Psychological Case Study - Essay Example

?Psychological Case Study Number of Sessions: 10 Individual sessions, two joint sessions with parents. Reason for Referral Client S was referred to counseling by her parents because she has been acting disrespectful and defiant towards them and her grades have deteriorated. Her parents state that she is angry all the time, argues a lot, becomes aggressive, slams the door and yells; she is also irritable and flighty. Her parents wanted to bring her behavior escalated. Client History/Background Information Client S is a 14 year old girl who is the only child in the family. Prior to the age of 13, her parents describe her as "well-behaved and doing well in school". Up to that time, she had no problems academically or behaviorally in school. The trouble began when Client S began eighth grade. At that time, her behavior began to change. Client S was born in Australia and her parents both work. It is not clear why the parents stated that she was born in Australia. Her mother works as a receptionist and her father is a supervisor for an electrical whole sale firm. It appears from what they have stated that they have traditional values and want her to abide by their rules. The client does not seem to think that these rules are necessary since she is now 15. Presenting Problems/Symptoms During the counseling session, the client presents as very positive and confident. She is dressed very clean. During the counseling session, she talks about her parents and feels that they are being too strict with her. She states that she hates doing chores and homework. She has been doing many things to show signs of rebellion: she snuck out of the house and stayed out late, complains about her parents to let her go out and hang with her friends. She states that her friends always get to do things that she does not. Evidence Based Theories and Models Client S does not seem to be exhibiting behavior that is inconsistent with being a teenager. In looking at theories and models, it was important to describe developmental theories and models that work well with teens. Although Sigmund Freud had many things to say about adolescence, it was Erik Erikson who took Freud's theories and advanced them. In Erikson's theory, Client S represent's Erikson's fourth developmental stage which is ego identity vs. role confusion. In this stage, the peer group is more important than family and the peer group acts as role models. During the time between ages 12 and 18, Client S will be struggling to be herself and to identify what that means to her. The psychosocial values that she will possess will be fidelity and loyalty (Boeree, 2006). In applying Erikson's theory to Client S, it becomes clearer that she is in the phase of wanting to be with her friends and they are making up a large part of her life. The challenge can be that the friends she has chosen may not be the best friends for her and they may be influencing her behavior. This would be something to explore in sessions. Piaget took a more cognitive approach in his developmental stages saying that children are able to reason in the abstract after the age of 12. Adolescents may become more self conscious about their appearance and that they are always being criticized for who they are at any given moment (Resource Center for Adolescent Pregnancy Prevention, 2009). Physical development is very important at this age as well. The hormones in the body are changing and the adolescent can be going through physical and emotional changes. The child is moving from being a child to maturing into adulthood. Although this happens differently for different children, all children go through this change at some time. In addition to the physical maturing of growing breasts and hair under the arms and in the pubic area, teens also experience their first menstrual periods and they begin to worry about their bodies. Emotionally, the teen may be experiencing mood swings, or pushing away from the parents in an attempt to create their own identity (U.S. National Library of Medicine, 2011). All of these changes are typical of the growing adolescent and they are nothing to be concerned about because these changes are normal. Formal Diagnosis After careful consideration, Client S is exhibiting typical teenage behavior. At her developmental stage, she is dealing with physiological, psychological and emotional issues. At this age, she is experiencing hormonal changes, a need for autonomy and a need for a separate identity from her parents. She is moving along quite well in terms of typical teenage behavior. Her friends are more important to her than her family which is typical of this age. Client S has the ability to do well in school because she has been a good student in the past. She seems to have challenges with handling her emotions but this seems to be happening only with authority figures. The basic problem in this situation is that Client S needs anger management and she needs to have some strategies that she can use to work more effectively with her parents. Client S does not seem to be exhibiting and pathology or mental illness concerns at this time. Implementation Plan There are several issues that are important to address with Client S. Each one of the issues goes back to her need for anger management. Goals: 1. To help Client S create tools to assist her in anger management. 2. To help Client S discover how to effectively work with her parents. 3. To understand why Client S is having problems in school (does she need tutoring in one of her classes? Anger management seems to be the most important issues to address with Client S. There are many approaches that can be used. Currently, the therapist has already used Rational Emotive Therapy (EFT) and Cognitive Behavioral Therapy (CBT) and they seem to be effective. I would suggest continuing to use these two therapies. There are many reasons to address anger now because it can be a precursor to other more volatile emotions. By learning to effectively deal with her anger now, this could stop her from escalating in her behavior. Both CBT and RET have been found to be effective in anger management with teens because they both address the irrational thoughts that are part of teenage anger. In both therapies, the individual must identify the situations that make them feel angry and the thoughts they have that lead into the anger. The purpose of both therapies is to help clients understand whether what they are thinking is rational or irrational, and then help them to find other thoughts that are more rational (Charlesworth, 2008). Some of the techniques we can use would come from CBT. Relaxation training may be a good technique to teach Client S because it would help her learn to be more relaxed. Most teens seem to be very tense because of the physical and emotional challenges they are experiencing. Relaxation can also help them control their anger before it begins. Homework assignments are also a part of CBT. The challenge for Client S is that she does not like to do school homework, so we may have to call these assignments something other than homework. It would also be beneficial for Client S to start self-monitoring those events or situations that trigger her anger. The suggestion will be made that she either write these things down in a diary or obtain a tape recorder and talk into it about her anger as it happens. It would also be beneficial to explore the differences between assertive behavior, non-assertive behavior and aggressive behavior so that Client S understands the difference. This is important so that she understands how her approach to people may be getting her into trouble. Role modeling and other assignments that would allow Client S to have specific techniques that she can use to learn assertiveness may help her understand how to better work with her parents (Charlesworth, 2008). Another interesting idea is to use play therapy with adolescents. Charlesworth suggests this stating that there are three types that work with teens: client centered, which allows clients to explore their own issues in they way that they naturally see fit, release play therapy, in which the client re-enacts stressful events and learns to walk through the pain of the anger that they experienced (more structured by the therapist) and cognitive-behavioral play therapy that allows the therapist to use many behavioral techniques to meet treatment goals. Any of these would be good to use with Client S. O'Lenic and Arman (2005) suggest that group therapy is also important for anger management with teens. They make a good point that anger management often does not happen until after teens have been acting out over a period of time. This is particularly true in the school setting. Group counseling would be something to explore with Client S after several individual sessions. Group therapy would accomplish the following: 1. The client would be able to identify and recognize the emotions that are a part of their anger. 2. The client would be able to "identify, challenge and replace" (O'Lenic and Arman, 2008, p. 55). 3. The client would learn how to effectively use stress reduction and relaxation skills in order to stop anger before it began. 4. To help the client develop positive problem solving skills. From the first few sessions, the therapist has already established trust with Client S and has begun to understand the foundation of what is happening at home and school. Client S appears to be unhappy in each situation and this should be explored because there could be a common trigger for her anger. I would also suggest to Client S's parents to take Client S to her primary care physician to see whether there are any chemical or physical challenges that she is having beyond the normal hormonal situations that teens go through. I would want to rule out anything physical in her behavior. Family counseling should be continued because there is a rift between the parents and Client S. Perhaps a compromise can be reached so that Client S can have a little more freedom under certain circumstances that she and her parents decide. Client S seems to be a typical teenager that wants to have her own independence. There is something she is not saying that has triggered her behavior. The fact that she is acting out in school and wanting to stay out late with her friends at home is something that needs to be examined. Also, her parents seem to be worried about her and this also needs to be explored in counseling without Client S to get a sense from her parents about what is happening at home. I would think that another 10 sessions focused on anger management would be enough to help Client S unless other problems were presented. The target behavior for Client S would be to help her develop skills to manage her anger rather than having to act on it. Risk Assessment In the current state, Client S does not seem to be at risk of hurting herself or others. The parents will need to give permission for the counselor to continue working with Client S because she is a minor. There would be no need for contracts about harm, but there should be a discussion with Client S about how she is handling her anger on an ongoing basis. To date, she has not presented where she is striking out at anyone or where she has acted out physically with anyone at school. This would have to be monitored to make sure that she did not escalate into more violent behavior. Known Triggers for Client's Behavior The only known triggers that are shown at this point are the authority figure maintaining that Client S must do something. She states that she does not like to do homework, does not like to do chores. Chores are a natural part of any child's life and it is important to make sure that she understands that everyone has some sort of job that this must do. For Client S, the job is to go to school, do homework and do chores at home. A challenge for her and the counselor would be that the counselor does not want to be seen as just one other authority figure who is telling Client S what to do. The counselor would have to help Client S come to her own conclusions about her behavior in order to keep her cooperation in the sessions. Client also expressed that she gets tired of having people tell her what to do. She states that no one seems to understand that she is an adult even though she is only 15. We talked about this and she is willing to talk to her parents more about this in family sessions. Application of Appropriate Intervention The application of the intervention was successful. Client S was interested in finding out more about why she felt angry all the time. She went to her primary care physician who said that what she was experiencing was "typical" at her age. This seemed to help Client S feel better. She also has been using the relaxation techniques. She has identified music in her music collection that she can use when she is feeling angry at home. She understands that her parents only want the best for her and that they are strict because they do not want her to get into any trouble. We also identified that she is having trouble in school because she does not understand the changes in math that have happened. The counselor helped her find a tutor and so far this seems to be working well. Client S is doing better in school once again. Client S is also doing very well with her homework and her task assignments for counseling. She says that she enjoys the counseling sessions and the subsequent homework tasks that she is doing after the counseling. She enjoys using a tape recorder. At this time, we have not suggested group therapy because it does not seem to be needed. Evaluation of Intervention and Summary Client S has done well using CBT as the intervention model. She has come a long way with her anger and she seems to feel very happy with what she is doing. Counseling has helped her understand and accept the fact that she is going through changes that are normal for a teenager. She has also found new friends because some of her friends were not helping her to do the right thing (this is how she stated what was going on). Client S has shown maturity for her age and she has developed well after the counseling sessions. We have no reason to continue sessions since she has fulfilled the ten weeks but she knows that she can come back any time if there are other problems. Client S was not a complicated case because she understood that she was acting out because of the changes she was going through. She began to settle into school once she had a tutor and she felt that her parents had her best interest at heart. This seemed to be a very easy client to work with once she understood these things. References Boeree, C.G. (2006). Erik Erikson 1902-1994. Personality Theories. Retrieved from http://webspace.ship.edu/cgboer/erikson.html Charlesworth, J.R. (2008). Helping adolescents manage anger. Professional Counseling Digest. Retrieved from http://counselingoutfitters.com/vistas/ACAPCD/ACAPCD-22.pdf O'Lenic, C. and Arman, J.F. (2005). Anger management for adolescents: A creative group counseling approach. Article 10. Retrieved from http://www.counseling.org/Resources/Library/VISTAS/vistas05/Vistas05.art10.pdf Resource Center for Adolescent Pregnancy Prevention. (2009). Theories and approaches: Adolescent development: Developmental theories. Retrieved from http://www.etr.org/recapp/index.cfm?fuseaction=pages.TheoriesDetail&PageID=316 U.S. National Library of Medicine. (2011). Adolescent development. Medline. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/002003.htm Read More