A Case Analysis of MDT with an Adolescent with Conduct Personality Disorder and Fire Setting Behaviors

By Apsche, Jack A.; Siv, Alexander M. et al. | The International Journal of Behavioral Consultation and Therapy, Winter 2005 | Go to article overview

A Case Analysis of MDT with an Adolescent with Conduct Personality Disorder and Fire Setting Behaviors


Apsche, Jack A., Siv, Alexander M., Bass, Christopher K., The International Journal of Behavioral Consultation and Therapy


Abstract

This case study examines a 16.5-year-old male adolescent who engages in fire setting, severe aggression and self injurious and impulsive behaviors. He was treated with Mode Deactivation Therapy (MDT) for four months and his problem behaviors have been reduced significantly. He was previously treated with Dialectical Behavior Therapy (DBT). It appears that in this case study MDT was effective in reducing his severe behaviors.

Keywords: MDT, fire setting, physical aggression, self injurious behaviors, adolescent males, personality disorders.

Introduction

In this case study a 16 year old adolescent male was treated successfully after MDT. The MDT therapist was trained by the first author of this case study in an intensive MDT training.

MDT was shown to be more effective with aggressive adolescent males with conduct and personality disorders then Cognitive Behavior Therapy and Social Skills Training. MDT has been demonstrated to be effective in reducing aggression, personality disorders beliefs and symptoms of Post traumatic stress disorder (Apsche, Bass, Murphy 2004; Apsche & Ward 2004, Apsche, Bass, Jennings, Murphy, Hunt, Siv (2005).

After a thorough literature review this appears to be the first case study that examines the effects of MDT with an adolescent with fire setting behaviors.

Case Summary

This case analysis is a step-by-step case study, with a corresponding theoretical analysis based in mode deactivation therapy (MDT). The methodology known as MDT suggests potential for effective treatment of youngsters with similar backgrounds as Peter. Peter is a 16.5-year-old Caucasian male. He has been diagnosed with Post Traumatic Stress Disorder, Conduct Disorder and Personality Disorder Traits. Peter demonstrated a pattern of continuous disruptive behaviors including; fire setting, lying, social phobia, aggressive and threatening posturing, property destruction, academic performance problems and school behavior problems, peer relationship problems and torturing animals. He also has tortured animals in front of other children and he had a history of early sexual experience, specifically sexual touching of other children.

Client Family History

Peter had demonstrated significant behavioral and impulsive problems since early childhood, which were manifested more prominently when he was four. During this time he was removed from his mothers care due to her continuous substance abuse. She reported using alcohol, cocaine, and crack cocaine during her pregnancy. He was the second youngest of six children all of whom have delinquent problems and are in Department of Social Services custody or involvement in some way. He was placed with his grandmother who also failed to provide adequate supervision; as a result he was removed from her care. From 2000 to 2003 he was placed in nine inpatient settings, including residential placements and hospitals. He was removed from most of the nine placements due to disruptive, aggressive, suicidal behaviors.

Peter preformed at the normal grade level at school, but he required increased structure and individualized attention. Peter has a history of repeated violations of school rules and disruption in class. He often was aggressive and cut school.

He was placed briefly at a hospital then moved to a residential setting on an island. Within a couple of days, out of staff supervision he started a fire, which destroyed over 40 acres of protected woodlands. This led to his brief placement as an inpatient at a local Hospital prior to being admitted. Upon admission he has disclosed for the first time the he was sexually abused (repeated anal rape) by a 16 year old male cousin, in his grandmother's home, for several years starting at the age of seven. He reported that he told his grandmother, who did not believe him and punished him as a result of his disclosure. Later one of his older sisters eventually believed him and reported the crime.

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