心理咨询师二级攻击性儿童心理咨询案例报告

心理咨询师二级攻击性儿童心理咨询案例报告 反应性防卫过度儿童心理咨询案例报告(范例) 一、一般资料 王XX，男，10岁，小学四年级学生，独子。身高大约1.5米左右，体态正常，无重大躯体疾病历史。父母均为公司职员，大专文化，家庭基本和睦，无老人同住。经详细询问、调查父母无人格障碍和其它神经症性障碍，家族无精神疾病历史。 从小随父母生活，在幼儿园大班前基本上性格温顺，甚至比较胆小，非常听对父母的话。这与父母的性格特点很相似，他们的做人风格就是"多一事不如少一事"，经常以息事宁人的方式教育孩子:要与小朋友团结，不可以打小朋友。如果有小朋友打你，你就躲开。甚至有时并不是孩子的错，只要有老师说今天王XX与某个小朋友"抢"玩具(实际上是后者抢前者的，老师也只是习惯性描述罢了)，父母就会再次教导:下次别与小朋友抢，给他算了，你再去玩别的。那时候，王XX基本上是个听话的孩子。 上了大班后，一次一个小朋友拿绳子去勒王XX的脖子，想牵着他走。王想起妈妈说过:脖子是不可以被随便勒的，很危险～于是，他反抗了，而且劲很大，一下子抢过了绳子。那个小朋友吓得跑掉了。据父母称，自那以后，一旦同小朋友发生口角，他就会用“暴力”的方式处理争端，老师和同学都说他“不好惹”。 其实，应该说，比起同年龄的孩子，王XX还是让父母少操了很多心，尤其在学习上。基本上这四年来，都是他自己独立完成作业的，象整理包之类别的孩子需要父母帮忙的事，他都能自己管好。而且可能是家庭影响，父母都爱看书，所以王XX也非常爱看书，小小年纪，已经将《水浒》、《三国演义》等名著看过了。三年级前，虽然爱打架，但功课还是中上偏优，只是最近2个月升了四年级，换了个班主任，比较严格，经常叫他到办公室，于是开始反感，不大听课，成绩下降了。而且前一周的某节班主任课(数学课)上，明明是他旁边的中队长叫他，他才说了一句话，但老师只批评了他，他感到愤愤不平，却并没告诉父母，还是父母听别的同学说的。 最近，他脾气很大，情绪经常很激动，父母问他多了，他就会发火，大喊大叫，很难控制自己的行为。 同学关系比较紧张。没有固定玩伴和要好的朋友。最近的学习成绩下降明显。 achieved. To strengthen the protection of the organization. City has established a special by I served as the commander of the create a national civilized city outstanding problems in the comprehensive improvement of the command, under the command of office, set comprehensive coordination, and small market, technical standards, publicity, security funds, supervisory effectiveness, assessment and other seven working groups, the division responsible for the comprehensive improvement of the work of the organization, coordination, guidance, supervision and examination. All districts and counties to set up corresponding organization and leadership, unified and coordinated command within the jurisdiction of the comprehensive improvement of the work of the organization and implementation. Second, we must strengthen the investment protection. City, district finance to increase investment, full and timely appropriated funds. At the same time, the spirit of "who invests, benefits" principle, to guide social capital, private capital participation in urban construction and management, broaden sources of funding. Practical. Third, we must strengthen the propaganda protection propaganda department through newspapers, radio, television, network, blog, micro channel and so on the many kinds of forms of the comprehensive rectification activities a full range, multi angle, 心理测验结果: ?1、《阿肯巴赫儿童行为量表CBCL》测验结果:总粗分57，超过分界值 40分;标准分71分，高于常模(50，10)两个标准差。 2、《EPQ少年版》测验结果:结果有效;E:54分;P:71分;N:62分。 3、《韦氏儿童智力测验》测验结果:IQ分值:118 二、主诉 王XX称，“讨厌班主任老师，对自己不公平”;“现在没兴趣学习”;“爸爸妈妈说心理学老师能帮助他提高学习成绩，做个好孩子，我不相信，懒得跟他们说”;“别人欺负我，我就要反抗，不想忍”。 三、观察和他人反映 父母主诉:最近，孩子在学校经常与同学发生争执，而且时有动手发生，因此同学关系开始紧张，相比从前，较少参加团体性活动，显得不合群。与现在的班主任很疏远，见到老师不会主动打招呼，并且对老师的批评感到反感，会在课堂上与老师争执。回到家中，与父母话很少，并且爱发脾气，不允许他人摸他的头，即使是亲戚们宠爱的表现，也会生气。因为经常怄气，所以上课注意力不集中，对不喜欢的老师，更不要听课。作业不会，也不会问老师或父母，也不愿意父母管他的功课。因此，学习成绩逐日下降。 四、评估与诊断 根据对临床资料的收集，该求助者智力水平正常;个性孤僻、较难适应外部环境;情绪不稳定。整体心理健康状态较差。求助者的心理与行为异常表现属于心理问题的范畴。 综合分析所获得的临床资料，对求助者问题持续的时间、强度和典型心理与行为异常表现的性质和严重程度进行分析判断;根据心理测验结果和躯体疾病历史、精神病家族历史以及典型心理与行为异常的表现排除了儿童精神障碍，例如脑器质性精神障碍、早发儿童精神分裂症、童年和少年期的多动障碍、品行障碍、情绪障碍。 问题主要表现为以下三个方面: 1、攻击性行为和交往不良倾向; 2、人际关系紧张(师生关系、同伴关系及亲子关系); ?内容较全面的一种行为量表。主要用于筛查儿童的各种行为问题，适用于4-16岁的儿童，本量表多用于儿童保健门诊和儿童咨询门诊。主要是用于家长对子女的评估，不同性别、年龄段有不同的行为问题，因此，可以根据儿童和青少年表现出来的行为问题进行有针对性的干预。 achieved. To strengthen the protection of the organization. City has established a special by I served as the commander of the create a national civilized city outstanding problems in the comprehensive improvement of the command, under the command of office, set comprehensive coordination, and small market, technical standards, publicity, security funds, supervisory effectiveness, assessment and other seven working groups, the division responsible for the comprehensive improvement of the work of the organization, coordination, guidance, supervision and examination. All districts and counties to set up corresponding organization and leadership, unified and coordinated command within the jurisdiction of the comprehensive improvement of the work of the organization and implementation. Second, we must strengthen the investment protection. City, district finance to increase investment, full and timely appropriated funds. At the same time, the spirit of "who invests, benefits" principle, to guide social capital, private capital participation in urban construction and management, broaden sources of funding. Practical. Third, we must strengthen the propaganda protection propaganda department through newspapers, radio, television, network, blog, micro channel and so on the many kinds of forms of the comprehensive rectification activities a full range, multi angle, 3、学习适应性不良。 五、咨询目标的制定 根据以上的评估与诊断，同家长和求助者协商，确定如下咨询目标: 具体目标与近期目标:减少求助者的攻击行为;改善其当前人际关系;增强学习兴趣，提高学习成绩。 最终目标与长期目标:完善求助者的个性，增强其社会(人际)适应能力，建立良好的人际沟通模式，习得健康有效的人际交往技巧。 六、咨询的制定 1、主要咨询方法与适用原理:行为治疗和认知行为治疗 求助者的心理问题主要表现在其适应不良的社会交往行为上，无论是攻击性的行为倾向还是人际关系的紧张、学习成绩的下降，都是因其不良的社会适应模式所直接导致的。而这一系列的不良行为模式，都是在其成长经历的背景下和个性特点的基础上，不断习得和形成的。这其中无论是情绪的变化，还是行为的异常，也都同样存在着个体社会认知的偏差和不合理等因素。而行为的不断重复和强化，反过来又会加剧认知和个性的偏离，再加上教养方式和学校教育环境等不利因素的加重和催化。如果不及时采用操作性、目标性、时效性很强的行为治疗和认知行为治疗方法加以矫正，求助者将陷入恶性循环的怪圈，急易导致反社会和攻击型人格的养成。 另外，求助者目前的典型的心理和行为异常还没有达到较为严重的程度，还有他特定的年龄阶段，都比较适于采用如上咨询方法。 2、双方权利和义务 咨询过程中，求助者及其监护人的权利和义务: 权利: (1)求助者可以根据个人意愿选择咨询师; (2)对咨询进程不满意可要求更换咨询师; (3)对咨询方案、咨询收费、咨询时间的知情权、协商权和选择权。 义务: (1)遵守咨询机构的有关规定; (2)遵守和执行商定好的咨询方案、咨询收费、咨询时间等方面的规则; (3)求助者应尊重咨询师，按照预约时间不失约、不迟到，如有特殊情 况提前通知咨询师。 achieved. To strengthen the protection of the organization. City has established a special by I served as the commander of the create a national civilized city outstanding problems in the comprehensive improvement of the command, under the command of office, set comprehensive coordination, and small market, technical standards, publicity, security funds, supervisory effectiveness, assessment and other seven working groups, the division responsible for the comprehensive improvement of the work of the organization, coordination, guidance, supervision and examination. All districts and counties to set up corresponding organization and leadership, unified and coordinated command within the jurisdiction of the comprehensive improvement of the work of the organization and implementation. Second, we must strengthen the investment protection. City, district finance to increase investment, full and timely appropriated funds. At the same time, the spirit of "who invests, benefits" principle, to guide social capital, private capital participation in urban construction and management, broaden sources of funding. Practical. Third, we must strengthen the propaganda protection propaganda department through newspapers, radio, television, network, blog, micro channel and so on the many kinds of forms of the comprehensive rectification activities a full range, multi angle, 咨询过程中，咨询师的权利和义务: (1) 热爱本职工作，坚定为社会做奉献的信念，刻苦钻研专业知识，增 强技能，提高自身素质，遵守国家法律法规，与求助者建立平等友 好的咨询关系。 (2) 心理咨询师不得因求助者的性别、年龄、职业、民族、国籍、宗教 信仰、价值观等任何方面的因素歧视求助者; (3) 心理咨询师在咨询关系建立之前，必须让求助者了解心理咨询工作 的性质、特点、这一工作可能的局限以及求助者自身的权利和义务; (4) 心理咨询师在对求助者进行工作时，应与求助者对工作的重点进行 讨论并达成一致，必要时(如采用某些疗法)应与求助者达成 书面; (5) 心理咨询师与求助者之间不得产生和建立咨询以外的任何关系。尽 量避免双重关系(尽量不与熟人、亲友、同事建立咨询关系)，更 不得利用求助者对咨询师的信任谋取私利，尤其不得对异性有非礼 的言行; (6) 当心理咨询师认为自己不适合对某个求助者进行咨询时，应向求助 者作出明确的说明，并且应本着对求助者负责的态度将其介绍给另 一位合适的心理咨询师或医师; (7) 心理咨询师始终严格遵守保密原则 3、咨询时间与收费 咨询时间:每周1次，每次1.5小时 咨询收费:每次120元人民币 心理测验收费:《阿肯巴赫儿童行为量表CBCL》80元 《EPQ少年版》100元 《韦氏儿童智力测验》100元 七、咨询过程: 咨询阶段大致分为: 1、诊断评估与咨询关系建立阶段; 2、心理帮助阶段; 3、结束与巩固阶段。 具体咨询过程: achieved. To strengthen the protection of the organization. City has established a special by I served as the commander of the create a national civilized city outstanding problems in the comprehensive improvement of the command, under the command of office, set comprehensive coordination, and small market, technical standards, publicity, security funds, supervisory effectiveness, assessment and other seven working groups, the division responsible for the comprehensive improvement of the work of the organization, coordination, guidance, supervision and examination. All districts and counties to set up corresponding organization and leadership, unified and coordinated command within the jurisdiction of the comprehensive improvement of the work of the organization and implementation. Second, we must strengthen the investment protection. City, district finance to increase investment, full and timely appropriated funds. At the same time, the spirit of "who invests, benefits" principle, to guide social capital, private capital participation in urban construction and management, broaden sources of funding. Practical. Third, we must strengthen the propaganda protection propaganda department through newspapers, radio, television, network, blog, micro channel and so on the many kinds of forms of the comprehensive rectification activities a full range, multi angle, 第1次 1999/10/23 目的: 1)了解基本情况; 2)建立良好的咨询关系; 3)确定主要问题; 4)探寻改变意愿; 5)进行咨询分析。 方法:会谈、心理测验 过程: 1)填写咨询登记表，询问基本情况;介绍咨询中的有关事项与规则; 2)父母做CBCL;儿童EPQ和智力测验，同时向父母了解孩子的成长过程， 尤其是重大事件; 3)确定咨询目标; 4)与孩子交谈，收集临床资料，探寻孩子的心理矛盾及改变意愿; 5)将测验结果反馈父母及孩子，并作出初步问题分析，让父母与孩子理 解"为什么会这样"。 6)布置咨询作业: a."再现"事件:父母与孩子重新讨论"老师冤枉"事件，着重让孩子表达"当时怎么想，想怎么做，感觉如何"，目的一在于让孩子宣泄;二在于让父母学习与演练与孩子的沟通;三可以顺势引导如何更好。 b.父母有必要与老师去谈一次，让老师增加对孩子的了解，并澄清孩子的"委屈"; c.孩子找出班中最受欢迎的学生。 第2次 1999/11/6 目的:1)加深咨询关系;2)突破"攻击性"应对策略。 方法:会谈、行为治疗仿同法 过程: 1)行为契约法 反馈咨询作业:父母与孩子交流了"委屈"等事件，且母亲与班主任老师谈了孩子的事，班主任了解了"委屈"事件，主动向孩子道了歉，孩子有些不好意思，但上课表现有进步; 2)与孩子就"最受欢迎的同学"谈"人际交往"问题，找出差异，促进自我 achieved. To strengthen the protection of the organization. City has established a special by I served as the commander of the create a national civilized city outstanding problems in the comprehensive improvement of the command, under the command of office, set comprehensive coordination, and small market, technical standards, publicity, security funds, supervisory effectiveness, assessment and other seven working groups, the division responsible for the comprehensive improvement of the work of the organization, coordination, guidance, supervision and examination. All districts and counties to set up corresponding organization and leadership, unified and coordinated command within the jurisdiction of the comprehensive improvement of the work of the organization and implementation. Second, we must strengthen the investment protection. City, district finance to increase investment, full and timely appropriated funds. At the same time, the spirit of "who invests, benefits" principle, to guide social capital, private capital participation in urban construction and management, broaden sources of funding. Practical. Third, we must strengthen the propaganda protection propaganda department through newspapers, radio, television, network, blog, micro channel and so on the many kinds of forms of the comprehensive rectification activities a full range, multi angle, 觉知; 3)初步制定"行为契约"，以加强自我控制，并在咨询室进行演练。 4)布置咨询作业: a.父母继续"特意"积极:只找孩子的优点，并至少准备10句好话; b.孩子按"行为契约"行事，诸如:不主动打人、不主动骂人、每天早 上对着镜子笑三下、上课"盯"老师、回到家说"我回来了"，出门说" 我走了"„„ c.制定反馈表，记录行为。 第3次 1999/11/20 目的: 1) 学会合理评价; 2) 提高自控力; 3) 加强亲子交流。 方法:会谈;合理情绪疗法、行为治疗代币法 过程: 1)反馈咨询作业:"行为契约"完成顺利，得到老师表扬，并在某天午餐 时有个同学碰了他一下，他也没有生气;父母说孩子10句好话，让父母与孩子体验感受; 2)进一步分析行为与情绪、人际的关系，强化"合理观念"，并引导对人对事的合理评价，练习评价班主任及父母; 3)改"行为契约法"为"代币法"，增强亲子之间的联系。 4)咨询作业: a. 找班主任老师的3个优点; b. 执行"代币法"，以"代币"量赢得自己愿望的满足，诸如:买某本书、 去游乐场一次、零用钱等等。 第4次 1999/12/4 目的: 1) 巩固咨询效果; 2) 发展学习策略; 3) 增强自信心。 方法:会谈、心理测验法、认知行为法 achieved. To strengthen the protection of the organization. City has established a special by I served as the commander of the create a national civilized city outstanding problems in the comprehensive improvement of the command, under the command of office, set comprehensive coordination, and small market, technical standards, publicity, security funds, supervisory effectiveness, assessment and other seven working groups, the division responsible for the comprehensive improvement of the work of the organization, coordination, guidance, supervision and examination. All districts and counties to set up corresponding organization and leadership, unified and coordinated command within the jurisdiction of the comprehensive improvement of the work of the organization and implementation. Second, we must strengthen the investment protection. City, district finance to increase investment, full and timely appropriated funds. At the same time, the spirit of "who invests, benefits" principle, to guide social capital, private capital participation in urban construction and management, broaden sources of funding. Practical. Third, we must strengthen the propaganda protection propaganda department through newspapers, radio, television, network, blog, micro channel and so on the many kinds of forms of the comprehensive rectification activities a full range, multi angle, 过程: 1)反馈作业:完成顺利，继续执行; 2)肯定其学习能力，找出学习策略问题; 3)训练"提问法"，以提高课堂效率，将注意力集中在学业上。 4)布置咨询作业: a. 选一门课，每天准备好一个问题，带入课堂，在课上找答案; b. 收集别人对他的"微笑"与"好话"; c. 父母继续"代币"激励。 第5次 1999/12/18 目的: 1) 巩固咨询效果; 2) 结束咨询。 方法:会谈 过程: 1)反馈作业:评价"提问"应用，调整提问角度; 2)指出继续努力的方向:自我监督与控制; 3)基本结束咨询。 制定行为目标，加强自我管理能力; 4)进一步巩固与父母、老师、同学的关系。 八、咨询效果评估 1、求助者及家长的评价: “感觉同学们开始喜欢我了”;“我不再害怕班主任老师了”;“爸爸 妈妈经常鼓励我”;“遇到不愉快的事情，发脾气也没用”。 “孩子回家后愿意说话了，经常谈起学校里发生的事”;“回家后很自 觉的做作业了”。“多表扬孩子还是有好处的”。 2、咨询师的评估: 通过回访和跟踪，发现咨询已基本达到预期目标:改善了攻击性行为 促进了良好人际关系的发展，提高了学习适应性水平。咨询过程较完整， 有条理。 achieved. To strengthen the protection of the organization. City has established a special by I served as the commander of the create a national civilized city outstanding problems in the comprehensive improvement of the command, under the command of office, set comprehensive coordination, and small market, technical standards, publicity, security funds, supervisory effectiveness, assessment and other seven working groups, the division responsible for the comprehensive improvement of the work of the organization, coordination, guidance, supervision and examination. All districts and counties to set up corresponding organization and leadership, unified and coordinated command within the jurisdiction of the comprehensive improvement of the work of the organization and implementation. Second, we must strengthen the investment protection. City, district finance to increase investment, full and timely appropriated funds. At the same time, the spirit of "who invests, benefits" principle, to guide social capital, private capital participation in urban construction and management, broaden sources of funding. Practical. Third, we must strengthen the propaganda protection propaganda department through newspapers, radio, television, network, blog, micro channel and so on the many kinds of forms of the comprehensive rectification activities a full range, multi angle,