Problem: Write a formulation report
In this TMA, you are asked to write a formulation report, drawing on a Cognitive Behavioural Therapy (CBT) approach that includes an intervention strategy applicable to the client case study of Leon. Need Assignment Help?
You are working as a psychologist at an adult men's prison and you have your first session with Leon, a 22-year-old male offender who is serving a three-year sentence for supplying drugs. His probation officer has referred him to you because she believes that he could benefit from therapy. She would like you to assess Leon's suitability for therapy and provide a formulation report that demonstrates how it could help him to overcome his current difficulties.
Leon's history and background
Leon told you that he had a difficult childhood. His mum was an alcoholic who was emotionally abusive and neglectful. She herself had a difficult history and spent time in prison. His mother had no relationship with Leon's biological father after he was born, but she told him he was a 'bad man'. Leon grew up as only child.
When Leon was eight, things became so bad that social workers removed him from his mother's care and he was then looked after by his maternal grandmother at her home, which was a small council flat. Things were better for a while, until Leon's grandmother died when he was 12. His mother was not well enough to look after him and he was fostered.
Leon stayed with his first foster family until he was 14, but this was a volatile period. He was grieving and struggling emotionally and this was impacting his behaviour in school, and he started to attend less and less often. The foster placement broke down as Leon's behaviour became increasingly erratic. He sometimes became very angry and aggressive, and other times, he shut down and refused to speak. After that, Leon lived in a children's home for a short time. The next foster placement was also unsuccessful, as the foster carers could not cope with Leon's aggression. Leon's emotional state deteriorated, and he became withdrawn and hopeless. He was referred to Child and Adolescent Mental Health Services (CAMHS) at 15, and joined the waiting list, but did not receive any support. At this time, Leon was placed with foster carers who had experience of caring for children and young people with challenging behaviour. He had occasional contact with his mother during this time, and his foster parents noticed that these visits tended to trigger a spike in his anger. He was also regularly smoking weed and drinking heavily, sometimes not coming home at night. By this time his birth mother had another two children, both of whom were considered by Social Services to be at risk of neglect. Leon reports that his childhood had taught him that you have to look after yourself. He believes that you can't rely on anyone to stick around or look out for you.
Leon didn't do well at school; he struggled academically and felt that he didn't fit in. He was bullied and frequently truanted or hid out in the art room, where the teacher let him stay during breaks. He started an apprenticeship in a garage at 16 but struggled to stay engaged with the college work. At 18 he formally left care and moved into a council flat in another area. He was unemployed, isolated and felt completely unprepared for living independently. He didn't know how to budget and frequently found himself without enough money for food. At around the same time, he got to know a group of men who hung around the estate. He quickly got involved in selling drugs for them, and his own drug use spiralled too. He had numerous casual sexual relationships, and one young woman became pregnant by him and decided to keep their child. He was not ready for being a father and cut off contact with the woman. He has not seen his child since he was born.
Leon's current situation
Leon arrived at the prison six months ago (aged 22) and has found it difficult to settle into prison routines. He is withdrawn and isolated, and often sits alone, telling himself that he is worthless and a failure. He has also begun to take some drugs when he can get them, but he knows that drugs are part of his problems. He reports feeling angry with the mother of his child and that his life has been ruined.
Leon's mood began to deteriorate on arrival at prison, and he reports the following:
- lack of energy and enthusiasm
- feeling like a failure and hopeless about the future
- constantly thinking that he has 'messed up', that his life is ruined
- feeling angry and on edge all the time
- difficulty concentrating, particularly on jobs at the prison, and day-to-day decision-making
- avoiding socializing and talking to others, finding it hard to make eye contact.
Leon is keen to find a way of overcoming his difficulties and making a fresh start when he is released. However, he also finds it hard to avoid drugs within the prison setting and can find it hard to stay focused on his goals.
He wants to change his behaviour so that he doesn't become aggressive when things get hard. He also thinks it would be better for him in long term if he could engage more with the prison routine and start preparing for a new life outside prison.
For the purposes of your assignment, there is no need to include any assessment of current risk and safety. You can imagine that this has been provided to the prison governor in an additional report, and therefore has been dealt with separately.