Using research to select a therapeutic modality

By Support

Using research to select a therapeutic modality

Imagine that some of your colleagues mention using cognitive behavior therapy, dialectical behavioral therapy, acceptance and commitment therapy, and reality therapy. Your colleagues continue to say that, based on their experiences, they really like these therapies and they appear to work. Your instincts also tell you that perhaps they might be helpful for your client in your case study. However, from Week 1, you recall that experiences and instincts as sources of knowledge are quite limited because they are biased. Instead, it is important to utilize existing research and data to support your choices of interventions. Theory helps inform the evidence-based practice process that should guide social workers’ practice.

In this Discussion, you examine the research related to a therapy based on cognitive or cognitive behavior theory to determine its effectiveness.

  • Recall the client from the case study you have been using in this course. You will apply your research for this Discussion to that client.
  • Select one therapy from the following: cognitive behavior therapy, dialectical behavioral therapy, acceptance and commitment therapy, or reality therapy.
  • Conduct a search in the Walden University Library for one peer-reviewed research study about the effectiveness of the therapy you selected.
    • Note: You must select a study that has not already been used by a colleague in the Discussion. Each student is required to identify a unique research study.
  • Remember when looking for studies to take into account your client’s age and developmental stage and presenting problem.

By Day 3

Post a response to the following:

  • Provide the reference for the study you found using APA guidelines. Be sure to provide a link to the article.
  • Identify the therapy that you chose.
  • Briefly paraphrase, in 2–3 sentences, the methodological context (i.e., research method, how data was collected, and the instruments used) of the study and the findings.
  • Explain how the findings are applicabile or appropriate for the client in your case study.
  • Determine whether you would use or not use the therapy you selected for the client in your selected case study (consider how culturally relevant it is, how aligned it is with social work ethics, etc.) and explain why.

By Day 5

Respond to two colleagues who selected a case study different from yours:

  • Compare and contrast the article you selected with your colleague’s article in terms of how they might inform appropriateness for use with the identified client.
  • Explain how reviewing the different studies presented in this Discussion influenced your decision about whether you would use the therapy, given various evidence for the different treatment modalities.

Ella Schultz
Identifying Data
Ella Schultz is a 16-year-old White female of German decent. She was raised in Ohio. Ella’s family consists of her father, Robert (44 years old), and her mother, Rose (39 years old). Ella currently resides in a residential group home, where she has been since she ran away from home. Ella has been provided room and board in the residential treatment facility for the past 3 months. Ella describes herself as bi-sexual.
Presenting Problem
Ella has been living homeless for 13 months. She has been arrested on two occasions for shoplifting and once for loitering (as a teen in need of supervision) in the last 7 months. Ella has recently been court ordered to reside in a group home with counseling. She refuses to return home due to the abuse she experienced. After 3 months at Teens First, Ella said she is thinking about reinitiating contact with her mother. She has not seen either parent in 6 months and missed the stability of the way her family “used to be,” although she is also conflicted due to recognizing the instability of her family. Ella is confused about the path to follow.
Family Dynamics
Ella indicates that her family worked well until her father began drinking heavily about 3 years ago. She remembers her parents being social and going out or having friends over for drinks, but she never remembered them becoming drunk. Then, her father lost his job as an information technology (IT) support professional and was unable to find meaningful work. He took on part-time jobs at electronics stores, but they left him demoralized. Her parents stopped socializing, and then her father was fired from his last job because he arrived drunk. Ella’s father would regularly be drunk by the time she arrived home from school.
When Ella started having trouble in school, her father would berate her when she came home if she didn’t study immediately. Then, he would interrupt her studies by following her around and verbally abusing her. Soon after, he began hitting her or throwing objects at her. Once she went to the emergency room for stitches on her brow when she was struck by a drinking glass her father threw. She was able to convince the emergency room (ER) staff, however, that it was a bike accident, as she was known as an avid biker around her community, often riding to and from school and elsewhere.
Ella’s mother did not witness these events, as they often occurred before she returned from work, and her father might be passed out by this time. Ella reports that her mother was in denial about her father, often pretending there was no issue. When Ella tried to report the abuse, her mother took her father’s side. Finally, after the stitches, Ella confronted her mom with her father present. Her father denied it, flew into a rage, and then physically abused both Ella and her mom.
The next day, Ella’s mom acted as if nothing happened. After the abuse quickly escalated in the next week, to the point where she could no longer hide it or cover it up, Ella fled home and has been homeless since. She left a note before leaving for school one morning and did not return home.
Educational History
Ella attends school at the group home, taking general education classes for her general education development (GED) credential. Shortly after her father lost his job, Ella began experiencing learning disabilities. Her difficulties began in math, where she had difficulty sorting and making sense of numbers. Then she began to fall behind in her reading. Her grades went from a B average to consistent D’s. Some of Ella’s Instructors began to raise the issue of a possible learning disability. A counselor made an appointment to discuss possible causes, but Ella left school and home just prior to that meeting, and did not attend.
Employment History
Ella reports that her father was employed as an IT support professional at a bank. When the bank downsized and closed many branches, her father was laid off. He was unable to secure another IT support position, as many companies had begun outsourcing this work to contractors or overseas. He began to work part-time retail jobs at consumer electronics stores but quickly became demoralized and lost a series of those jobs. Her mother works as a full-time home health aide.
Social History
Ella reports that the homeless encampment (where she wound up for a long stretch) had a group of teens that stuck together for protection and to shield themselves and each other from certain bad choices. It was at this time that Ella reports she became bisexual, seeking out and bonding to a group of women who were able to avoid being exploited for human trafficking.
The encampment group did still engage in risky behavior, however, including frequent shoplifting and other theft to secure food, supplies, etc. Likewise, although Ella reports that she did not engage in prostitution, she did engage in unprotected sex with one woman whose sexual history may have included prostitution or intravenous drug use. Thus Ella contracted a sexually transmitted infection (STI) in one instance.

Ella reports she might consider trying to go home if she knew her father was no longer there, despite feeling betrayed by her mother. She would also be willing to reconcile and attend therapy with her. However, Ella feels that her mother, who comes from a very religious family (though does not practice much now), would ultimately reject her due to her bisexual identification.

Ella also feels a strong bond to the group of teens and women with whom she stayed in the homeless encampment. She reports that she misses them and wishes she could see them—especially one teen in particular named Marisol. She says she considers these women to be as much, if not more, her family as her biological family.
Ella began counseling to address the abuse in her history. In her initial reports, as detailed above, she cites mostly verbal and psychological abuse with only two instances of physical abuse. She denies any sexual abuse.

When Ella recounts the physical abuse specifically, however, she shows added signs of acute distress and trauma. The physical harm caused by the event that triggered her leaving was reportedly significant—bruising on both arms, a split lip, a bloody nose, and a bump on the head—all from punches—as well as bruises on her leg from being kicked. She did not seek medical help and avoided as much social contact as possible the day she ran away, so as not to encourage inquiries about her home situation.

Ella does have positive memories of what she calls “the before time,” and she shows a desire to return to that time. She worries for her mom, despite feeling betrayed by her. The last time she did have contact with her mom, she promised to leave her dad, but Ella does not know if this ever occurred.

Legal History
Ella has been arrested three times, twice for shoplifting and once for vagrancy. Citing the abuse she reported at home and the fears she felt, Ella was mandated to services at the Teens First agency, unlike her prior arrests when she was sent to detention.

Alcohol and Drug Use History
Ella denies any alcohol or drug use while living homeless. She reports the homeless encampment (where she wound up for a long stretch) had a group of teens that stuck together and were able to shield themselves from certain bad choices.

Medical History
During intake, it was noted that Ella showed signs of living homeless, including carrying all her possessions in one bag, signs of malnourishment, feet with heavy callouses, and clothing in disrepair. She did not show signs of drug use or self-harm. The STI she contracted was diagnosed upon intake, and she received antibiotics for treatment.

Strengths
Ella is resilient in learning how to survive in a difficult situation. She was able to avoid the more severe negative outcomes, such as human trafficking and drug use. She is able to form beneficial bonds for protection and support.

Father: Robert Schultz (44 years old)
Mother: Rose Schultz (39 years old)
Daughter: Ella Schultz (16 years old)

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