Jason return. The school administrator would only agree to do so if Jason had a scheduled, confirmed appointment with a psychologist. Jason's father reluctantly made the appointment and so informed Jason. Questions
Notes on Previous Sessions Session 1: Dr. Rubenstein spent the initial part of the first session acclimating Jason to the environment, including the snack room downstairs. Jason declined a snack. Dr. Rubenstein then described to Jason what she had been told about him and asked him what he thought she might do to help him. Jason responded by saying "get my father to stop grounding me and let me go to the Dave Matthews concert in 2 weeks." Dr. Rubenstein took this opportunity to ally with Jason by sharing her admiration of Dave Matthews, at which point Jason reconsidered getting a snack. As Jason ate his snack, Dr. Rubenstein introduced the idea of psychological testing, framing it as a way of "finding out why a smart kid like you are doing poorly academically and behaviorally in school." She described the testing as a potential means of finding out whether the school needs to be doing something different. She presented the testing as one choice for Jason to consider in dealing with his suspension from school and explained that a psychologist who was a friend of hers was available to do the testing. Dr. Rubenstein also introduced the therapeutic contract, which she described as "three strikes and I'm out." She told him that if, after three sessions, he didn't feel she could be of help, she would support his decision not to come to therapy. Jason agreed to both the testing and the three-session contract. Dr. Rubenstein also explained her rules about confidentiality: She would always tell Jason when she had contact with others about him, and she would not reveal the content of what they discussed in sessions together without checking with him first. Session 2: Jason arrived at the session having already visited the snack room. Dr. Rubenstein asked how his week had gone, but Jason was impatient to discuss the results of the psychological testing. Dr. Rubenstein described the results, summarizing with the comment that Jason is very bright but that the test results showed that he has attention-deficit disorder. She described the disorder and suggested that the diagnosis might explain why he's been having so much difficulty in school. Jason was interested and engaged as Dr. Rubenstein helped him see that some of his problems at home and at school were not the result of laziness or a lack of intelligence. She suggested that there were some actions they could consider together that might help him, including a possible trial on medication, a change in his class schedule and courses, and some adaptations to homework and testing. Dr. Rubenstein also offered Jason the option of her calling his father to suggest that because Jason was so cooperative with the testing, his father might terminate his grounding and let Jason go to the concert in exchange for doing tasks around the house. She also would suggest to his father that he buy Jason a membership at the local gym so that he could work off some of his energy after school before settling down to do homework. Jason readily agreed to the call, and Dr. Rubenstein contracted with him to "keep his act clean" for the next week. At the end of the session, Jason told Dr. Rubenstein that he had recently shoplifted some items at a local convenience store. Dr. Rubenstein responded by saying, "They must have been things you really wanted, or at least you really wanted to piss off Dad." Jason appeared relieved that Dr. Rubenstein was not going to violate his confidentiality and left the session on an upbeat note. Session 3: To be viewed. Questions
Stimulus Questions About the Session Dr. Rubenstein opens the session by asking, "How ya doing, kiddo?" as she and Jason walk into the office together.
Dr. Rubenstein adopts an informal and casual demeanor in her language, dress, and posture.
In the first few minutes of the session, Jason relates that he stole an airline ticket, that his father has discovered the theft and is angry, and that his father wants to discuss the incident with Jason and Dr. Rubenstein immediately. Dr. Rubenstein asks Jason whether he wants his father to join the session now. Jason replies that he does not want to see his father immediately. Dr. Rubenstein assents to his wish and says, "This is your time." She proceeds to the waiting room to talk to his father.
About 4 minutes into the session: Dr. Rubenstein establishes the treatment agenda for the session and the therapeutic contract in general (e.g., how to survive Dad). She warns that she will be unable to change the father's behavior and attitude to any appreciable degree.
Dr. Rubenstein characterizes Jason's mother and father as a "wimp" and a "tight ass," respectively.
About 17 minutes into the session, Dr. Rubenstein asks Jason whether his father's "coldness" was a reason for the parents' divorce. Jason replies by saying, "I don't want to talk about it." Dr. Rubenstein responds, "Message clear. I respect your limits. I will not bring that up. But I am available if you want to talk about it. Okay?"
For much of the session, Dr. Rubenstein negotiates the treatment contract and outlines her and Jason's respective responsibilities in working together as a team. This process entails a variety of alliance-building and commitment-enhancing methods.
In bringing the father into the session, Dr. Rubenstein alters her interpersonal and therapeutic style. She mediates a quid pro quo on some of the conflicts between Jason and his father, establishes mutual responsibilities for the parties during therapy, and sets parameters for contact and communication between Jason's father and herself during therapy. In short, a great deal of material is negotiated in a brief time period and much is agreed on without detailed processing.
Most viewers are impressed with the extent to which Dr. Rubenstein establishes and nurtures a sense of closeness with Jason.
General Questions
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