A Case of Rejection, Redemption, and Resilience: Commentary on the Case of Rafael

Abstract

Paul Clement (2011) presents a unique case of an adolescent with congenital limb deficiency. He integrates a number of approaches that encompass positive psychology, cognitive restructuring, social problem-solving skills, outcome assessment, and a quantitative evaluation of therapeutic change. We examine this case using resilience as a theoretical framework with an emphasis on identity formation, self-esteem, coping strategies, and assessment. We provide some comments on the strengths of Clement's approach as well as offer suggestions of additional assessment procedures and interventions that may have been beneficial to Rafael's treatment.Keywords: resilience; limb deficiency; cognitive behavioral therapy; orphan; clinical case studies; case studies _____________________________________________________________________________________ Paul Clement (2011) provides a valuable glimpse into his practice and therapeutic approach in the case of Rafael. Anchored by a clear theoretical approach, Clement provides a very useful view of the practical use of outcome assessment in private practice. His patient, Rafael, demonstrated significant and long-term gains associated with his treatment with Clement. This unique case addresses treatment of an adolescent with congenital limb deficiency-a condition not often encountered by the general practitioner. Clement integrated a number of approaches that encompassed positive psychology, cognitive restructuring, social problemsolving skills, outcome assessment, and quantitative evaluation of therapeutic change. His approach was to assess strengths and weaknesses and to replace weakness with new competencies.Drawing on his past experience as a swimming coach, he saw his role as practicing new competencies in the "pool." We will review the case through the perspective of research on children with chronic health conditions, with a focus on resilience, self-esteem, coping strategies,