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					Department of Psychology MSc Child, Adolescent and Family Mental Health Evidence-based Interventions & Treatment Approaches Written Coursework Assignment (80%) & A Case Study Presentation (20%)

SUMMER RE-ASSESSMENTS, ACADEMIC YEAR 2007/2008
Module code: Module title: PYP110C Evidence-Based Interventions and Treatment Approaches Dr. John McCartney

Module leader:

Date: Day / evening:

Re-assessments due by 1st. September, 2008. Day

NOTE:

Re-sit case presentations are not required this year. Re-assessments are due by 1st. September, 2008.

STUDENTS ARE REQUIRED TO SELECT ONE QUESTION. ADDRESS THE THEORETICAL ISSUES & RESEARCH FINDINGS IN RELATION TO THE CORRESPONDING CASE (or to ONE of the CASES, where there is more than one).
STUDENTS REFERRED ON COURSEWORK ARE EXPECTED TO SELECT ONE QUESTION OTHER THAN THE QUESTION SELECTED AT THEIR FIRST ATTEMPT. WHERE STUDENTS PASSED THE PRESENTATION PART AT THE FIRST ATTEMPT, MARKS FOR ORIGINAL PRESENTATIONS SHALL BE CREDITED ACCORDINGLY (THIS APPLIES TO ALL STUDENTS FOR 2007-8).

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COURSEWORK: QUESTIONS

STUDENTS ARE REQUIRED TO SELECT ONE QUESTION. ADDRESS THE THEORETICAL ISSUES & RESEARCH FINDINGS IN RELATION TO THE CORRESPONDING CASE (or to ONE of the CASES, where there is more than one).

[1] To what extent is it appropriate to take an individual psychological treatment approach to adolescent depression? (Case, pages 3-4)

[2] Evaluate the available evidence-based psychological treatments for anxiety disorders with specific reference to EITHER (i) dental phobia OR (ii) social phobia. (Case (i) pages 4-5; Case (ii) pages 5-6)

[3] What types of treatment have been found useful in the treatment of infant and childhood sleep disorders? (Case, pages 7-8)

[4] Critically discuss psychological approaches to the management and treatment of adolescents who attempt to commit suicide. (Case, pages 8-9)

[5] Discuss effective treatment approaches for helping children and adolescents who have (or believe they have) experienced sexual abuse. (Case, pages 9-11)

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CASES FOR THESE SPECIFIC QUESTIONS 1. Case for Question 1: Adolescent Depression
At the time of her referral to the child guidance clinic (child & adolescent mental health services, CAMHS), Maria was a 13-year-old Hispanic girl. She had attended a private school over the previous 2 years after completing a program for gifted and talented inner city children in the public schools. Shortly before her first visit to the clinic, Maria told one of her friends at school that she had thought about killing herself. This friend persuaded her to see the school's psychologist. After meeting briefly with her, the school psychologist contacted her mother to recommend that she seek help for her daughter. Maria‟s mother promptly arranged the initial appointment at the child guidance clinic. During the history taking session, Maria reported that she was feeling increasingly depressed and was having more suicidal thoughts that were scaring her. Maria said that she now felt that she needed help to feel better. Although her mother stated that she had not realized that her daughter was depressed, she had noticed that Maria had become more irritable, oppositional, and difficult to manage at home. As the clinical interview progressed, it became clear that Maria had been experiencing depression for a long time. She said she had felt down and depressed almost every day over the last year. More recently, these feelings had intensified and had been accompanied by irritability, loss of energy, and fatigue. Other features were increasing loss of interest in her normal activities (e.g., visiting friends, participating in the school's swimming team); evidenced by her statement that she “feels like sleeping all the time." She had also noticed that her appetite had decreased. She had also experienced some difficulty sleeping and frequent headaches. She stated that she had been constantly worried about such matters as her physical appearance and whether she had done something wrong (e.g., unknowingly upset one of her teachers or classmates). Increasing irritability led Maria to have more conflicts with her peers and more arguments with her parents and two younger sisters (ages 6 and 9). Maria said that she would feel like the world was coming down on her and would then think about suicide. Later, a classmate she told about these feelings persuaded her to see the school‟s educational psychologist. Although Maria had not decided to see the psychologist on her own, she felt relieved by the opportunity to express the feelings she had been having. Maria‟s symptoms of depression began when she was 11, although they had not intensified or become persistent until the year preceding her first visit to the psychologist. When the symptoms first emerged, she was living with her mother and two sisters. Her parents had been divorced since she was a toddler. However, over the years since the divorce, Maria‟s father continued to move in and out of the house and back and forth from Mexico. The family received public assistance and lived in a poor urban community. She had been faced with several stressors that could have triggered or worsened her depression. First, after receiving a full academic scholarship, she had switched from attending a public school in her neighbourhood to attend an expensive upper-middle-class private school in a distant part of the city in which there were few minority students. The stress associated with the transition to this school was worsened by the fact that Maria‟s family was very poor and on state benefits. She had very different social activities and opportunities available to her, compared to her new classmates. However, Maria‟s father had recently returned to the United States from Mexico to live with his mother. He was very ill, with an

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extensive history of medical and psychological problems including several heart bypass operations, ulcers, high blood cholesterol levels, lung problems, alcoholism and depression. Recently, he had been in and out of the hospital a few times, and she was worried that he might die, even though she was angry with him and spoke very little to him. Much of her anger about her father stemmed from the years before her parents' divorce, when she was exposed to many physical fights between her parents. Although Maria was angry at her father for his sporadic and unpredictable involvement with and abandonment of the family, she was also angry about the manner in which her mother had interacted with him over the years since the divorce. In addition to her father's depression and alcoholism, other members of the family had histories of psychological disorders. Her mother had received outpatient psychotherapy for an episode of depression that occurred shortly after her marital separation. Her maternal aunt and paternal grandfather also had had recurring periods of depression. Maria‟s visit to the psychology clinic was the first time she had received treatment for an emotional problem.

2. Cases for Question 2 : Phobias 2 (i) Dental Phobia
Raoul was 9 years old when his father and mother complained to their family physician that he was not complying with their wish that he attend the dentist for a routine check-up. He was annoyed, frightened and argumentative whenever they approached the subject and he thought them cruel for saying that it was necessary. His father worked as a taxi-driver and his mother was rather preoccupied by the needs of her other children. There were three siblings; all younger than the identified patient and one of whom was born 5 months ago. The family were part of the Bengali community in an outer-London suburb. The parents were born here although their own parents had moved from India to find work and residence here. They were, for the most part, fairly happy with their lives although their accommodation was now stretched and they were worried about finances from time to time; they looked forward to when Raoul‟s mother could take on paid work of her own. The parents said that Raoul‟s schoolwork was reported by his teachers to be generally good, although he had considerable difficult settling initially, responding very angrily to the departure of his mother; then subsiding into tears when she was not there. He was responsive to his siblings, although he tended to spend more time playing with friends of his own age from school. There had been no complaints of any kind from the school. The parents admitted that they rather disliked going to the dentist themselves. Raoul‟s father had said once that he thought it was all more trouble than it was worth; perhaps he should just change to dentures rather than experience the torture. Now he felt guilty about that discussion in front of the children because he felt sure that Raoul had taken it rather too seriously. He really didn‟t mean it seriously. The parents looked at each other during the discussion with a wry sense of amusement; more for the sake of mutual support thought the clinical psychologist than from any kind of collusion. The family seemed genuinely warm, if somewhat pressured, and

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the parents seemed more able to support one another appropriately, if anxiously, on the specific issue of dentistry. Although Raoul‟s mother didn‟t like going to the dentist she said she wasn‟t anxious over it; nor had she had any very serious problems, except for before she was married. Raoul had previously seen a specialist for tonsillitis although it was not thought necessary to perform any kind of surgery. His milestones had all been normal although he was slower to read than most of his class at school. He was a lot better with numbers and enjoyed sums better than reading. They reported that Raoul had experienced (what they believe to have been) occasional nightmares between the age of four and five. Nevertheless these were alleviated by means of gentle supportive cuddling and a teddy bear. His last visit to the dentist (almost one year ago) had been unpleasant. He had a tooth filled for the first time and the dentist had hurt him when he was cleaning his teeth. They bled and he couldn‟t eat well for more than a week later. He noticed they were bleeding when he brushed them even although they hadn‟t done so prior to the dental treatment. His mother said he wasn‟t able to judge these things because he hadn‟t been brushing his teeth prior to the appointments. It was the dentist who encouraged him to brush more regularly and the bleeding had been very temporary and predicted, by the dentist, to be a short-term side-effect. Raoul repeated that he couldn‟t go to the dentist again. He said the injections also hurt and it frightens him even to think of sitting in the chair. He had the thought that he was going to stop breathing during the operation. He didn‟t dislike the dentist who had been friendly and was himself a member of the Bengali community. On psychological testing he proved to be slightly above average in intelligence, above average in trait anxiety and low in extraversion. He worried over loss of control and disliked, as well as feared, the dental drill. When the focus was more on emotional experiences he described his experiences vaguely rather than precisely, although it became clear that his experiences at the dentist included symptoms of panic (e.g., heart beating fast, sweaty palms, fear of suffocating). He cooperated well during the testing and seemed more relaxed than when in the company of his parents. He did not identify any additional fears although he admitted that he sometimes dislikes going to school. Sometimes he didn‟t pay full attention to what was going on because he didn‟t know what the teacher was expecting of him. He liked it most when the lessons involved drawing pictures and doing sums. He found reading a bit more difficult and thought that the stories were often very old-fashioned; very different from what he sees on television. When the conversation focussed more on the dental fears he became visibly tearful, distracted, and much less communicative. He seemed to feel that the point of the conversation was to convert him to another view rather than understand his dental anxiety.

2 (ii) Social Phobia
Sally‟s parents heard about a treatment program for social anxiety from the parents of a boy who had recently completed the program successfully. The information about the program was very timely because Sally had lately been asking her parents for help with her fear and anxiety. Accordingly, after hearing about the program, her mother contacted local child psychiatric clinic and arranged an initial evaluation appointment for the family. Sally was a l5-year-old Caucasian girl preparing for GCSEs. As part of her initial

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evaluation, a clinical psychologist who specialized in the treatment of childhood anxiety disorders interviewed Sally and her parents separately. At the outset of the interview, Sally stated that her problem was that she would get nervous about everything, particularly things at school and doing anything new. When asked to give an example, she told the interviewer that her father wanted her to go to camp this summer, although she did not want to and refused to do so because of her "anxiety." During the course of the interview, it became clear that Sally‟s anxiety took the form of a persistent fear of social situations where she could be the focus of other people's attention. For example, Sally reported that she felt very self-conscious whilst in the shopping mall and constantly worried about what others might think of her. The interviewer asked Sally about a variety of situations that are frequently feared or avoided by teenagers with social anxiety. For almost every social situation, she reported at least some level of fear and avoidance. Sally stated that she was very fearful of such situations as eating in public, using public restrooms, being in crowded places, and meeting new people. She claimed that she would almost always try to avoid these situations. At school, Sally reported fear and avoidance of such activities as speaking up in class, writing on the blackboard, and talking to her teachers or school principal. Although she was very good at playing the flute she said she had dropped out of the school band because of her anxiety over participating in band performances. In addition to anxiety about talking to teachers, she reported that she feared talking to unfamiliar adults. She would never answer the telephone in her home. She claimed that she was also very hesitant to use the phone when she could have to interact with strangers. In most of these situations, Sally said that her fear and avoidance related to her worry about possibly saying the wrong thing or not knowing what to say or do, which would lead others to think badly of her. Quite often, her fear of these situations would be so intense that she would experience a full-blown panic attack. In certain circumstances, her intense fear would usually be accompanied by a variety of symptoms: accelerated heart rate, chest discomfort, shortness of breath, hot flashes, sweating, trembling, dizziness, and difficulty swallowing. To gain a thorough picture of the nature of Sally's difficulties, the psychologist conducted a separate interview with Sally‟s parents. While confirming what Sally had said the parents conveyed that their child's social anxiety was even more severe than what she had indicated. In fast-food restaurants she would not order or pay the cashier but, instead, would have her younger sister do everything for her. Her parents reported that she would never initiate any activities, join clubs, invite friends over, or even call friends on the telephone. They said that the "last straw" had occurred two weeks ago when they had a family gathering at their home with a number of relatives and friends attending. Because of the large number of people in the house, Sally had experienced severe anxiety resulted in locking herself in her bedroom for the entire visit until the last guests had left. Sally was the first of two children; her sister being two years younger. Their lifestyle was middle-class and their home life was said to be happy. Her father was a building contractor; her mother worked in a local bank. There was no history of marital discord and her parents had always been quite supportive of her. In response to Sally‟s social anxiety, they had pushed her to socialize more, which seemed to have the opposite effect for she would become even more avoidant. Sally‟s parents reported no history of anxiety problems among the immediate relatives of the family. Despite her problems with social anxiety, Sally had two or three close friends and a number of "acquaintance" friends. Indeed, her parents told the interviewer that Sally could always make friends; she just would never make the first move. However, she preferred to spend time with her close friends with whom she felt safe. Sally‟s grades at school were usually Bs or Cs. Her parents said that she achieved these grades with little effort. Interestingly, while Sally was often quite fearful of school, she had not missed many days over the past several school years (and not at all this year).

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3. Case for Question 3: Sleep Disorders
Jay was four-and-one-half years when his mother and father divorced. He had an older sister of school age. The children were in the care of the mother because the father had left his wife for another women who had herself four children. The divorce had been delayed for a year because Jay‟s parents had attempted to resolve their marital difficulties through attendance at Marriage Guidance. Unfortunately the hostilities that had occurred and the attachment he had formed to the third party proved to be insurmountable obstacles to reconciliation. Jay‟s mother had not adjusted to being a single parent. Whilst she was working part-time in a well-paid administrative role she had financial concerns despite her husband‟s committment to paying maintenance; although these concerns rarely became a worry. Jay, his mother and his eight-year-old sister attended the initial appointment at the department of child psychiatry. They were seen by a consultant psychiatrist on the first occasion. He discussed the children‟s milestones and the marital problems, including the children in the discussion where appropriate. Jay‟s mother was very articulate and perhaps more confident than the psychiatrist had expected, given her recent divorce. Whilst he didn‟t think it appropriate to go into details, it was necessary to look at the emergence of the child‟s sleeping problems within the overall context of their recent upheavals. The mother said she had no difficulties with either child until a year or so ago when they were attending marriage guidance. When her husband stopped sleeping at home; or sleeping at home on a regular basis, Jay started to be fretful at night. He had become used to a routine whereby his father read to him and cuddled him prior to his going to sleep. Therefore she had to take on that role. Nevertheless Jay found the change of routine hard to understand. Why was daddy not there? Most times he didn‟t seem too anxious and tended to fall off to sleep. Unfortunately he awakened not very long afterwards, crying much louder than ever before and therefore his mum couldn‟t ignore his distress. More recently, there have been sleep onset problems to add to these difficulties. Sometimes she can solve the problem only by taking him into her own bed. She doesn‟t like that, partly because she worried he could get used to depending on that and partly because she herself is now seeing another man who could perhaps stay over. Jay‟s speech was limited although he could understand language at a higher level than he could produce language. At times during this discussion he looked at his mother and responded by nodding when the psychiatrist looked for him to confirm statements, He played with the dolls and later in the session said the doll was “tired”. That gave a good chance to engage the child and his family on a more focussed discussion of plans to help with the child‟s sleep problems. Jay was initially shy when the psychiatrist focussed on these problems (as he had been when these were discussed previously in the session). Instead of a focus on criticism the consultant looked at what he liked to do in the evenings, identifying his preferred routines and seeing what kind of things he liked to do during the day. This helped to clarify that he tended to have naps during the early evening. Jay‟s sister reported that she had not experienced any severe difficulties although she found it difficult to understand why her father had left. She started to cry when the psychiatrist asked of her school work. It turned out that this was not because there were problems; it was because she had difficulty talking to her friends of her home life. She had previously been very happy and even boasted of her father taking her swimming. She agreed with the psychiatrist that she was very fond of him. Then he reflected that perhaps “she felt a bit cheated; as if she‟d been taken in and that

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maybe it was harder now to trust her parents?” That led to a more detailed focus on the family‟s pattern of home life and Jay‟s nursery school. Most of what they had to say sounded fairly healthy and positive although the psychiatrist thought that the break-up was still an emotional burden for all of them. Jay seemed to have, or at least to manifest, little understanding of where his father was now and it seemed that, after times of access, he expected his father to return home with him. The psychiatrist thought it best to refer on for psychological therapy of the child‟s sleep problem although he wanted to arrange for a physical examination by a paediatrician prior to the therapy to rule out, or to identify, any relevant organic factors. He thought there were no indications, at the moment, of physical causes and he predicted a positive response to the fairly well established behavioural treatment.

4. Case for Question 4: Adolescent Attempted Suicide
Richie was 17 years old when he was referred for psychiatric evaluation following an overdose. It was an especially worrying case because the overdose was very unexpected, so far as his family were concerned; with very few precursors of which they were aware. He attended an initial session with his parents. His older sister was no longer living at home therefore it was not thought necessary for her to come along. It was explained that their initial family meeting was a precursor to an individual session for Richie and a separate session for the parents. Richie‟s father was a schoolteacher; his mother was too. She no longer worked on a regular basis although she sometimes took work as a relief teacher when there were long-term absences of staff. The parents were in a state of disbelief. He had been performing well at school and his grades were very good. He had realistic hopes of entering medical school; as was the family‟s ambition for him. Richie was initially very silent in the session and it took a while for him to say anything. When he did speak he was surprisingly calm and had no difficulty or reluctance in answering the questions. The psychiatrist thought it best to focus on the interpersonal issues in this setting, taking up his recent success and his hopes for the future in the context of two parents who were successful in their careers. Did he feel that it wasn‟t easy to live up to their hopes? He seemed very warm to his parents and he thought there was no real pressure from them. He didn‟t feel he was out of his depth or that he thought he couldn‟t succeed. What had led to the suicide attempt was something that he hadn‟t really been able to come to terms fully within himself therefore he hadn‟t discussed it with his parents. The psychiatrist thought that perhaps if he‟s found it difficult it could need a bit more discussion on a one-to-one basis with the clinical psychologist prior to discussing it within the family setting; unless he felt ready right now to say more. Richie thought he needed to think it through first because it had been his difficulty thinking it through that had contributed to his wanting to stop thinking altogether. That‟s what the psychiatrist had thought, therefore the session moved to the history and the present circumstances of the family. Most of the discussion suggested a warm and supportive kind of environment, with no evidence of „family secrets‟ in the past. The parents were worried that they had not paid enough attention to Richie‟s emotional needs, nevertheless Richie thought they had been generous in many different ways; ensuring his space for study, supporting his piano lessons, and encouraging him to balance his work with leisure. The problem was not really a family problem it was something more personal. The psychiatrist wondered if there was a difficulty identifying need for help in a family where there seemed to be a rule

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about not having problems. The parents were surprisingly amused; followed by a real sense of acknowledgment that that‟s exactly what worried them. The parents and Richie soon afterwards moved into separate sessions. The couple‟s session went well although there were signs that the parents had a lot more by way of divergences of view than had been obvious previously. Richie‟s mother sometimes felt stifled and restricted in her career. The parents had good relationships with her daughter and her boyfriend. Most of the session focussed on the couple‟s reactions to the crisis, their functioning, boundaries, sense of control, stage in the lifespan, and their hopes for the future. They also discussed their own parents; reactions to death in the family and generational issues that seemed relevant to the case. Richie‟s individual session focussed on the immediate and longer-term cognitive and emotional precursors to the suicide attempt. The immediate precipitating cause had been his fears regarding the future. He had gradually become convinced that he was not heterosexual. He had been very attracted to one of the boys in his year at school and he had also read novels of a kind that involved homosexual relationships. At times he put these out of his mind and at other times he couldn‟t stop the longings that he felt. He felt ashamed of these ideas. How could he let his father down? How could he possibly be a medical doctor and a homosexual? It was that specific thought that was the most perturbing. It seemed so dirty, so unacceptably abnormal, that he just couldn‟t face the idea of it. Yet, at other times, prior to focussing on the disparity, it had seemed reasonably acceptable; if never quite entirely so. He had no history of sexual relations nevertheless his masturbatory fantasies were usually homoerotic. He had reasonably good friends at school; one of them very good. When he was younger the boys sometimes called him names to the effect that he seemed effeminate; nevertheless neither party took it very seriously although he sometimes felt secretly worried. These features did not seem obvious now. One of the other precursors to the suicide attempt was going out with his closer friend and feeling very drawn to him emotionally. He had felt that before nevertheless he couldn‟t bear it on the most recent occasion and it made him feel overwhelmingly anxious. The clinician began to integrate the threads. She emphasised the value of his sensitivity to not being premature with respect to his sexual identity and discussed the complexity of reaching a balanced view in a short period of time. That it wasn‟t wise to jump to conclusions as to either its nature or its meaning. The rest of the session focussed on the more specific context of his suicide attempt and on what to do in future if he felt like that again. The level of suicide intent was not especially high (as measured psychometrically) although the level of hopelessness was; perhaps because of his fears over his identity. He said that he didn‟t understand fully what he had done because he had taken a lot of alcohol prior to the drug ingestion and that was unusual for him. He regretted causing pain to his parents; it was ironic because, in a sense, suicide was to avoid letting them down. He had no plans to do so now.

Case 5: Sexual Abuse
Cindy was sixteen-years old when her mother discovered that her father had allegedly been “interfering” with her. Social Services were alerted to the possibility of sexual abuse by a general practitioner. During her first interview at the social services department, she was accompanied by her mother. Cindy reported she had been depressed and agitated with outbursts of rage and feelings of suicidality for more than three months. The emotional turmoil was said to have begun following alleged sexual contact with her father. She was unable to stop distressing images of

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the abusive experiences coming into her mind out of nowhere; flashbacks included times when Cindy would momentarily feel as if the abuse were being repeated; yet it had not occurred more than once. The social worker found it difficult to gather more than a sketchy account of the alleged incident during the first interview. Cindy seemed very withdrawn and she made very little eye contact with the interviewer. She took up her mother‟s account of what had happened; simultaneously observing the girl. The alleged incident had occurred when her mother was away from home visiting relatives. When her mother realised the cause of her upset she thought of contacting the police, nevertheless she had trusted her husband beyond question and therefore doubted the truth of what she was being told; at least initially. She thought Cindy could have had impulsive sex and then felt guilty about it. Cindy started to cry when her mother was speaking. Cindy said “nobody seems to believe me”. Her mother said she wasn‟t saying that; merely that she had THOUGHT that there could be other reasons. The social worker thought it best to interview the child on her own for a while next time, emphasising that time could be needed to see the whole picture and it could feel like a pressure cooker unless they kept the discussion to their session for the time being. If there were any problems they shouldn‟t hesitate to call during the interval. The social worker looked in more depth at Cindy‟s own account of things at the next session. Cindy described her earlier childhood as a happy one. She characterized her house as the „safe house‟ in the neighbourhood, where all the kids could come to play and where some found refuge from problems in their own homes. Cindy's father had been a Vietnam veteran who continued to have posttraumatic stress disorder from events he had experienced during the war. She described her father as emotionally shut off; yet spoke very fondly of him. She described her mother as a self-help fanatic who kept the house filled with self-help books. Cindy also stated she had a close and supportive relationship with her mother. Cindy had one older brother who left home a few years ago; they rarely interacted now. After describing her childhood before the alleged abuse, Cindy told the social worker about how drastically things had changed since these incidents. Cindy said that she had told her mother what had happened and that her mother seemed to have stopped the abuse. Despite their being no re-occurrences Cindy withdrew from her normal high school activities. She became less interested in schoolwork. She began drinking. She thought she‟d become a "total rebel" and had started to date a "wild guy who was totally bad news"; so far as her mother was concerned. She was frightened of becoming pregnant by him. The social worker tried to focus in on the incident of alleged abuse. “I don‟t want to think of it” she said angrily. It had occurred when her father had returned from a “night out with his friends”. He wasn‟t drunk although he had been drinking. It was later in the evening that he came to say goodnight to her when he approached her bed and sat on it stroking her hair and saying how he was so proud of her schoolwork. He suddenly, almost unintentionally she thought at the time, placed his right hand on her negligee and started to touch her breast. She was absolutely devastated yet at the same time excited. Her father became sexually excited and he wanted her to allow him to touch her lower down. Nevertheless when she started to scream he looked shocked and started to apologise saying he didn‟t know what had come over him. Cindy said that one of her fears was being at home with her father when her mum wasn‟t available. She had never felt that kind of lack of safety in the past. She feared lacking control and that she needed to know what she could do to get out of the situation if it happened again. She had not discussed any of these events with anyone other than her mother and her boyfriend. The lack of trust at home was very

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hard to bear. At the time of the accusation, her father had replied to her mother by saying it was “nonsense” and “hysteria” and how could she take Cindy‟s side against his? Cindy felt disgusted at times and sick to death of her family. She felt now that she no longer knew her father; it was like living with a stranger. She couldn‟t trust getting close to him in any normal way until he was honest about what had happened. She thought that they could have got over it if he‟d apologised and promised not to do it again. The problem was his denial of it. That‟s what she thinks has caused the turmoil. She often feels as if she‟s “going mad” because she‟s aware her version of what happened could seem so irrational beside that of her father.

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MORE DETAILED INSTRUCTIONS & INFORMATION on ASSESSMENT

80% essay; 20% group-based presentation related to essay. Deadlines: Week 9 or 10 Presentations; Week 14 Submission of Written CW. Select ONE QUESTION and the corresponding case [or ONE of the cases (where there are two)]. Provide a detailed critical evaluation and response to the theoretical problem. The case study should be used to illustrate the types of assessment that should precede treatment and the therapeutic intervention(s) that could follow assessment. Be sure to relate your choice of methods of assessment or intervention to the available evidence. Your written submission should be no more than 3000 - 3500 words. Group-Based Presentation
Coursework is preceded by small group presentations. These presentations are based on a combination of self-directed learning and learning action groups. These methods facilitate breadth and depth of learning; enabling students to prepare for a particular piece of coursework, which requires them to address evidence-based treatment approaches. Reading a wide range of sources is relevant to each task. Students are required to work in small groups (for their presentations) for planning their approach to the clinical problem part of their work. Each individual student is expected to produce and submit their own individual written assignment. Students have to demonstrate critical thinking and be able to communicate the results of the problem based learning exercise through group and independent learning.

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Aims of Presentation: 1) To enable students to work as part of a group. 2) To require students to do independent learning and to reflect on the case part of their assignment in the light of their group discussions. 3) To form a plan of treatment. The group-based experience should result in written plans for assessing and treating the case selected. 4) To enable students to combine theoretical and psychosocial evidence from a variety of sources and to devise a method for tackling the selected clinical case, acknowledge best evidence-based intervention(s). 5) To enable students to see the applied nature of psychological treatment to reallife clinical cases 6) To give students experience relevant to their postgraduate education and future employment. The results of groupwork discussions should be summarised prior to presentation. There should be points relating to the various separate sections of coursework, although the focus of attention here should be the case study. Assessment Criteria for Written Coursework Each individual student is expected to produce and submit their own individual written assignment. Students have to demonstrate critical thinking and be able to communicate the results of the problem based learning exercise through group and independent learning. Students are expected to deliver presentations prior to submitting their 3000-3500 word assignment. Written coursework essays should contain the following sections. 1) Background to problem: students will demonstrate knowledge of the case problem described. This section should not make up more than 500 words of the final report.    Students should give an account of the history of the problem and any psychological, environmental or biological factors causally linked to the problem. If additional information is required, plans for investigating hypotheses should be stated (e.g., interviews, psychometric testing, behavioural observations). Issues to be addressed: There should be a discussion of evidence-based interventions. Careful thought should be given to the selection of treatment as well as role of culture, gender and age while thinking-through choice of intervention(s) & making predictions regarding the course & outcome of therapy. Should the intervention focus on the child or adolescent, the family, the school, or combinations of these? What does the literature say about context and location?

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2) Design of intervention. This section comprises the main part of the report and should be no more than 2000 words max long.  Background. A background to the type of intervention(s) being used must be described. A clear justification for intervention must be given.  Theory. The theoretical basis of the intervention must be described. Students will be expected to show the pros and cons of the theory used and make a good justification for the theoretical background.  Biopsychosocial causal factors: Psychological, social and biological factors relevant to the intervention may need to be discussed.  Description of the intervention: A clear description of the intervention should be given.

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3) Discussion of intervention effectiveness. (500 words approx)  Summary of the intervention. A brief summary of the expected outcome of the intervention should be given with clear justification too.  Problems to be envisaged in application. Students should be able to highlight any relevant issues in carrying out the proposed intervention.  Future work. Student will be expected to demonstrate an appreciation of what could be done next. Critical appreciation of the pros and benefits of the intervention would be expected to be addressed. 4) References: Appropriate referencing should be used throughout your assignment in the text. A reference section is also required to be attached at the end of the assignment using Harvard Style. These instructions and word lengths are for guidance only. You may find that some sections overlap. This is acceptable as long as you demonstrate an awareness of all the relevant factors in justifying, designing and carrying out your evidence-based assignment. Assessment criteria: Students will be assessed on the following:

    

Critical appreciation of the literature both theoretical and practical Justification and design of intervention Presentation of information and write up of report Appreciation of cultural, social and psychological factors in intervention delivery Appropriate referencing throughout

Other Marking Criteria Students are advised to consult the main marking criteria, and grading criteria for master‟s level, given in module booklets (pages 19-20).

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