Forests and Trees: Commentary on the Case of "Daniel"

The Case of "Daniel" (Tice, 2019) provides an in-depth look at the implementation of an empirically supported psychotherapy, Exposure and Response Prevention (E/RP), in the treatment of a boy with a severe and complex symptom presentation. The discussion begins with explication of guiding theory pertaining both to the disorders that were targeted, Obsessive-Compulsive Disorder (OCD) and generalized anxiety disorder (GAD), as well as their cognitive-behavioral treatment. The assessment and hierarchy-development aspects of the case are presented, and treatment targets identified. Implementation of E/RP followed a specific treatment manual, but the discussion of case material goes beyond the manual in addressing the interpersonal context of therapy, challenges met and overcome along the way, and the importance of using positive reinforcement for effort in keeping a child moving successfully towards more and more challenging tasks. The role of the therapist’s own interpersonal style is also addressed in how this factor may facilitate and complicate treatment delivery, and therapists are encouraged to examine how this may affect what they do and do not do even in the context of protocol-driven treatment.