One of the counseling theories that align with the needs of a client with ADHD is the cognitive theory. The theory is based on the assumption that an individual suffering from a mental condition experiences certain negative thoughts that influence his or her emotional state (Beck & Haigh, 2014). This phenomenon, known as automatic thoughts, covers the individual’s self-assessment, the perception of the environment, and the ability to make decisions about the future (Corey, 2015).
According to the common approach, the possibility to reflect on automatic thoughts usually results in their re-evaluation, which is more realistic and, in most cases, less negative. The counselor is thus expected to assist the self-reflection and guide it in the direction that promises the most favorable outcome as well as raise the client’s awareness of the effect and, by extension, enhance his or her self-sufficiency (Capuzzi & Stauffer, 2016). The theory often used for the treatment of depression and anxiety as well as any condition associated with patterns of negative thinking.
In the client’s case, the theory can be implemented through several sessions during which specific situations will be identified that have a negative effect on client’s life. The scenario will then be analyzed in order to identify the core cause of the challenge as well as the falsely attributed side-effects. Finally, tactics will be assigned to each major issue that would help the client to reframe his perception and manage the situation.
Considering the theory’s focus on thinking as a determinant of behavior, it would be reasonable to identify the following goals:
- Improved self-esteem in terms of academic achievement (the increased confidence in school performance and the ability to accomplish tasks given by the teachers);
- Overall improvement in the quality of life (the improved positive perception of the environment, peers, teachers, and the new community).
The first goal is expected to address the gaps in academic performance associated with ADHD. According to the available information, the client is unable to concentrate on a specific task for a long time and is rarely attentive during the lessons. However, he occasionally displays above-normal results in some disciplines. Since there is no system to the tendency, it would be reasonable to attribute the outcome at least partially to the fact that he is aware of his underperformance and, as a result, is discouraged by it.
As is common in such scenarios, he is subject to at least one mental distortion, such as mental filtering (in which he remembers the negative results associated with his efforts and ignores the positive ones) or mind reading (where Andres makes an inadequate estimation of others’ negative thoughts about him and holds the as objective reality) (Wells, 2013). The latter is especially relevant since the client also undergoes treatment for type 1 diabetes which often serves as a cause for stigmatization by the peers (Mayo Clinic, 2017).
The second goal is intended to facilitate an overall improvement in Andres’ quality of life. Several issues, such as a recent move, a serious medical condition, a language barrier, and the lack of community involvement likely have a cumulative effect on the boy’s well-being. While each of these aspects can be addressed separately, it would be more appropriate to adopt a holism principle (Moe, Perera-Diltz, & Rodriguez, 2012). From such perspective, most of the said issues can be partially linked to self-esteem. Thus, the overall improvement can be considered a wellness-oriented goal.
The successful application of the theory to the counseling process is expected to alleviate the negativity associated with academic underperformance and, by extension, encourage the client to adequately evaluate his academic progress (Wells, 2013). In other words, he will be able to critically analyze his productivity, identify improvement, recognize positive results, and maintain effort at a steady pace. Another likely outcome is the improved perception of the environment and a more positive perception of peers’ treatment. Andres’ behavior will not be inhibited by his expectations of rejection associated with the treatment of a medical condition, insufficient knowledge of English, recent immigration, or any of the unaddressed cultural or socioeconomic issues (Pineros-Leano et al., 2017). Simply put, the holistic, wellness-oriented application of the theory will produce a net improvement of the client’s quality of life and minimize the occurrence of negative behaviors in the future.
The second theory that is relevant to the client’s case is the behavioral theory. According to the theory, the behavior is based on previous experience and is learned (Corey, 2015). This also means that the acquiring of the desired behavior can be achieved through the collaboration between the client and the counselor and peer support. In counseling practice, the behavioral theory can be utilized through several approaches that usually include training, rehearsal, reinforcement, and education (Corey, 2015).
The first step necessary for such approach is the identification of positive goals, usually by the client. Once the intentions and goals of the client are clear, techniques can be chosen that reinforce them. Depending on the nature of the desired skill, the techniques can be based on repetition or situational application (Capuzzi & Stauffer, 2016). Once the rehearsal is performed, the counselor is expected to provide feedback in the form of praise for improvement or corrective remarks to improve certain areas.
Considering the case at hand, two goals can be identified pertinent to the theory:
- Better results in academic performance (the improvement of attention span and minimization of wasted time during classes);
- Greater independence in individual academic assignments (e.g. the decreased reliance on supervision during the completion of the homework).
It should be pointed out that while the distorted perception of the environment and inadequate self-assessment is at least partially responsible for the presenting problem, the effect can be alleviated through a development of relatively simple skills. The effect can be applied with equal success to self-esteem once the specific causes of its decline are identified. Importantly, the latter approach has been criticized for targeting the symptom rather than the causes (Fall, Holden, & Marquis, 2017). On the other hand, it provides a feasible, robust solution that can produce an observable and measureable effect. Thus, in combination with the cognitive theory suggested above the behavioral theory is expected to be effective.
If the first goal is successfully met, the client is expected to show stronger ability to concentrate on a given academic task, focus on the instructions of teachers, and demonstrate better communication skills. Consequently, these enhancements would allow for better academic performance, a more even distribution of results, and, by extension, a more predictable progress. The second goal is expected to equip Andres with the techniques and tactics that minimize distraction during independent tasks performed individually (e.g. homework). Such improvement will eliminate the need for parental supervision, which is especially important considering their current socioeconomic situation and mutually reinforce the trust within the family. It is also noteworthy that decreased reliance on external assistance will have an overall positive effect on many aspects of quality of Andres’ life and can thus be considered a wellness-oriented goal.
Special Needs
The special needs identified in the case are the ADHD and type 1 diabetes. The former is associated with disruptions of the boy’s social and academic interactions due to the behavioral issues. The latter introduces several undesirable psychological effects such as a negative reaction from peers in response to observing unusual practices (e.g. administration of medications). In the long run, such reaction can be amplified by the distortion of perception through automatic thought and compromise the client’s self-esteem. Thus, the ADHD can be considered the primary focus of the intervention.
The special need should first be introduced in a session through mutually agreeable terms. Most likely, it should be related to the inability to concentrate attention on specific tasks or people. Once the negative effects of such phenomenon (e.g. poor performance) are outlined, it is then possible to set goals for the following sessions. The goals need to be realistic, doable, and, preferably, observable and measurable. For instance, the inability to concentrate on a homework assignment can be addressed by the goal of engaging the task for a certain period of time.
This, in turn, can be achieved either through a rehearsed action (e.g. setting a time limit and keeping a record of successful adherence to it) or through the deconstruction of the scenario and the subsequent identification of the core cause. It should be noted that while the former example is relatively straightforward and requires no major planning, the latter needs to be based on the conclusions reached in collaboration with the client and would thus require at least one session to be formulated.
For instance, if the inability to finish the assignments will be tied to the perceived inevitability of the unsatisfactory results, the respective goal would be the ability to objectively estimate the outcome and predict the most likely (rather than the most negative) result. Such goal can be met through a variety of techniques achieved either through learned behavior or through the breakdown of necessary activities. For the homework assignments, the components can be the ability to start working on time, tackling the tasks that the client would otherwise avoid, and review of the tasks at hand in order to prioritize them by difficulty.
Importantly, at least some of the techniques and tactics need to be performed in-session while others can be left for Andres’ independent use. The latter would then require progress logging. The easiest example is a daily journal where Andres would describe or grade his success in completing school assignments. Such information would allow evaluating his progress in reaching the formulated goals and adjust the content and focus of the future sessions if necessary. More importantly, it would visualize the progress for the client and boost his confidence, strengthening his independence.
It should also be emphasized that the client’s cultural background may require minor adjustments to the intervention. Specifically, his recent change of schools due to immigration as well as a lack of English proficiency likely has at least some effect on the overall self-esteem as a result of social anxiety disorder (Patel & Reicherter, 2016). The said disorder is a thoroughly studied phenomenon that can be addressed through several well-established techniques (Pineros-Leano, Liechty, & Piedra, 2017). Importantly, the failure to recognize the possibility of the disorder can compromise the feasibility of the intervention whereas its acknowledgment requires only minor adjustments of the session protocol. In other words, its inclusion is relatively simple and should not be overlooked.
References
Beck, A. T., & Haigh, E. A. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual Review of Clinical Psychology, 10, 1-24.
Capuzzi, D., & Stauffer, M. D. (Eds.). (2016). Counseling and psychotherapy: Theories and interventions (6th ed.). New York, NY: John Wiley & Sons.
Corey, G. (2015). Theory and practice of counseling and psychotherapy (10th ed.). Chicago, IL: Nelson Education.
Fall, K. A., Holden, J. M., & Marquis, A. (2017). Theoretical models of counseling and psychotherapy (3rd ed.). New York, NY: Routledge.
Mayo Clinic. (2017). Type 1 diabetes in children. Web.
Moe, J. L., Perera-Diltz, D. M., & Rodriguez, T. (2012). Counseling for wholeness: Integrating holistic wellness into case conceptualization and treatment planning. Web.
Patel, S., & Reicherter, D. (Eds.). (2016). Psychotherapy for immigrant youth. Thousand Oaks, CA: Springer.
Pineros-Leano, M., Liechty, J. M., & Piedra, L. M. (2017). Latino immigrants, depressive symptoms, and cognitive behavioral therapy: A systematic review. Journal of Affective Disorders, 208, 567-576.
Wells, A. (2013). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. New York, NY: John Wiley & Sons.