Brian's Case Study: Paladaptive Therapy

TFCBT can help Brian to make connections among his thoughts, emotions, and physical sensations. As Brian’s nose would bleed when he is fearful, it is important to help him recognize his physical sensation and the emotion connected to the physical sensation. Most importantly, Brian continues to seek for the truth, even though the incident happened 10 years ago. The TFCBT can be used to address his desire to make sense of the event. Focusing on processing his trauma experience, the therapist can help Brian to create a new meaning of the event. Additionally, the cognitive therapy component of TFCBT can be used to identify and address Brian’s underlying maladaptive cognitions that present prior or after the event. Using cognitive restructuring,

He might have difficulty developing a trusting relationship due to his prior experience. While Brian did not seem to have a good connection with his father, he seems to have a better connection with his mother and sister. Hence, it might be easier for him to connect with a female therapist. However, given the nature of his traumatic experience and his experience with Avalyn, Brian might have difficulty expressing himself in front of a female therapist. He might be fearful of being judged. All of these suggest that a strong therapeutic alliance is indicative prior to the work of processing his trauma. The therapist needs to be patience and meet Brian where he is to help him to address his difficulty. Additionally, the therapist needs to be careful to avoid retraumatizing Brian if his experience with Avalyn is also another source of trauma to him. Moreover, Brian seems to have low self-esteem. In order for Brian to feel confident, the therapist has to focus on increasing Brian’s self-efficacy (Beck, 2011) and resilience (Barnes & Josefowitz, 2014) prior to challenging his maladaptive behaviors or thoughts to avoid long-term behavioral consequences such as engaging in delinquent

Besides the importance of building a strong therapeutic alliance, it is important to address any therapeutic interfering behaviors such as suicidal ideation or substance use issues. It is also recommended Brian to have a medical consultation to rule out a physical cause of his nosebleed. Depending on Brian’s presentation, TFCBT can start off with teaching him anxiety-reduction skills. This is to eliminate fears or avoidance behavior when confronting his traumatic experience (Freeman, Pretzer, Fleming, & Simon, 2004). The treatment can also incorporate mindfulness techniques, which can help Brian to be more aware of the connections among his thoughts, feelings, and physical sensations and cope with his emotions (Daigneault, Dion, Hébert, & Bourgeois, 2016; Didonna, 2009; Garland, 2016). If Brian is severely depressed at the beginning of treatment, the therapist should consider focus on addressing his depression. In addition to behavioral intervention, it is important to include cognitive strategies to address Brian’s maladaptive thoughts and the impact of the trauma. Brian’s sense of self-efficacy can be increased through cognitively challenging his unrealistic appraisal of his ability and through training in coping skills such as assertive training (Beck, 2011; Freeman et al., 2004). Even though group-based interventions are likely to be difficult for Brian at this