Re:Treatment Plan for Final Exam

Toy Story’s Jessie

Introducing the Character

Jessie is one of the main characters in the Pixar/Disney animated blockbuster movie Toy Story 2 (Plotkin, Jackson, & Lasseter, 1999). In the story, Jessie is a cowgirl doll modeled after the fictitious cowgirl character in a 1960s children’s western TV show called Woody’s Roundup. The story centers on a band of toys who are going to be sold to a Japanese toy museum and their efforts to undermine that sale and remain together.

As the story unfolds, we learn that Jessie, once a favored toy to her owner, was abandoned when the girl grew out of her interest in childhood play things. Jessie was subsequently purchased by Al of Al’s Toy Barn, who was in the process of collecting a full set of toys that were marketed in conjunction with the Woody’s Roundup television show.

As Toy Story 2 unfolds, the pain of Jessie’s abandonment becomes obvious to the other toys, and especially to Woody, who is also struggling to remain in the favor of his boy owner, Andy. As the toys work together to overcome the differences that divide them, they ultimately rally to liberate themselves, and in the process, stage a last-minute rescue of Jessie and provide her once again with connection, attachment, and a sense of being loved.

Basic Case Summary

Identifying Information. Jessie, who refuses to use her last name because “it reminds me of them” (her foster parents), is an 11-year-old white preteen who has, for the last 3 months, been living at the Storyland Home for Girls. She has displayed increasingly disturbing asocial behavior at this facility, which has led to her spending increasing time alone, “shying away” from staff, and watching other peer residents with what was described as a “cold aloofness.” In appearance, she can be described as a wiry, energetic, and wide-eyed red-haired waif. She has her own room at the facility because of her wary behavior and unwillingness to interact with the other residents.

Presenting Concerns. Jessie was referred for counseling by the disciplinary dean at the Storyland School due to escalating concerns about her highly ambivalent reactions to staff and peers. Background, Family Information, and Relevant History. Jessie was born in Muskegon, Wisconsin, the youngest and unexpected third child to parents who were both under 20 years old. Jessie’s mother and father were both raised in the Wisconsin Foster Care System after being abandoned at birth; her father was in recovery for Alcohol Use Disorder. When Jessie was born, her parents were living in a one-bedroom apartment over a grocery store in downtown Muskegon, were receiving government support, and had recently placed Jessie’s older brother up for adoption.

Jessie was born 5 weeks premature and presented a significant challenge to her young parents, who were referred to, but did not take advantage of, pre- and postnatal social services resources. As a result, Jessie received poor postnatal care and was often left in the company of her parents’ friends, where she was also neglected. When Jessie was 1 year old, she was removed from her parents’ care and placed with a private foster family who hoped to adopt her; however, when those plans fell through, Jessie was moved into a foster-care facility where she remained until 4 years of age. By that time, Jessie was already showing signs of disrupted attachment, including resisting the attentions of her foster parents, avoiding her foster parents’ soothing touch or comforting remarks, hiding from foster siblings in the home, and carefully watching babysitters before responding. She also began a habit of sometimes leaving the home and telling strangers that she was lost.

Invariably, she would be returned to the foster home. In spite of her troubled history, Jessie was once again adopted at age 6 by an ostensibly loving and older couple who convinced the state that they had ample financial and psychological resources to provide for the girl’s needs. However, Jessie was harassed by the biological child of this couple and when she began running away from their care at age 8 she had already displayed a pattern of seeming to indiscriminately approach strangers on the sidewalk as if she was closely familiar to them.  When one of these “strangers” turned out to be a state care worker, Jessie was immediately removed from this couple’s care and placed with a middle-aged couple who had successfully raised their own children and who had been foster parents for 15 years. In that home, Jessie appeared to thrive and slowly began to trust her new parents. Although she tested limits, attempted to run away from home, aggressed toward them, and challenged their patience and experience, the couple’s commitment to the 9-year-old seemed to be having a positive effect on her. By the time Jessie was enrolled in Storyland Middle School she, at least outwardly, appeared ready to enter into a new social world. She was placed in a small classroom with a teacher who had been extensively trained in providing for the educational and emotional needs of troubled children, and Jessie seemed to trust this woman, at least as much as she had ever trusted anyone before. She formed very tentative bonds with several classmates, mostly other troubled children, joined the school’s Martial Arts Program, and was referred to the school guidance department for possible inclusion in group and individual therapy.

Problem and Counseling History. Jessie was referred by the Storyland facility to Creative Counseling Consultants, where she was seen for three sessions separated by a week in time. She was a very arming and superficially endearing child who was playfully dressed in what appeared to be a cowgirl outfit and indicated that “this reminds me of that movie cartoon character who lost her parents and was looking for a family.” Ironically, much of Jessie’s creative play, whether it was art, story-telling, clay modeling, or dollhouse activities, centered on themes of disrupted families, abuse of children, and retaliatory behavior against parents. Jessie’s affect during this disturbing play was quite flat as she recounted incidents in several of the foster and adoptive placements that “make me feel so angry and sad.” The results were a very highly destructive element to her play in that she would angrily erase, destroy, or negate her various creations, followed by a tantrum and withdrawal to a corner of the room. She resisted supportive and compassionate gestures by the evaluator and made it quite clear that “I don’t like you and I’m only doing this because they made me.” At such moments, her body stiffened, her face reddened, and she quickly withdrew and stared off into space for minutes at a time. Jessie spoke dispassionately about the various families with whom she had lived over the years and noted that “if they really loved me they would have kept me . . . I hate them all so much.” She angrily added that “they all thought that if they just sent me to a shrink, that I could be fixed . . . like some sort of broken toy.” then asked about her current living situation, she quickly shot back with, “Oh yeah, they’re nice enough people, but I don’t think they’re going to keep me and maybe they’re just using me to get money from the state like everybody else.” Nevertheless, Jessie acknowledged that they seemed different from previous foster or adoptive parents but that “I’m going to keep a really close eye on them and if they make one wrong move, that’s it.” Jessie denied having difficulty with her anger, trusting people, or feeling safe, but reluctantly agreed to return to counseling

This is your Final Exam.   The exam is two-parts:

Part I: Inverted Pyramid

• Use the four (4) step method to assess the client, pertaining to the story above.
•  Step 1:  Be thorough
•  Step 2:  Don't forget to also add a narrative based on the 4/5 D's(Dysfunctional, Distress, Deviant, & Dangerous)
•                Don't forget the "V" Codes if there are any
•  Step 3:  Don't forget to provide citations and justification's for your choice
•  Step 4: 

Part II:  Treatment Planning :

• Use the four (4) step method to develop your treatment plan
• Step 1:  Remember you can get these from the inverted pyramid
• Step 2:  Two goals- using this tip:  Don't forget to use SMART Goals and the 3-I's to treatment planning
• Step 3:  Don't forget tojustify this stepwith citations and abrief narrative of why this intervention is appropriate
• Step 4:  Don't forget toprovide a DIAGNOSTIC TOOL (both reliable and valid)

Example of a Treatment Plan Below

George Lopez

Inverted pyraimid

Step 1 cast a wide net Problem Identification

ABC- affect ,behavior  and cognition

Step 2 Organize into Thematic grouping (4 D’s narrative – Deviant, dangerous, Distress, dysfuntion and can use disruptive psychological symptoms)

4D’s

Deviant none in list

Dangerous none in list

·         Distress (ABC)– defined by thoughts, feeling behavior

o   Distressing thoughts about money, job pressures, upper management pressure, family, loss of dreams, and happy life

o   Distressing feeling of anxiety, depression and anger

·         Dysfunction

o   Dysfunctional behavior of withdrawing, inattentive to family, disengaged, escape drinking, irritability when home resulting in arguing and maintain family conflict., and avoiding new job demands.

·         Disruptive physiological symptoms of headaches poor sleep and fatigue

THE BULLETS ABOVE IS THE 4 D’S NARRATIVE IF THE CLIENT DOES NOT HAVE IT YOU DON’T LIST IT.

Step 3: Thematic Inferences (what are the inferred areas of difficulty) C

·         Chooses anxiety behaviors

·         Choose depressing behaviors

·         Chooses angering behaviors

·         Chooses avoiding and escaping behaviors

·         Chooses headache and fatiguing behaviors

Interventions:( CBT-you have to define why you chose it and identify the cognitive distoraotin (look up list of distortion) and the resulting behavior., Psychotherapy)- DON’T USE!!!!

Nicole choose: Reality Therapy -

WDEP-  WANT CLIENT TO IDENTIFY, Direction, Evaluation,Plan according

DSM – Trauma and stress realated

R/O( Rule out)

309.28Adjusment disorder with mixed anxiety

 and depressed mood

V codes are on page 715 – Other conditions that may be a focus of clinical attention

V62.4 Acculturation difficult p724

V62.29 Other factors related to employment: job change, job reduction

Step 4:Narrowed inferences

Choosing external locus of control to deal with unsatisfying family and work relationships.

Goals of change

                                                                             Step 1 Behavior definition        (came from the 4D’s narrative- then turn them into goals (step2))

·         Distress (ABC)– defined by thoughts, feeling behavior

o   Distressing thoughts about money, job pressures, upper management pressure, family, loss of dreams, and happy life

o   Distressing feeling of anxiety, depression and anger

·         Dysfunction

o   Dysfunctional behavior of withdrawing, inattentive to family, disengaged, escape drinking, irritability when home resulting in arguing and maintain family conflict., and avoiding new job demands.

·         Disruptive physiological symptoms of headaches poor sleep and fatigue

Step 2: Identify and articulate goals for change (SMART - 3I’s to tx planning)

Identify feeling of resentment for having to sacrificthey impact his daily functioning

e his life’s drea to support his family

Understnat his feeling of anxiety (epression/anger) and the way they impact his daily funtciton.

Develop more adaptive responses to stress

Restore a restful sleeping pattern

NOW TAKE GOALS AND TURN INTO SMART GOALSonly require 2 goals and include 3 I’s

1. Identify 3 feeling of resentment for having to sacrifice impact his daily life’s dream to support his family by next session

2. Identify 3 coping skills to mediate negative feeling by next session

a. Implement: 3 coping skills to mediate negative feeling by next session

b. Insight –Evaluate effectives of 3 coping skills to mediate negative feelingby next session

Understanding his feeling of anxiety (depression/anger) and the way they impact his daily funtciton.

Develop more adaptive responses to stress

Restore a restful sleeping pattern

we have to remain consistent to strengthen relability and validity

Step 3: Therapeutic Intervention

Reality Therapy _ strengthen client internal locus of control WDEP method, fostering insight, effective problem solving skills (Wubbolding, 2007,radtke, Sapp & Farrell, 1997) include citation

Step4 : Provide Outcome measures with (Diagnostic Tool)

Family report

Client report

Clinicial observation

Improved pre-post clinical anger scale

She looking for diagnostic tool (measurement yearbook) in Step 4 of Tx. Plan example above Pre-post clinical anger scale

Evidenced based practice can also give you a diagnostic tool!