Case Study 13
CALD Child and Adolescent Mental Health Resource
eCALD Supplementary Resources
The following case study illustrates CBT for behavioural issues resulting from bullying in a girl from a refugee background. The case study provides a question for viewers to consider and reflect on.
Case Study 13: Cognitive behavioural therapy (Iraqi)
(Adapted from Friedberg, et al., 2016).
Aliyah, age 11 is Iraqi; she and her parents left Iraq when she was 3 and moved in with an aunt, uncle, and four cousins in New Zealand. Her parents brought her to therapy for treatment of anger outbursts that occurred solely in the context of school. Upon intake, Aliyah had been suspended twice for fighting. Her parents were so perplexed by her behaviour; they were considering sending her back to live with family in Iraq. Therapy revealed that Aliyah was lashing out at peers physically in response to racially motivated bullying at school. Aliyah lacked the complex language skills to be able to “fight back” with her words.
Aliyah created a hierarchy specific to the behaviours of her peers that “made her explode.” The lower-rated behaviours included people staring at her, pointing, and whispering and then climbed to name-calling and physical contact (eg, pushing her).
After learning skills to use when she “got hot”, Aliyah and her therapist went out into the waiting room wearing different props to attract people’s stares. Aliyah noted that she did not feel as angry when adults looked at her as she did when other youth did. Therefore, to make the exercise more relevant, Aliyah and her therapist went to sit in a paediatrician’s waiting room.
For the final step, Aliyah and the therapist went into a crowded café close to the clinic to practice how to remain calm when others bumped into her. When they first began this step, Aliyah’s father came to the café with them. Aliyah realised that she felt safe with her father near, stating “he will always take care of me.” Thus, they pursued further practice with no parent nearby. Because the therapist attended closely to the level of emotional activation evoked by the interventions, Aliyah was able to generalise her learning to the school environment and finished the academic year without another fight.