Case Study Tanyia

Tanyia is a 13-year-old African American female who currently resides at Vista Maria after being adjudicated on a Domestic Violence offense and being placed on Level 2 probation. She presents with a multitude of problems that will be the focus of her treatment needs of: verbal and physical aggression, fluctuating moods including irritability and anger, defiance, truancy from school, running away from home, associating with older males, substance use, traumas including physical abuse and rape, other sexual behaviors not appropriate for her age, and limited intellectual functioning. Her relationships within her family are very strained and lack adequate support, excluding her great grandparents. The goals in the therapeutic process are to facilitate

With regards to her ADHD diagnosis given by the psychiatrist at Vista Maria, Tanyia’s therapist (my supervisor), as well as myself do not feel that she meets the criteria for this diagnosis and feel that her attention issues are due to intellectual difficulties and learned behaviors of reacting. Under her main diagnosis of Oppositional Defiant Disorder, Tanyia meets the following criteria: A. A pattern of angry/irritable mood, argumentative/defiant behavior lasting at least 6 months with symptoms of often losing her temper, often touchy or easily annoyed, often angry and resentful, often argues with authority figures, and often actively defies or refuses to comply with requests/rules from authority figures, B. The disturbance in behavior is associated with distress in the individual or in her immediate social context (family), and impacts negatively on her social educational, and other important areas of functioning, and C. Her behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder, and does not meet the criteria for disruptive mood dysregulation disorder ( ). In treating Tanyia’s diagnosis

Beck, MD, provides the understanding of how dysfunctional thinking is common to all psychological disturbances and can influence a person’s mood and behaviors and vice versa ( ). Through CBT, the therapist looks deeper into the client’s thoughts-their beliefs about themselves, the world, and others. When these thoughts are changed to a more positive view, behaviors and feelings often will project a more positive change as well. With adolescents who struggle with Oppositional Defiant Disorder, CBT has been shown to be quite effective in treating this disorder. It is used often times to break the cycle of emotion-thought-behavior. The cycle is explained as a person feeling an emotion which then leads to a particular thought that makes them uncomfortable which then leads to the negative behavior occurring that then creates another negative feeling and the cycle continues. CBT is then used to change this cycle by creating a more realistic thought that the child can then view in terms where they are more under control and can help them to see their fallacies in thinking, which then lead to them being able to behave in a more appropriate way. ( ) Children often do not look or even understand these thoughts or feelings and thus then act impulsively with their behaviors. With Tanyia, CBT has helped her in addressing her feelings of inadequacy and abandonment, which then create the thoughts that she is not loved or that no one