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


  • Paul W. Clement Private practice, South Pasadena, CA




adolescent psychotherapy, birth defects, child psychotherapy, developmental assets, developmental trajectory, evidence-based practice, positive psychology, resilience, stealing, vandalism, clinical case studies, case studies


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.

Author Biography

Paul W. Clement, Private practice, South Pasadena, CA

Pan Fishman, Ph.D. Editor-in-Chief, Pragmatic Case Studies in Psychotherapy Professor of Clinical and Organizational Psychology Graduate School of Applied and Professional Psychology Rutgers University Mailing address: 57 Jaffray Court Irvington, NY 10533 914-693-8549 fax: 603-917-2567 email: dfish96198@aol.com




How to Cite

Clement, P. W. (2011). A Strengths-Based, Skill-Building, Integrative Approach to Treating Conduct Problems in a 12-Year-Old Boy: Rafael’s Story. Pragmatic Case Studies in Psychotherapy, 7(3), 351–398. https://doi.org/10.14713/pcsp.v7i3.1097