Child Impulsive Pornography Viewing and Cognitive Behavioral Therapy Questions

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senyrx

Humanities

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Answer the following questions. Please include information from the class, including the readings in your answers.

Please see notes in bold on the bottom of this page-these are notes which need to be implemented into questions a and b. Also these two questions carry most of the points.

  1. The following client sees you in your office:

A Puerto Rican family with a 12 year-old boy (Luke) comes to see you in your clinic complaining that Luke’s motivation in school is low and that he is excessively impulsive. He was recently suspended for three days for saying he was going to rape a girl at school. Prior to this, he has been found viewing "extreme" pornography on several occasions. His parents have put security on the computer to prevent access to indecent material, but he has figured out ways to get around this. He has explosive anger when confronted. While he has not been violent toward anyone, he will yell and make threats of violence toward his parents and others. Because he is big for his age, he can be intimidating. In addition, his grades have been failing to barely passing. He has a history of struggling academically since he began school and has been required to spend more time on assignments than other students. However, it became worse when he entered the sixth grade and a permanent substitute teacher was assigned to his class. It is a result of the suspension that his parents would like to work on both his anger and impulsive pornography viewing. In addition, recently, his mother found a note in notebook in his room in which he has detailed drawings of sex acts with names of girls at his school under them.

It is perceived by the family that the new teacher is unfairly singling out Luke for minor behaviors, as well as his academic difficultly. The teacher is an ex-Chicago police officer and is “rigid” in classroom discipline. She holds high standards for the class. It is seen that she is unwilling to compromise or “attempt to understand Luke’s situation.” Luke has several classmates who appear to look up to him. He has a stoic presentation that frustrates the teachers during disciplining, but seems to earn him respect from other students.

Luke lives with his biological parents and 17-year-old brother. Luke’s parents have been to marital counseling and have had a difficult marriage for several years. (Their arguments concern the father’s lack of motivation in their relationship. While he appears to have strong emotional feelings for his wife, he does little initiation of activities, both in taking her out or initiating intimacy in the home. Despite the wife expressing much anger at this, he does not change. He believes that she is too pushy and negative. A recent fight: he took a week off from work. She wanted to spend time together and do things. He built her a patio so she could enjoy being outside. She was upset and he thought when she got use of it, she'd be thankful) Luke’s mother stays at home and his father is a truck driver for a local balery. His hours are early, from 3 am to 11 am. He is very tired when home during the day and mostly sleeps and watches TV. His mother wants “more of a family life” and pushes him to spend more time with their sons. He makes fleeting efforts, but has low energy and rapidly discontinues the effort. His mother has lupus and pulmonary hypertension, and is frequently symptomatic.

Luke shows no interest in other activities. He is large and, in the past, has shown interest in sports. Recently, he had an opportunity to play football, but chose not to without explaining further. His mother believes that this was done to “spite” her so she kept pushing him to do it. This just got him angrier and he threatened violence to get her to stop.

In the home, fights between his mother and Luke occur daily in an effort to get him to study and do his homework “properly” (he can be sloppy and careless in his efforts). It is stated that Luke would play his game system all day if he could. The video games and the TV are frequently taken away from him as a result of his not stopping using them when asked to finish the homework. Luke sees everything as being taken away from him and when positive reinforcements were suggested he stated, “it wouldn’t matter, they’d also be taken away.” He is close to failing this grade, but he does not show anxiety. He appears apathetic.

With regard to the pornography viewing, he only is known to do this on the computer (the family has only one placed in a central area of the house) and at night when his parents are sleeping. He provides little information about this behavior and appears embarrassed. He stated it started over a year ago when an older friend showed him a website and he has been visiting these sites regularly since. He states that he knows it makes his mother upset, but he gets “urges”. He reports he often thinks about it when bored or stressed, but the urge is very strong at night, particularly when he hears snoring and he knows his parents are asleep. His parents have said they have found him looking at extremely graphic and violent images and are very disturbed by the excessiveness this activity.

When asked what he would like out of therapy, Luke just shrugs and says, "I am only here because I have to be here".

Based on this limited information, do the following: One Paragraph each question!

  • a) Make a formulation of his impulsive behaviors and problematic anger behavior from the cognitive-behavioral perspective, including suspected causal and maintaining variables. Include a discussion in how operant conditioning is relevant to development and maintenance, include evidence that you have read material. What further information do you need for this formulation?
  • b) Create a treatment plan using specific treatment strategies and discuss why you chose this plan and these strategies. Because motivation for therapy may be low, also discuss how you would compensate for that weakness.
  • c) Treating adolescents who come involuntarily in individual sessions can be difficult. How can dialectical (include a discussion of what dialectics are) strategies be useful in these contexts? Give an example of a dialectical strategy (not behavioral or cognitive) and apply it to this case.
  • d) Make a brief formulation of the marital distress (ie. 3 formulations). Because you know very little about this case, this formulation is expected to be brief and speculative.
  • e) Unrelated to the above case: Briefly explain the cognitive formulation of positive symptoms of schizophrenia (delusions and hallucinations) and compare and contrast it to the cognitive formulation of personality disorders (not Linehan's model). Note, only one paragraph.

Here are notes on Anger and Impulse:

ANGER-Compliance vs power= less emotion and stay focused on value being thought. Gain authority with consistency.

Generalization; vary the setting of the operant.

Incidental modeling: how we show problem solving, frustration management.

Children: random disruption of perceived reward.

Pervasive Anger: Event trigger-something happened, perceived injustice. Attribute to unfairness, blamable, intentional. Changes in Physiology-anger continues.

Anger vs Frustration: Anger-you have someone to blame. Frustration is similar to disappointment.

IMPULSE-being interested in immediate consequences rather than in long run.

Provide immediate gratification despite the known consequences.

Urge to engage is classically conditioned.

Voluntary behavior is reinforced.

Repetition of behavior maintains the learning by repeated connection to the context and then generalizing it.

Lack of motivation to stop or lack of skills to stop urge (overcome urge)

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Explanation & Answer

Attached.

Cognitive Behavioral Therapy – Outline
I. Question A
A. Borderline personality disorder
(i)

Causes
(a) Genetically

(ii)

Maintenance
(a) Parents

II. Question B
A. Addressing Luke’s cognitive, social and behavioral variables
III. Question C
A. Dialectical behavioral therapy
(i)

Extending strategy

IV. Question D
A. Marital distress


Running head: COGNITIVE BEHAVIORAL THERAPY

Cognitive Behavioral Therapy
Name
Institution

1

COGNITIVE BEHAVIORAL THERAPY

2

Cognitive Behavioral Therapy
Question A
Luke's behavior depicts that of an individual with a borderline personality disorder.
The understanding of the characteristics he displays is through the cognitive developmental
model. The model mentions that the disorder arises from genetic propensities, deficiencies in
acquiring regulation skills, and the establishment of maladaptive tacit beliefs regarding
oneself and relating with others (Reinecke & Ehrenreich, 2005). Luke's parents have been to
marital counseling because of their difficulties in marriage thus highlighting the possibility
that the behavior Luke shows is genetic. There is also the maladaptive belief regarding
himself and relating to others that Luke shows. The characteristics Luke shows confirms that
he has a borderline personality disorder. Luke's parents appear to be the cause of his
behaviors through genes and continue to maintain the behaviors because of their constant
fights while at home. He is impulsive with his interests in the immediate consequences rather
than in the long run. Other than becoming impulsive, Luke fails to overcome his urge to do
things as depicted by his continued use of pornographic contents.
Question B
The cognitive-developmental treatment plan for Luke would focus on addressing his
cognitive and social as well as behavioral variables and the factors that maintain the
difficulties he faces. The strategy would focus on developing effective emotion regulation
skills and improving his social skills as well as changing the maladaptive schema that
continuously contributes to his negative feelings and anger (Reinecke & Ehrenreich, 2005).
Focusing on the emotional part is essential since it ensures that Luke get to understand what
is going on around him thus making it easier to handle his condition. Since therapy can be a
lengthy process, it is essential to have short-term actions such as the provision of support and

COGNITIVE BEHAVIORAL THERAPY

3

the encouragement of expression of effect as well as the placement of limit on specific to
provide short-term relief.
Question C
Dialectical behavioral therapy uses the cognitive-behavioral approach in its treatment
while also emphasizing on the psychosocial aspects of treatment. The development of the
approach is because of the perception that some people tend to overreact than others towards
certain emotional situations. Dialectical strategies are impactful when the therapist uses them
fluidly to balance it with acceptance and validation strategies (Pederson, 2015). Several
dialectical strategies exist, but the best that works in Luke's case is the extending strategy.
The strategy entails the therapist joining and flowing with the client's energy instead of
meeting it with opposition. The strategies encourage the overplaying of the client's position
thus leaving him or her off balance and requiring self-correction.
Question D
Marital distress results in the development of feelings of sadness, anger, and rage
towards the other partner as depicted by Luke's mother who expresses much anger towards
her husband because of his little initiation activities. The individual lives the family partners
live impact their relationship. Luke's father has a demanding job that usually makes her come
home tired thus usually spending most of the time sleeping and watching TV. It adds to the
marital distress that exists between the partners.
Question E
Development of cognitive behavioral therapy for psychosis was for the reduction of
distress that arises from psychosis symptoms as well as the improvement of functioning.
Beck's cognitive behavioral therapy, on the other hand, is a talk therapy used in the treatment

COGNITIVE BEHAVIORAL THERAPY
of individuals with several mental health problems. Similarities in the model are that they
both focus on improving an individual while the difference is on the condition it improves.

4

COGNITIVE BEHAVIORAL THERAPY
References
Pederson, L. D. (2015). Dialectical behavior therapy: A contemporary guide for
practitioners. John Wiley & Sons.
Reinecke, M. A., & Ehrenreich, J. (2005). A cognitive-developmental formulation of BPD.
Comparative treatments for borderline personality disorder, 151-184.

5

Attached.

Running head: COGNITIVE BEHAVIORAL THERAPY

Cognitive Behavioral Therapy
Name
Institution

1

COGNITIVE BEHAVIORAL THERAPY

2

Cognitive Behavioral Therapy
Question A
From the presented facts, Luke appears to fail to regulate his emotions and develops
impulsive behaviors. The understanding of the characteristics he displays is through the
cognitive developmental model. The model identifies the arising of the behaviors of an
individual and their continued development. Luke’s behavior could have risen from genetic
propensities, deficiencies in acquiring regulation skills, and the establishment of maladaptive
tacit beliefs regarding oneself and relating with others (Reinecke & Ehrenreich, 2005). Luke's
parents have been to marital counseling because of their difficulties in marriage thus
highlighting the possibility that the behavior Luke shows is genetic. There is also the
maladaptive belief regarding himself and relating to others that Luke shows. Luke's parents
appear to be the cause of his behaviors through genes and continue to maintain the behaviors
because of their constant fights while at home. He is impulsive with his interests in the
immediate consequences rather than in the long run. Other than becoming impulsive, Luke
fails to overcome his urge to do things as depicted by his continued use of pornographic
contents. His continued use of pornographic content is because of the boredom and stress he
gets that usually, pornographic viewing relieves. There is also the urges he gets that increases
his continued persistence in the use of pornographic content even if it makes his mother
upset.
Question B
The cognitive-developmental treatment plan for Luke would focus on addressing his
cognitive and social as well as behavioral variables and the factors that maintain the
difficulties he fac...


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