Pragmatic Case Studies in Psychotherapy


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June 29, 2016 -- From the Editor 

ANNOUNCING THE PUBLICATION OF OUR 45th ISSUE (Vol. 12, Module 2)

The Impact of Implementing an "Incredible Years" Group Within a Family Living Unit in a Transitional Living Shelter: The Case of "Cathy"  

***  Karen Rogers, Michelle Bobich, & Patrick Heppell, University of Southern California School of Medicine and Children's Hospital Los Angeles   

Commentaries  

***  Marian Williams, Children's Hospital Los Angeles   

*** Arielle Gartenberg and Robin Lang, Foster Care Counseling Project at the Graduate School of Applied & Professional Psychology, Rutgers University, Piscataway, NJ    

Response to Commentaries 

*** Karen Rogers, Michelle Bobich, & Patrick Heppell   

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EDITOR'S NOTE:

At the time of this case study, "Cathy," a Latina girl, was residing in a transitional living facility with her mother, "Ms. Z," and her older sister "Yvette." Cathy had experienced a daunting set of traumatic and other challenging events by the young age of 4, including: exposure to the intimate partner violence of her parents, her mother’s chronic depression, her mother's PTSD symptoms, her family's homelessness, and her lack of any exposure to structured daycare with other children her own age.

Consistent with the empirical literature and trauma theory, Cathy manifested "frequent tantrums (three times a week of yelling, screaming and crying fits); physically aggressive behaviors towards her older sister (pinching, pushing and hitting her); and extreme 'moodiness'," leading her mother to view her as "the devil," compared with Yvette, who was described by mother as "the angel." 

Parents in the transitional living facility, including Ms. Z, were required to take a parenting course. Rogers, Bobich, and Heppell—the authors of the case study—were part of a team that took advantage of this requirement to offer a course based on the evidence-based "Incredible Years" (IY) program, which involves groups consisting of both children and parents.

IY uses techniques such as games and life-size puppets and is based on cognitive-behavioral theory—like Bandura's concept of modeling and self-efficacy, and Patterson's concept of family-based coercion by negative reinforcement. IY is designed to reduce children's aggression and behavioral problems, to increase their emotional regulation and social competence, and to train parents in how to maintain these positive changes.

Rogers et al.'s case study documents in detail the process whereby Cathy and her mother made major positive changes, shown by both quantitative and qualitative indicators.

Strongly endorsing the important, effective clinical work that Rogers et al. report, the Commentators suggest ways to complement and expand upon the impact of the IY therapy on clients like Cathy and her family. First, Williams proposes adding a more trauma-focused treatment like Child-Parent Psychotherapy, which is designed to help clients like Cathy and her mother to more directly process the traumas they have been through, so that a mother like Ms. Z "can restore her role as a 'protective shield' for her family."

Second, coming to the case of Cathy as therapists with foster care families, Gartenberg and Lang see the potential of IY programs with the foster care population, in part because of "the high crossover between homelessness and foster care, ... [with] homeless youth 34 times more likely to enter the foster care system than same-age peers in the United States." 

A crucial issue discussed throughout the Commentaries and Rogers et al.'s Response to them is how to learn from the experiences of cases like Cathy's to create institutional policies and programs for increasing access to much needed, evidence-based care for marginalized families.   

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Vol 12, No 2 (2016)

Table of Contents

Case Study

The Impact of Implementing an "Incredible Years" Group Within a Family Living Unit in a Transitional Living Shelter: The Case of "Cathy" Abstract PDF
Karen C. Rogers, Michelle Bobich, Patrick Heppell 65-112
Integrating Early Childhood Mental Health and Trauma-Informed Care for Homeless Families With Young Children Abstract PDF
Marian E. Williams 113-123
Considerations for the Dissemination of Incredible Years in Welfare Systems: Implications of the Case of "Cathy" for Intervention in the Foster Care System Abstract PDF
Arielle S. Gartenberg, Robin Lang 124-138
Further Consideration of Systems, Stigma, Trauma, and Access to Care Abstract PDF
Karen C. Rogers, Michelle Bobich, Patrick Heppell 139-157