Counseling an Adolescent Child - Essay Example

Counseling an adolescent child Human psychology is so complex that the theories developed about it could be effective only in different contexts and different combinations. When it comes to children and adolescents, the best combination is a mix of theories which handle the psychological development associated with growing up and also the process of human development (Kendall, 3). Major theories that come handy in treating children and adolescents are the cognitive behavioral theory and Bowen theory. Cognitive behavioral therapy deals with the individual in relation with her cognitive, emotional and social environment while therapy based on Bowen’s theories draws its conclusions and therapeutic energy from the family of the client. By declaring that “only intelligence ….tends towards an all-embracing equilibrium” in human life, Jean Peaget had been one of the pioneers of cognitive behavioral theory (9). Kendall has described cognitive behavioral theory as “problem solving in its orientation, deals directly with the cognitive forces that impact social information processing, incorporates emotional and social domains, addresses matters associated with parenting and families, and emphasizes performance-based interventions” (4). The ability to identify a problem and arrive at possible solutions is a skill that a child has to acquire as she grows up (Kendall, 4). The psychological health of a growing child depends heavily on cognitive problem solving strategies, that is, her capacity to consider the full range of solutions, evaluate them properly and choose the best one applicable in a given situation (Kendall, 4). Cognitive behavioral theory, in its application, aims at enhancing the cognitive problem-solving strategies in the mind of a person (Kendall, 4). As the emotions of a person always meddles with the problem-solving process, this theory also helps one learn to understand one’s emotional experiences and modify them (Southam-Gerow and Kendall, 320). Social domain is included as another major factor in this theory because any psychological problem that arises out of the interaction of an individual with other individuals as well as the society as a whole (Kendall, 5). When it comes to a child or adolescent, naturally the parents and family become yet another influencing factor. Last but not least, the child or the adolescent has to be constantly encouraged to practice their problem-solving skills so as to strengthen their cognitive problem-solving strategies (Kendall, 6). While doing a cognitive-behavioral therapy (CBT), the therapist has thus to take into consideration, all the aspects discussed above while dealing with an adolescent. The methods of CBT include, “performance-based procedures and structured sessions” and also “strategies designed to produce changes in thinking, feeling and behavior” (Kendall, 7). One major attribute of CBT is the capacity to comprehensively assess the social as well as personal factors affecting cognition and behavior and intervene accordingly on multiple levels (Kendall, 8). Kendall is of the opinion that the role of a therapist is similar to that of a coach in CBT (9). It is argued that the therapist like a coach, draws from his own experience and helps the client to make her abilities grow, and allows her to find “fun in that process” (Kendall, 9). CBT focuses its treatment options around the notion that behavior is the product of “multiple causes” (Kendall, 18). So the therapy model has to give space for feedback from “multiple behavioral events” so that they can be linked to different emotions related to them (Kendall, 18). It is through the repetition of cognitive events having high emotional attributes that the stability in cognition is achieved (Kendall, 19).Thus Kendall concluded that a fruitful CBT program is the one which “ intentionally plans and capitalizes on creating behavioral experiences with intense positive emotional involvement while paying attention to the anticipatory and after-the-fact cognitive activities of the participants” (20). Though CBT has a procedural methodology in which parents have to be involved, it is only one factor among a few (Kendall, 9). But Bowen’s theory practices mental therapy solely based on the behavioral characteristics shaped within the family system. Family system assessment is the approach prescribed by Bowen in counseling. According to Bowen, by knowing the actual state of relationships between the siblings and also the “general level of family functioning”, the therapist can accurately gain a mental picture of the personality of the client (Bowen, 183). To know the feelings and experiences that the family members had on the day in which the symptoms began has to be explored deeply (Bowen, 181). By understanding them the therapist can acquire valuable insights into the causes of the problem (Bowen, 181). To learn about the thoughts and emotions that the client’s mother had during and after her pregnancy is yet another effective way to project the behavior of the client back to the very beginning (Bowen, 182). But Bowen has also warned that families may backtrack from the therapy if the therapist is over enthusiastic to find a connection between events (Bowen, 184). Youth having anxiety disorder have been found to have less ability to hide or change their emotions, which is an integral part of the management process of emotional expressions ((Southam-Gerow and Kendall, 320). If the emotional cut off from the family, described by Bowen in his major theoretical works, is very strong, then according to Titelman, the possibility is higher that symptoms of anxiety and other disorders develop at a greater pace (62). As per Bowen’s theory, the self of the therapist also plays a great positive role in the process of therapy (qtd. In Titelman, 3). Also, the major elements of therapy based on Bowen’s theory has been identified as “theory in clinical practice, the therapist’s own family, and natural systems thinking” (qtd. In Titelman, 1). The therapy has to include an “ effort to modify the family relationship system, whether the effort is with multiple family members, the two spouces together, or only one family member” (Bowen, 310). Unlike traditional theories, Bowen’s theory is against putting people into diagnostic categories such as normal, psychotic etc. It is to “adapt and deal with the vicissitudes of life” that the family therapy prescribed by Bowen teaches a client (qtd. in Titelman, 8). In that way, the therapy helps the client and/or her family members to acquire the ability of differentiation. This is the skill to deal with the emotions of one’s own as well as that of others (Bowen, 253). Thus Bowen has set his focus upon the emotional process involved (Bowen, 253). To achieve differentiation, the person who undergoes the therapy has to learn to reduce her anxiety and the therapist has to help her do that (qtd. in Titelman, 9). In Bowen’s approach, family is a “multigenerational emotional unit”, the emotional give and take process inside a family is understood based on the concept of “interlocking triangles” and the therapist has to focus on the “interlocking process of fusion and cut off” (qtd. in Titelman, 9). Here I am discussing the case of a 15-year old student who came to me and wanted to talk to me when I was working as a high school counselor. This adolescent had a curious kind of problem. Not solving it was to have very crucial consequences in her future. This girl was deeply afraid of getting pregnant. This fear followed her in her thoughts as well as in her worst nightmares, that too on a daily basis. The interesting aspect of this case was that she was not yet sexually active in her life. I tried to treat this problem by way of a therapy which based itself on a combination of two theories- cognitive behavioral theory and Bowen Theory. While using CBT theory in treating her, I had to find ways to help her rational thoughts mediate between the events that happen to her and around her and thereby stabilize her emotional response to it. In this case, I had to help her alter the belief that pregnancy was a dangerous condition and instead instill in her the beauty of becoming a mother and make her understand the perfect mechanism of a woman’s body and mind crafted out by nature to sustain human life on this earth. I began my therapy by trying to understand the particularities in the behavior of my client, as my therapy method was equally concerned with behavior and cognition. I then tried to understand the distress that the girl was experiencing from her own point of view. By exploring deep into the moments when her fear is low and when it is at its peak, I could find out that her fear was very high when she saw the huge bellies of pregnant women and also when she saw blood during the period of her menstruation. But when she met and played with children, the fear almost quit her. By drawing her attention to these variations in her feelings, I could rationally prove to her that her fear was not related to reality but only to her own anxieties. Then as part of my CBT therapy, I made the girl meet a few mothers of new born babies who could narrate to her the wonderful experience of becoming a mother. I also collected and showed her a number of aesthetically taken beautiful photographs of beaming pregnant women. Then I could make her reason about that herself. If all those women were feeling that pregnancy is a wonderful experience (which was evident from their smiling faces), then the problem is with the distortion of thoughts that has occurred in my client’s mind. That argument stroked a positive note with her, though to an extent. Then, there were these visits that I made her to carry out to the kindergarten which was inside the school and mingle with the small kids. Her visits were scheduled to be during the school-ending hours when mothers will come to take their kids home. She was assigned by me to take notes on the behavior of at least five of the mothers and the corresponding kids every day. This assignment, I entrusted her not telling her that this was part of her therapy. Instead I told her that I needed some data on that topic and requested her to help me out. She was very eager to be of help to me and through that process, I could see that she was developing the skill to observe emotions and behavior of others and deep inside correlate them with her own emotions and behaviors. Thus this exercise became yet another part of strengthening her cognitive abilities. Even as I went on addressing her cognition part through CBT, I also tried to bring her into a family therapy system as advocated by Bowen. First, I traced her family genogram and involved her father and two siblings (her mother had died delivering her younger brother) in this process as equal partners to me. I encouraged her and her family members to visit their relatives, to read family history catalogues and talk to elderly people in the family to know more about their grand parents and her parents’ childhood. This process they carried out with great enthusiasm and became an opportunity for them to look at themselves through the eyes of others. This was the first step of differentiation that each of them learned as described by Bowen in his theories. I had found out that the cause of her mother’s death was related to pregnancy and that this was the most important factor that has led her to fear pregnancy. Though in her childhood, she had a number of times heard the details of the story of her mother’s death and this had left an imprint on her mind. The child had become the most susceptible member of the family in assimilating the collective anxiety of the family during the period of her mother’s death (Titelman, 147). But as she grew up, that memory had faded. But one year back, a girl in her school had died and the rumors had it that she had died after getting pregnant and while trying to get rid of it in an unscientific way, using some medicines given by quacks. The dead girl was not very close to my client. But she had shared a room with her for one week in the hostel, some three months back. This was to have an impact on my client and her previous fear of pregnancy evoked by her mother’s death came back with added anxiety. By collecting all these information, I could have somewhat a clear picture of the cause of her problem. I gave her some reading material on safe ways of pregnancy termination and unsafe ways as well that still exist in certain minority pockets of the community. The biological process of pregnancy and pregnancy termination was clearly described in these written materials. Thus I could prove to her that the death of that school girl was not a natural occurrence but a very rare exception. But I took care not to show her any pictures of the reproductive organs inside a woman’s body as that may evoke further fear in her. Whatever details that is considered generally macabre, was opted out from the information provided to her. I talked to her father and siblings after having this personal history of my client and made them understand how they also owe a responsibility to help her get rid of her anxiety. Her sister who had two kids, then under my instructions, talked to her about the real process of having kids. The way her sister was supported by her husband during the pregnancy period and at the time of delivery and the special joy of sharing that happens between husband and wife, when a child is born, were explained by the sister to her. As her sister had got married and went away when she was a small kid, this girl was left to live with her father alone. This had deprived her of the care and advice of a woman, which was very crucial at the adolescent stage. So, in the session I had with her father, I made him understand that she should be made more to mingle with her aunts who lived nearby so that she can have some amount of feminine knowledge sharing and emotional sharing. Her father agreed to this and also talked to his sisters about this. They also consented to intervene. The sister of the girl also decided after talking with me, to come home as frequently as possible and spend time with her. I also tried to draw positive strength from my family experiences as a teenager. I could understand that my client’s apprehension about getting pregnant had some indirect connections with sexuality as well. I had also my own apprehensions at that age regarding my love life and pregnancy. I selectively shared some experiences of mine with her so that she can see that it was not her alone who was going through this kind of distressing mental state. On several moments of my personal story telling, I could see that she empathized with me. And her face brightened up after this session after knowing that she was just another normal teenager as I was. As the girl had been sexually inactive up to that point, it was also the accumulated fear about sexuality that manifested partly in her fear about pregnancy. She had rejected some advances from the side of a boy friend, which she had to justify to herself by way of some rational argument. The fear of pregnancy, which was already inside her mind, thus became a plausible excuse in that case as well. But she had maintained a steady going friendship with her boy friend despite this problem. Whenever she was feeling alone, as it were only her and her father who lived in their home, she went to her boyfriend to avoid her loneliness. At such moments, she would blame her father. But whenever the boy friend was getting intimate, she would withdraw to the very loneliness that she hated. Then, the blame will pass on to the boy friend. Once I knew this behavioral pattern, I slowly made her understand the triangles involved in these two behavioral responses and thus helped her to develop differentiation abilities. But I did not try to tell her much about the sexual connotation of her fear of pregnancy. I felt that too much of making connections could fear her away from the process of therapy itself. So I left that comparatively less serious problem of her to get solved itself as she grew up and became more mature. The girl now has become almost reconciled to her womanhood in terms of cognition as well as emotional acceptance. I believe the right mix of CBT and Bowen’s family therapy system worked this visible change. Works Cited Bowen, Murrey, Family Therapy in Clinical Practice, NJ: J.Aronson, 1978.print. Kendall, Philip. C., Child and Adolescent Therapy: Cognitive-behavioral Procedures, Guilford Press, 2006.print. Peaget, Jean, The Psychology of Intelligence, London: Routledge, 1999. print. Southam-Gerow, M and Kendall, Philip. C., “A Preliminary Study of the Emotional Understanding of Youths Referred for Treatment of Anxiety Disorders”, Journal of Clinical Child Psychology, 29 (2000): 319-327. print. Titelman, Peter, Clinical Applications of Bowen Family Systems Theory, London: Routledge, 1998.print. Read More