Cognitive and Behavioral Interventions: A Site Visit Report Julio F Caceres BSHS 312 December 19, 2011 Cherlie Saffeels Cognitive and Behavioral Interventions: A Site Visit Report Famed American psychologist, Abraham Maslow, once said, “We may define therapy as a search for value. ” That value that the client is seeking is in one’s self. Self value is very important. Human beings are creatures that require self validation; why do they exist?

Why do they continue to live? Why do they live when so many others die around them? Is there is a purpose to their life, to their existence and is that purpose, that value, of enough worth to warrant their continued existence. The job of the therapist, in many ways, is to provide that value. The therapist often serves a similar purpose as that of a Wall Street trader; raise the value of the stock each individual holds inside them self.

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The therapist, like the Wall Street trader, has many tools at his or her disposal, many theories, programs and tools have been made available through decades of research, trial and error practice and many bright minds have spent countless hours studying the human psyche in order to provide effective means of intervention. Therapists and psychologists spend much time working through different agencies, services and clinics in order to effectively use these tools that have been made available.

For the purpose of this paper the writer will consider such an agency, its purpose, methods and the wonderful and professional people that make it happen. The Dorchester County Department of Mental Health is a clinic that falls under the jurisdiction and purview of the state of South Carolina and is part of the larger state department, S. C. Department of Mental Health. The S. C. Department of Mental Health, according to their website, is a state agency that is headquartered in Columbia, S.

C. The Charleston/Dorchester Community Mental Health Centers are commissioned to, “provide community-based mental health services to the citizens and families of Charleston and Dorchester Counties. ” The writer of this paper interviewed a supervisor at the Dorchester County Department of Mental Health, Vanessa Brown. Vanessa Brown is a professional with a big heart with sixteen plus years of experience in her field. Mrs.

Brown is a well qualified professional with a Master’s in Counseling and Psychology and is a Licensed Professional Counselor (LPC) in the state of South Carolina. She went to school and began her professional career in northern Florida before moving to South Carolina where she has earned herself the position of Supervisor. The writer of this paper first met Mrs. Brown while taking his son to her office for a preliminary interview for counseling and he was struck by her professionalism and her kind demeanor and requested an interview with her for this paper. Mrs.

Brown has her heart in the right place and does her job, not for personal gain but rather for the personal satisfaction of helping others; one of the first things that she said in the interview was that, “if you are looking to make a lot of money this is not the profession for you, but then, if you have chosen this career path, making a lot of money is more than likely not the priority you have in mind. ” The first thing discussed in the interview was the types of programs that the Dorchester County Department of Mental Health Center participates in and oversees.

The writer of this paper was surprised at the wide variety of programs used as he did not have a clear understanding of how the center worked. The center primarily operates with outpatient therapy for both children and adults. This outpatient therapy primarily takes the form of one on one sessions between a therapist and the client, often at the office, though not necessarily the only setting that they have.

In cases that are severe, clients that are dangerous to themselves or dangerous to others, or for whatever reason are not recommended to travel to the office to participate in sessions at the office, the Center has what they call “ACT like” (due to the fact that it does not strictly follow the ACT system) therapy. ACT stands for Assertive Community Therapy and has a greater emphasis on home visits for those patients that are unable, unwilling or not advised to go to the office for their sessions.

The Dorchester County Mental Health Center also participates in schools, having counselors that see students right there at the school, helping kids deal with the problems and anxieties they face, and providing counseling sessions that do not require a visit to the office itself. The center has counselors that work with both the Department of Social Services as well as the Juvenile Justice System as well. Youth in Transition is also a program that he center operates that is intended to help with the transition from childhood to adulthood, advising young people that are looking at the very daunting challenge of adulthood with all of its responsibilities achieve independence and self reliance. When discussing who in the center actually participates in presenting the programs or interventions, Mrs. Brown explained that there is a “chain of command” of sorts in the department, as is usually the case in any office system, medical or otherwise. The therapists generally are the primary participants with the therapy sessions.

The therapists form the diagnosis but behind the therapists, rarely participating in the actual therapy, are psychiatrists that sign off on the diagnosis of the therapist. The Psychiatrists also perform a psychiatric medical assessment that the therapist is not trained or qualified to perform, the results of which also play into the final diagnosis. Therapists are required to have a Masters degree and two years of experience, though as Mrs. Brown clarified, most of the therapists at the center have 15-20 years of experience. Assisting the therapists are clinical assistant therapists.

Much as an assistant teacher, they help with sessions and are supervised by the therapists. A Bachelors degree is required to be a clinical assistant therapist and is a great way to break into the field while working on a Masters degree and then the licenses required in order to become a therapist. In regards to the question about the portion of the population that participate in the programs as well as who actually designs these programs, Mrs. Brown stated that the target population for the center are those that are more severe and persistently mentally ill.

Such cases include schizophrenia, bi polar disorder, major depression and anxiety disorders and other severe disorders. These can be found in a variety of walks of life, in different age, gender and racial groups. There are several therapists that work in the schools with children and many of the counselors work with families, children and adults individually. As for the design and choice of the programs, since the Dorchester County Department of Mental Health is part of the larger S. C. State Department of Mental Health, the programs are controlled, overseen and mandated by the State of South Carolina.

The interview then proceeded to the discussion on what specific behavioral or cognitive-behavioral techniques are used and how are they used. Mrs. Brown explained that the theories, techniques and interventions used are primarily left up to the therapist and more often than not are client specific, in the sense that the best approach to reach a specific client and their specific disorder is used. Mrs. Brown, however, did state that as an office they were more and more beginning to promote the use of evidence based practices.

In further discussion on the evidence based techniques, primarily two were mentioned. The first was Trauma Focused Cognitive Behavior Therapy (TF-CBT). TF-CBT is designed for anyone who has experienced a significantly traumatic event. As Mrs. Brown explained the TF-CBT she explained that a large percentage of cases in therapy have a basis in some traumatic event, even if the client themselves is not aware of what that traumatic event is. The second technique that is being promoted at the center, is used for primarily more severe cases, and is known as Dialectical Behavior Therapy (DBT).

DBT was designed by Marsha M. Linehan and is most often used with people that suffer from Borderline Personality Disorder (BPD) and often are in danger of self harm. DBT is founded on the belief that “environmental and biological factors that remain undetermined cause some people to respond to emotional states more quickly, and sustain a heightened emotional affect for an extended period of time before they return to baseline. ” As the writer understood Mrs. Brown TF-CBT tends to be done on a more one on one basis while DBT is often done through teaching and group therapy.

Determining the need for as well as the effectiveness of a program or an intervention on a client is done mostly through the process that the center uses in working with a client. The center is treatment plan driven and will begin with an opening session during which specific and attainable goals are discussed and set. Goals and objectives, specific and measurable, are an important part of a treatment plan driven environment. The treatment plan in and of itself is an evaluation of the needs of the client as well as a guided path to follow in order to fulfill the needs of the individual client.

In order to keep track of the progress being made there is an evaluation process completed every three months in which both the client and the therapist can evaluate the progress being made towards those goals set forth in the treatment plan. The success of the treatment plan is determined by specific measurements as well as the client’s view of their progress. Other tools used to measure the success of an intervention is the Child Behavior Checklist which is checklist designed originally by Thomas M.

Achenbach to assess social competence and behavior problems in children. The Child Behavior Checklist is a parent-report that is one of the most widely used standardized measures in child psychology for evaluating maladaptive behavioral and emotional problems in preschool subjects. Another tool used by the center to determine the success of the intervention is GAF Score, or the Global Assessment of Functioning Score. The GAF score is used by a clinician to gauge an individual’s overall level of functioning and his or hers ability to carry out activities of daily living.

It is a 100-point scale that measures a client’s overall level of psychological, social, and occupational functioning on a hypothetical continuum. American poet and writer, Emily Dickerson, once said, “If I can stop one heart from breaking I shall not live in vain; if I can ease one life the aching, or cool one pain, or help one fainting robin unto its nest again, I shall not live in vain. ” That is the life work of a therapist and should be their goal, to not have lived in vain because they helped ease the pain of the people they come in contact with every day.

Therapists like Mrs. Vanessa Brown and others like her working day in and day out, not for personal gain but rather to help others, intervene in their lives, help their clients cope with life and it’s pressing problems; these people, these therapists, help their clients find value in themselves and in their lives, and through that value, that mission, they too find value for themselves and find that they too have not lived in vain. References GoodTherapy. org. (January 01, 2012). Dialectical Behavior Therapy. Retrieved from http://www. goodtherapy. rg/Dialectical-Behavioral-Therapy. html GoodTherapy. org. (January 3, 2012). Trauma Focused Cognitive Behavioral Therapy. Retrieved from http://www. goodtherapy. org/trauma-focused-cognitive-behavioral-therapy. html Inter-University Consortium for Political and Social Research. (2012). Child Behavior Checklist. Retrieved from http://www. icpsr. umich. edu/icpsrweb/PHDCN/descriptions/cbcl-w1-w2-w3. jsp NOVA Southwestern University Center for Psychological Studies. (2012). Child Behavior Checklist. Retrieved from http://www. cps. nova. edu/~cpphelp/CBCL. html