A Strengths-Based, Skill-Building, Integrative Approach to Treating Conduct Problems in a 12-Year-Old Boy: Rafael's Story

Abstract

School administrators suspended Rafael, an adopted, 12-year-old boy being raised by a single mother, following an episode of vandalism. They demanded that he enter psychotherapy in order to return to school. Raphael had a history of acting out, aggressive behavior, angry outbursts, disruptive classroom behavior, destruction of property, fighting, lying, stealing, and being teased by peers about his serious birth defects. The initial task facing the clinician was to make a differential diagnosis including to determine what developmental trajectory the youth was following. The first course of treatment covered 29 sessions. Goal setting, assertiveness training, and training in conflict resolution were the major components of treatment. Based on his mother's ratings, Rafael was clearly improved by the 17th session and greatly improved by termination. Eight months later he returned to treatment because of an episode of stealing. The second course of treatment was for 20 sessions. Rafael and his mother evaluated Rafael at intake and at termination during this second course. Based on their input his treatment outcome was extremely positive, with an effect size of 3.02. The article concludes by describing Rafael's major accomplishments during the eight years since treatment ended as well as his plans for a career.