Application of Theory ~ Billy ~ Behaviorism Friday, Jul 10 2009 

1. Based on this theory, describe the role of the therapist in relation to the client.
Billy’s therapist, Dr. Constanti, first needed to determine the events that led to Billy’s inappropriate behavior. After this, Dr. Constanti took a developmental history and social history taking note of Billy’s competencies and deficiencies. Third, Dr. Constanti determined through not only meeting with Billy, but also his mother, Jennifer, that both of them needed to enter into therapy. This would help both of them in being able to communicate and interact together as well as getting Billy to start working on his behaviors that he was committing at school that would bring him negative attention. Through family, school and individual interventions, Billy would be able to start being assisted in starting his own recovery with Dr. Constanti.

2. Apply this theory’s explanation of personality development to the individual(s) in this case.
In the case of Billy, I find that negative reinforcements, no matter how positive the teacher, vice-principle, police or his mother were intending, as well as the generalization, all-be-it negative, and the discrimination that Billy felt that he had to make in his various ways of acting out against his different teachers and his mother took, assisted Billy in taking the wrong path of behavior. All of these factors where shaping the overall outcome to take Billy from simple behaviors to a final, complex behavior.

3. Apply the theory’s explanation of maladaptive/ abnormal behavior development to the individual(s) in this case.
As a maladaptive or abnormal behavior, conduct disorder is learned through the interaction of the individual and his environment. His inappropriate behavior, starting fires in a library, throwing things at others, physical cruelty to animals (ducks), frequent truancy from school, and physical fights, have all been learned because it has been rewarded at various times. Billy became constantly disruptive in the classroom and behaved that way because he found that with such behavior he received attention. When the other children avoided Billy and called him names, Billy first found that he could avoid the situation when he was uncomfortable. This behavior eventually brought Billy into conflict with his entire environment.

4. What are some of the goals for the individual(s) in this case based on the theory?
For the family realm, Jennifer participated in several psychoeducational sessions designed to help her recognize that Billy’s behaviors were not due to fixed, stable traits. Instead of thinking of Billy’s conduct problems as a global disposition, she learned that each behavior was the result of a situational antecedent.
The next step was the parent management training where Jennifer was taught how to modify, through constant rewards and punishments, Billy’s behavior at home.
The third section in the family realm was learning interaction and communication training. After about a month of psychoeducational treatment, both mother and son began weekly meeting with a family therapist and worked on their communications and interactions.
With interventions at school, along with school agreed individual, specialized tutoring each day, this would help Billy start learning properly. There was also meeting with Billy’s teacher and Dr. Constanti about having them to consider in greater detail Billy’s misbehaviors in the classroom. There would now have to be antecedents and consequences as well, just like at home, if Billy acted out in class.
Finally, with individual interventions, Dr. Constanti believed that Billy would benefit from an impulse-control and problem-solving intervention. With Billy’s appreciation for music, Dr. Constanti and his mother agreed that for every two meeting that Billy had with his counselor, she would buy him a cd of his choice.

5. Describe the use of this theory’s specific treatment techniques and interventions with the individual(s) in this case.
The first technique used by Dr. Constanti was shaping. By modifying Billy’s behavior through positive reinforcements, Jennifer as well as Billy’s teachers would be able to help Billy acquire more of a normalcy and more desirable behaviors. The second technique that I saw by Dr. Constanti, was the modeling technique. Through learning new behaviors, Billy would be able to start changing his patterns of his old behaviors and would start on the road to recovery. The third technique for Billy was contracting. This was used by Dr. Constanti with help from Jennifer, Billy’s mother. When Billy would attend two of his individual counseling sessions, his mother would then buy Billy a cd of his choice.

6. Describe the theory’s pertinent basic concepts, principles and/ or tenants that have not been explored elsewhere in this activity. Describe them relative to the case presented.
I believe that Dr. Constanti could have used cognitive learning and covert reinforcement with Billy as well as the three techniques mentioned above. I believe also that Dr. Constanti used assertive training in working with Billy, his mother Jennifer, and Billy’s school. I think it would have been appropriate to also work with Billy on relaxation training techniques, and systematic desensitization techniques. I feel that these techniques could have also helped Billy recover, and possibly helped him beyond the manner in which his recovery ended.

DSM-IV Assessment Saturday, Jul 4 2009 

PATIENT NAME: Miss Agnes Skinner
(Her favorite phrase is, “Don’t look where I’m pointing,” while pointing to Bart Simpson’s ‘doodle!’

IDENTIFICATION & BIOSOCIAL HISTORY: 85 years old
(A brief description of how this patient looks and acts)
Agnes see
ms very kempt. Always wears a dress, but seems a bit odd to wear a sweater all year round.
She keeps her hair up in a bun. Miss Skinner is socially active with friends from her church and organizations she is involved in; The First Church of Springfield, Springfield Investorettes Club, Springfield Book Club and the NRA. She is very possessive of her son, Seymore, and believes that “he owes everything to her swift hand and watchful eye.” She has been taking care of her son since he returned home from the military for 26 years.
Lives with and dependant on son, domineering, grouchy, controlling, yells at her son, causes trouble with others, always making harsh comments about Marge Simpson and Edna Krabappel.
She represents the domineering virago of a mother that emasculates sons in a Freudian manner.

MAIN COMPLAINT:
(Why this patient is coming for treatment)
Miss Skinner has reoccurring thoughts of murdering Edna Krabappel, so that her son has to stay living with her.
She also desires that someone shoots the school superintendent, Gary Chalmers, for working her son so hard.
She would love to kill Mr. Montgomery Burns for raising the energy prices just to get richer.
She also desires to burn Homer Simpson at the stake for being such a stupid idiot.
Finally, Agnes has shown a great deal of interest to see Rev. Timothy Lovejoy, Marge Simpson, and Ned Flanders dead.

CURRENT SYMPTOMS:
(A list of symptoms as explained in the text)
Forgetfulness; disregards other peoples’ rights; controlling, manipulative; feels no empathy towards others; behavioral eccentricities; discomfort in close relationships; extremely bizarre patterns of thinking; uninterested in the needs of others.

Regarding her son and his affairs, Miss Skinner seems to have the following symptoms: fear of separation, clingy, desires much admiration from, repetitive behaviors toward; persecutory, jealous, and obsessive; cold and domineering.

PRECIPITATING FACTORS:
(Are there any ‘prodromals’ (physical, social, stressors, abuse or cognitive causes) that bring out the symptoms)
Widowed, (husband’s name is Sheldon Skinner,) lives with adult son, has dated Superintendent Chalmer’s & Comic Book Guy (aka Jeff Albertson )

CULTURAL/RELIGIOUS BACKGROUND:
(Including divorce, substance abuse, family dynamics, etc.)
Eighty-five year old widow living with her son.
Even though her adopted son, Armin Tamzarian is a grown man, she constantly refers to him as “Spanky,” who goes by the name of her biological son, Seymore Skinner, whom she cannot stand.
She does not allow her adopted son to have any interaction with his on-again/ off-again girlfriend, Edna Krabappel.

INTELLECT: Average

INSIGHT & JUDGMENT:
(Any observations of abnormalities, otherwise write “Patient appears to have normal insight & judgment.”)
Patient appears to have a slightly skewed insight and judgment on specific neighbors and her son.

SUBSTANCE USE / ABUSE: None that patient is revealing.

OTHER:
(Comments on any other relevant issues)
Her hobbies include making silhouettes and collecting pictures of cakes, even though she cannot stand eating cakes because they are too sweet.

(The following group of questions is only looking for hints of psychosis such as Schizophrenia)
APPEARANCE: Neat, slumped

SOCIABILITY: resistant, hostile,

MOTOR ACTIVITY: normal

RELATEDNESS: good eye contact

SPEECH: fast, halting, variable, slurred, mumbles

ORIENTATION: Person

AFFECT: blunt, dysphoric, angry, irritable

IMPULSE CONTROL: inadequate

HALLUCINATIONS: none

SELF-CONCEPT: adequate

THOUGHT CONTENT: obsessions, jealousy, persecutory, bizarre, illogical

PATIENT’S STRENGTHS / RESOURCES –
(Look for positives)
Patient seems to be able to care for herself, although she wants someone, specifically her son, to care for her.

DSM-IV DIAGNOSIS

Axis I, Primary Dementia

Secondary Delusional Disorder

Axis II Obsessive-Compulsive P.D., Anti-Social P.D., Dependant P.D., Narcissistic P.D., Schizotypal P.D., Schizophrenogenic mother.

[Axis II Is only for Personality Disorders and/or Mental Retardation; not considered to be treatable –
use ‘V71.09’ (which means ‘none’) if neither of these conditions exist]

Axis III Osteoporosis, Arthritis (History of medical conditions: significant illnesses, surgery, etc.)

Axis IV Social Environment, Housing Problems (Environmental / social stressors – see following page)
Axis V 68
(See following pages for explanation)

CASE FORMULATION & TREATMENT PLAN
(Specific issues as ‘focus of treatment’, and specific types of treatment)
It is my opinion that, although Miss Skinner is 85 years of age, she could undergo treatment to help her become less controlling of her son, it is my belief that she will not be able to change at this stage in her life. I give the patient five to 25 years left to live, and see no possibility of this patient changing her ways.

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