Case History of Jen - Essay Example

?Case History Client Information The client is a 14 year old female d Jennifer (Jen). Jen is the eldest child in the family. She has a younger brother and a sister. Jen is studying in 9th grade and her progress at school is good. Both her parents are educated. Her father is a doctor and mother is a housewife. Jen’s mother decided not to work as she wanted to focus her complete attention on her children. Also, as Jen’s father was doing well in his medical practice, their financial condition was very good. Jen’s parents got along very well and provided all the support needed to the children. Background of The Case Jen was referred for psychological counseling by her teachers. Jen was a disciplined student and was very good at her studies. She never missed her school and was always prompt in doing her home work. Her performance at school was progressing day by day. She was quiet and docile by nature. However, at the same time, the social aspect of her personality was not flowering. Her parents had realized that her quiet nature and her habit of being alone had increased in past few months. With every passing day, Jen was becoming more and more private. Her friend circle was becoming smaller and she refused to mix with people. Her relationship with her siblings was also getting affected. She avoided playing with her siblings giving a reason of home work and studies. When the family had guests or relatives coming, Jen used to get worried. She avoided coming in front of people and gave one word answers when she was asked something. This behavior became consistent and Jen started getting into a cocoon. Initially, her parents did not pay much attention as her performance in studies and at school was consistently good. However, they found that her social interactions and her interaction with the family members were decreasing day by day. Jen’s mother was worried as the number of phone calls from her friends started decreasing and her behavior with her siblings had changed a lot. Jen’s mother decided to take help of her teachers before Jen’s social behavior worsened. Hence, she contacted Jen’s teachers to discuss the changes in Jen’s behavior and personality. Jen’s teachers told Jen’s mother that even they had recognized a change in her behavior pattern. Even though Jen was consistent in her studies, her social behavior was changing dramatically. They told her mother that she has stopped participating in games and extra curricular activities. Her interactions with teachers and students in the class had also decreased to a great extend. She had become shy and aloof. The teachers also said that Jen used to ask lots of questions regarding her studies in the class. However, lately she had stopped even that. After talking to her mother, Jen’s teacher realized that Jen’s behavior was becoming threat to her progress and growth. Hence, after consulting her mother, Jen’s teacher referred her to the school counselor. Deeper study of Jen’s behavior and personality pattern revealed that Jen’s problem was related to her social life. Her fears related to social interaction were turning her into an introvert person. Diagnosis Assessment Interview is one of the most effective and result oriented tool for diagnosis and assessment of mental disorder. Interview not only allows a proper flow of information regarding the client but also gives an opportunity to the counselor to gain client’s confidence and trust. Hence, in Jen’s case, the ‘Anxiety Disorder Interview Schedule for Children’ (ADIS-C) was utilized to understand the nature of the disorder (Kearney, 2005, p. 72). The questions were structured around Jen’s social behavior, her thoughts regarding her social relationships and interactions, her emotional and physical response to social presence and overall behavior pattern when she is in presence of other people. (Kearney, 2005, p.73). Another reason why ADIS-C was used for assessment was that it also included a version for parent interview (Kearney, 2005, p.72). Jen and her mother were interviewed to know the symptoms in order to diagnose the root problem of her behavior. Symptoms The background information about Jen was given by her mother and teachers. It was evident from the information that Jen is displaying the avoidance behavior when it came to public appearance and social interactions. It was important to know the roots of Jen’s fears about social life and to understand her psychological, emotional and physical reactions to her fears. . The interview questions were designed to gain a deep insight into Jen’s social fears. During the interview, Jen revealed that the thought of being watched by other people creates anxiety in her. She suffers from self-consciousness and this makes her to behave in a rigid and an unnatural way. The fear of being ridiculed and laughed at by others create great amount of distress in her. The fear of social interaction freezes her physical movements as her heart starts pounding hard and her muscles get tense. She avoids everything (like talking in classroom or in public) that attracts the attention of others to her. If she is made to talk in front of others, her body reacts with fear and she finds it difficult to think properly and to converse with others. Her jaw becomes tight, the words are slurred and she begins to mispronounce the words. Moreover, Jen revealed that she also feels shy in front of others. Jen’s mother revealed that Jen blushes uncontrollably in front of others. If she is made to talk to others or to interact with visitors, she feels flushed and self-conscious. Her skin becomes red and she becomes anxious about other people’s opinion about her. Jen said that she feels that everyone is trying to judge her and this makes her feel nervous. Her skin becomes warm and her palms become sweaty. All these fears make it difficult for Jen even to carry out her everyday activities with confidence. She avoids every situation where she has to interact with people. Moreover, her mother revealed her concern for Jen as according to her, Jen was becoming shyer with each passing day. She did not enjoy talking to people. Jen also found it difficult to make friends and to socialize with others. Jen’s behavior had started affecting her school and family life as she was getting emotionally and socially distanced from everyone around her. Social Phobia From the symptoms displayed in Jen’s behavior, the mental disorder of social phobia was diagnosed. Marks (1969) has defined phobia as a “special form of fear” that is excessive, maladaptive and persistent in nature (House, 2002, p.66). When an interpersonal communication triggers a phobic reaction in a person, then social phobia is diagnosed (House, 2002, p.66). Children and young adults suffering from social phobia feel extreme anxiety, embarrassment, humiliation and self-consciousness in situations where they feel judged and evaluated by others (House, 2002, p.67). Jen’s symptoms were triggered by the thought of communication with other people and social interaction. Her symptoms were clear sign of social fear and social anxiety. Hence, it was concluded that Jen was suffering from social phobia. A risk assessment was conducted to know if other disorders or destructive thoughts were accompanied by social phobia. However, it was found that in Jen’s case, social phobia was not accompanied by other mental disorders like mood disorder, substance abuse or suicidal thoughts. Intervention After diagnosing social phobia, the treatment was planned after consulting the time factor with teachers and Jen’s mother. Forty-five minutes of sessions for three weeks were planned with Jen to reduce her anxiety and fears of social interactions. Evidence based intervention was chosen as a method of treatment. According to Cornoyer and Power (2002), evidence-based interventions are “likely to produce predictable, beneficial, and effective results” as they are based on prior empirical findings and hence, it is time and cost effective practice to treat mental disorders (Braden & Shernoff, 2008, p.12). Behavioral technique of positive reinforcement and cognitive restructuring through modification of beliefs were used to reduce the anxiety related to social interaction. Modification of beliefs The verbal techniques were used to challenge Jen’s conditional beliefs about social performance. Her assumptions, beliefs and automatic negative evaluations were challenged by asking her questions about the formation of those beliefs. Jen was asked to give evidence to the formation of the negative beliefs. Questions like “why do you think people will laugh at you”, “what makes you think that people will ridicule you”, “have you ever witnessed anyone humiliating you or talking about you negatively” etc., were asked to make her realize that her negative thinking was nothing but her own creation. By questioning the evidence for her assumptions, reviewing counter-evidence and pointing out the errors in her thinking pattern, Jen was challenged to change her assumptions and think positively about her social presence (Wells, 2002, p.155). Jen was later encouraged to break free from her unconditional negative beliefs by defining her negative opinion about herself. For example, in one of the session, Jen said that she is not good at sports and this makes her think that if she plays any game, people will laugh at her. However, after asking her to give evidence for this assumption, she said that it did not happen yet but she was sure that her friends will laugh at her if she plays. She was encouraged to focus on positive aspects of her game like being able to run fast, being energetic and healthy enough to play, getting to spend quality time with friends etc. In this way, her beliefs and assumptions were modified in a positive way. Once her assumptions and beliefs were modified, it was time to bring the positive beliefs into actions and this was done through behavioral technique of positive reinforcement. Positive Reinforcement According to Skinner (1972), a process where a situation or a reward given after particular behavior, increases the likelihood of that behavior in the future, is called as a ‘positive reinforcement’ (Engler, 2009, p.224). A reinforcer of positive thought and praise was applied to behavior where Jen approached the social situation fearlessly and positively. Jen’s need for appreciation was utilized as a positive reinforcer. Her parents were suggested to provide her a positive reinforcement by expressing their appreciation lavishly whenever she talked to visitors, called her friends, went out to play and interacted openly with her sibling. The technique of positive reinforcement worked very effectively and in a week’s time, Jen showed improvement in her behavior. In this way, challenging the negative beliefs and positive reinforcement proved to be very effective in reducing the anxiety and social phobia in Jen. The treatment was continued for three weeks and Jen showed remarkable improvement. References Engler, B. (2009). Personality Theories. Boston, MA: Houghton Mifflin Harcourt Publishing Company. House, A.E. (2002). DSM-IV Diagnosis in the Schools. New York, NY: Guilford Press. Kearney, C.A. (2005). Social Anxiety and Social Phobia in Youth: Characteristics, Assessment, and Psychological Treatment. New York, NY: Springer Science +Business Media, Inc. Braden, J.P. & Shernoff, E.S. (2008). Why the Need for Evidence-based Interventions? In R.J. Morris & N. Mather (Eds.), Evidence-based Interventions for Students with Learning and Behavioral Challenges (pp.9-32). New York, NY: Routledge. Wells, A. (2002). Cognitive Therapy for Social Phobia. In F.W.Bond & W.Dryden (Eds.), Handbook of Brief Cognitive Therapy (pp. 101-117). West Sussex, UK: John Wiley & Sons Ltd. Read More