We Still Love John

October 15, 2009

Discovery & Reporting

Filed under: #3: discovery and reporting — welovejohn @ 1:16 am

During this PBL, we have researched on how to include Cognitive Behavioural Therapy (CBT) in rehabilitating John and helping him to assimilate back into school and family life with a positive attitude.

There is an urgency to nip John’s antagonistic tendencies in the bud because there is a high chance that John may feel a reluctance to attend school if his anti-social behaviour perpetuates. School refusal can contribute to a greater set of problems including a child’s academic, social, and psychological problems; these in turn impact a child’s chances for future educational, financial, and personal success, and significantly affect family functioning especially when he becomes a parent himself. The possible reasons for refusal that we have found out include the avoidance of negative social or evaluative situations at school, and for John it could be to avoid his teacher who constantly picks on him, to ignore the impending exams and also avoid his friends who have been shunning him in return.

To help John to cope especially when family support is almost negligible for him, positive support at school – to provide him with at least one environment where he will feel safe. Our group has decided to address this by teaching him some coping strategies using CBT. This includes training in positive thinking and resilience. We hope that this will help him to focus on solving his problems one at a time, starting with an attitude makeover.

Resilience is an amoral quality that refers to an individual’s capacity to withstand stressors and not manifest psychology dysfunction, such as mental illness or persistent negative mood. These stressors could include traumatic experiences such as abuse, a death in the family of someone dear or in John’s case, it is instability in the home due to divorce. It is interesting to note that resilience is a dynamic quality that gets reinforced through each conscious decision to remain positive. If a person does not “practise” this quality, it can be lost and individuals find themselves increasingly being worn down from the stressors that they face. Resilient people tend to bounce back and recover faster from trials they face as compared to pessimistic people. Through CBT, we hope to help John realize that while he is going through a rough patch, having a positive attitude (or the ability to see opportunities through problems) will tide him over this difficult period in his life.

It is important to incorporate the idea of resilience especially for John since he has to be aware of the detrimental nature of his own negative thoughts (through mislabeling, overgeneralizations and jumping to conclusion) before he can attempt to change them to positive ones. Resilient children are also better able to understand their emotions and control them better than children who are not – a characteristic that John has to learn because it seems that he gets into rather destructive behaviour when he is angry.

Contrary to popular belief that resilience is a quality that is “caught and not taught”, the University of Pennsylvania conducted their pilot resiliency programme in the early ‘90s where children were taught to tell the difference between productive and self-defeating thoughts for 12 weeks. Additionally, they learnt to analyze a problem and elicit different possible solutions, in that way they learnt that what they were going through “may not be that bad after all”. Two years after the programme, the results were astonishing. The children who took part were all at risk for depression because of conflict or instability in their homes. When they were interviewed again two years later, it was found that only 22% of the children in the programme still felt depressed, compared to 44% of kids from similar backgrounds in a control group. If resiliency is a quality that can be taught to children and the benefits observed so quickly, we are indeed inspired by the convincing results to begin CBT on John in order that he may break away from his depression and return to the cheerful and high-achieving child that he was.

A salient feature of positive thinking is Seligman’s positive psychology where the merits of a more positive way of life are scientifically proven to be good for health. It is therefore not something merely idealistic because it can actually help John paint a more realistic picture of his current situation: he has many negative factors in his life that are not within his control, but he also has strengths and values that he can positively tap on to deal with his situation and change his worldview to a more balanced one. Another name for this is Seligman’s balanced psychology, where, to use an analogy, the glass is both half empty and half full. This perspective is crucial for John because he can be taught to realise that he is not entirely helpless, that he has potential and agency which he can learn how to effectively utilise for the advantage of his well-being. In other words, John’s situation will ameliorate with learned optimism. To aid him in that, CBT and its metacognitive strands of being aware of one’s own perception and situational interpretation will be employed to ensure that John will reach his optimal functioning.

We think that CBT will be useful in managing John’s behaviour because it will help him to regulate his own thoughts and process his emotions. This will break him out of his pessimistic, circular thinking that he is bad at his studies and that is the cause of his parent’s breakup. CBT sieves out the erroneous thought process and allows John to recognize his automatic response when something bad happens. The teacher/therapist can then take him through the cognitive distortion and discuss some coping strategies to dispel the negative thoughts before they even begin.

In addition, John has to be aware of what his “pressure points” are, what are the things that set him off so that he will know when and what coping strategy to apply. He should also learn to see things from other people’s perspective, this will make him more sensitive to other people’s feelings when he gets angry and lashes out at them.

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