Capella University Course- HS 854- Child and Adolescent Counseling Topic: Project Case Study - Shayla

Abstract

This case study is about a 4 yr old African American boy whose parent is going through a contentious divorce. Shayla is a fraternal twin whose aggressive behavior in school has attracted the attention of teachers and parents to seek counseling. Using two theories (Developmental and Cognitive) to address client’s need, Shayla has been diagnosed with depression and anxiety disorder. The etiology of client’s behavior was determined including the strength and weakness of therapeutic approach. Shayla family unit was consider owing to the fact that her mother is African American and wanted to marry a Latino American. Due to the dynamic of Shayla’s family composition different family systems such as (systemic, traditional and strategic) were consider for proper adjustment. Proper diagnosis were assessed, reviewed and evaluated for mental health treatment team professionals to follow. There are ethical and legal guidelines associated with treatment such confidentiality, informed consent and right to privacy.

Table of Content

Project topic --------------------------- page 1 Abstract ----------------------------------page 2 Table of content -------------------------page 3 Theories ----------------------------------page 4 Strength and Weakness -----------------page 5 -7 Cultural factors --------------------------page 8 - 9 Family systems --------------------------page 10- 11 DSM Diagnoses -------------------------page 12 -13 Legal and Ethical Issues ---------------page 14-15 Reference ---------------------------------page 16 -17

Having studied Shayla case, the writer of this paper came up with two theories suitable for this case study are Developmental theory by Piaget and Albert Ellis Cognitive Therapy (psychotherapy). Developmental theory will deal with anxiety disorder and Cognitive therapy will deal with depression. It is the writer’s opinion that Shayla need developmental and cognitive theorist to address confusion, pain and adjustment that come with divorce. Jean Piaget according to (Flavell, 1963) noted that young children have difficulty observing objects from more than one perspective. In his theory of development, Piaget states that children between the ages of 2 to 7(preoperational thought) acquire representational skills in the area of mental imagery, and especially language. They are very self-oriented, and have an egocentric view; that is, preoperational children can use these representational skills only to view the world from their own perspective (Silverton, 1999). Shayla is a 4-year-old girl whose parents are going through contentious divorce. Shayla may not understand the overall implication of the divorce right now since she enjoys the duplicity of attention from both parents. When Shayla’s custody is granted to one parent and she will not get to live on the same roof with both reality starts to set in. At this time Shayla will begin to feel anxiety and depression.
Separation Anxiety Disorder is common disorder associated with children whose parents are undergoing divorce and emotional separation from their parents. They suffer aggressive behavior, mal-adjustment, and emotional trauma in coping with the changing situation. In another development, cognitive is a branch of psychotherapy that can assist individual with depression in several ways. In the case of Shayla, she has to deal with emotional separation from his father or mother and twin brother. Cognitive therapy will assist Shayla with understanding why her parents are divorcing, the need for her to stay with parent, provide supportive counseling that will ease the pain of depression associated with divorce; address the feelings of hopelessness that accompany depression. Already, Shayla is exhibiting aggressive behavior at the daycare. Children tend to blame themselves when parents get divorce.
Cognitive therapy will provide understanding of the guilt and blame game that goes through the mind of children like Shayla. Cognitive therapy will diffuse pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem-solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems (Franklin, 2003).
These theories are not without flaws. It will be imperative to consider the strengths and weaknesses of these theories as they apply to Shayla. As strength, according to Piaget, the process of equilibration drives development. In other words, Equilibration encompasses assimilation that means people transform incoming information so that it fits within their existing schemes or thought patterns; and accommodation means that people adapt their schemes to include incoming information. This theory prepares Shayla for the battle ahead. The theory through the process of accommodation lets the child to know how distressing it must be to be separated from his father or mother but reassures her of better future.
In the other hand, the strength of cognitive therapy is to diffuse irrational thoughts and beliefs, overgeneralization of negative events, a pessimistic outlook on life, a tendency to focus on problems and failures, and negative self assessment, as well as other cognitive distortions, promote the development of psychological problems, especially depression as Shayla sees it (Franklin, 2003). The mother announced that she would marry a Latino man after the divorce goes through. Who knows whether the man is going to nice to Shayla if mom gets custody? Who knows if Shayla’s father will marry someone who will provide motherly care like Shayla’s mother? Using cognitive therapy, family counselor can assist Shayla to identify and understand how these cognitive distortions can affect her life. Cognitive therapy helps you to change, so that these issues will not rule your life. (Franklin, 2003)
Exploring the weakness of development therapy, Piaget was blamed for growing restless with the emphasis on cognitive structure that lay behind the middle-period work. He was not satisfied with his attempts to explain how structures change, and concluded that the processes of development themselves needed to become the focus of his research. Shayla transition from double parent home to single parent home or better yet, dwelling in the world of unknown is a transition and change that Piaget did not prepare his admirers. Shayla is not taken her parents divorce battle lightly. She is torn by choice of whom she will be with and where his brother will be. She is suffering from guilt, anxiety and depression which only cognitive therapy can solve. In the other hand, when depressed, a person will focus on minor negative aspects of what was otherwise a positive life experience. In Shayla’s case, at age 4, nothing seems to make sense until much later in life. Realistic expectation about Shayla’s situation is that the parent is divorcing and there is nothing she can do about it. Therapy can help he understand that nothing in life is permanent but the healing aspect of emotions, feelings and thought will take time.
In consideration of Shayla’s condition their individual family, community, multicultural, and societal factors that contribute to the development of her depression and anxiety. Factors such as genetic, environment, internal, and external stimuli can influence individual, family, community, multicultural, and societal development of aggressive disorders in children and adolescent. According to an Austrian ethnologist Konrad Lorenz, he suggested that aggression was innate, an inherited fighting instinct, as significant in humans as it was in other animals. He contended that the suppression of aggressive instincts, common among human societies, allows these instincts the chance to build up, occasionally to the point where they are released during instances of explosive violence. Every human being has aggressive instinct in him/her. Shayla’s aggressive behavior towards other children at their daycare was triggered by contentious divorces her parents were going through. Shayla’s natural instinct must be may have been activated by separation and lack of love that she observed in the household. Genetic component to her aggressive behavior may have come from either from her mother side or her father side. All children I believe are product of their of their parental personality trait. Shayla’s feelings are hurt and non-verbal communication that she experienced from her mother behavior or father lack of presence can be frustrating. Shayla may have realized that his twin brother will not be living with her in the same household if her parent divorce. Cognizant of the fact she may be spending with a man who is not his biological father with add pressure and agitation to her individual adaptation. Albert Bandura (1955) has performed studies that indicated that aggression is a learned behavior. Using children in his studies, Bandura demonstrated that, by watching another person act aggressively and obtain desirable rewards, or by learning through personal experience that such behavior yields rewards, aggression can be learned. Shayla’s parent may have gone through process of disagreement, quarreling, fighting, argument, and confrontation that could also influence her behavior. For Shayla’s parent to undergo divorce there must have been an ongoing violence, animosity, and hatred that cumulated to divorce. Shayla experienced it all. On a family level, I don’t think that Shayla’s parent is bad people. They may have good plan to raise their kids in more productive and responsible way. Circumstance and problems in life do occur but how one handles it can make or break family unity and happiness. As a parent I can relate to difficulty responsibility for Shayla’s mother to raise her by herself. I don’t know if they have any extended family that could share the responsibility. As a family counselor, it will be my recommendation to the court that Shayla and her twin brother stay with their mother. It is going to be hard for Shayla’s brother, however, court can grant visitation right the man and he can take the boy out when he wants. Shayla and his brother’s close contact with their father will alleviate juvenile delinquency and youthful exuberance. From the community point of view, Shayla and his brother need church for moral support, mental health agency for counseling for therapeutic service, and department of social service for community based support services. Since her mother is African American, it will interest her to enroll in social recreational activity like play therapy in one of the local parks. Cultural influences in treatment begin with the first point of contact. Culture may impact why and when a family seeks treatment for their child, and whom they trust to approach for treatment (Ginsburg, et al, 2006). As an African American four-year-old girl, Shayla need family counselor who shares the same background. It is going to be turf on her especially as her mother is trying to marry another man from another race. According (Zayas, 2004), ethnic and racial minority children and adolescent enter therapy with the behavioral, emotional, social, familial, and educational problems common to clinical practice. While Shayla is struggling with parent’s divorce, it will be cumbersome to draft her into another relationship that is different from her race. As (Zayas, 2004) contends, of the myriad issues that become part of therapy with minority children and adolescents, the profound effects of racism and the process of ethno racial identity development can be seen in adolescents’ sense of self and behavior.
I don’t know if I will blame society as a whole, but one key element of society I would like to mention is culture. It seemed to me that divorce rate among African American male and female is high. There are a lot of single mothers raising children by themselves. Discipline problems among African American teenagers in the home are as a result father’s absence in the home. An environment with such type of family culture is bound to fail and not doubt in my mind that society contributed to development of Shayla’s aggressive disorder.
Despite contributions of individual, family, community, multicultural, and societal development of aggressive disorder, it is important to note that culture individual role in each segment of this functioning cannot be undermine. We are people made of different traits and personality. We each contribute the best we know how to make a better future for children. But in a process where by we have done our best and hopes for better future for kids and it turns out to be bad, let us blame no one but fate. The therapist has to be cognizant of Shayla’s family structure for a comprehensive diagnoses and treatment to be effective. There are different family units and for therapeutic necessities these family units have to consider in finding appropriate family setting for Shayla. According to the textbook, the structural family is based on the make-up of the family or family hierarchy. Family structures are not the same; Family structures consist of single, blended, extended, etc. Patterns of the family consist of how the family interacts and communicates with each other (Prout and Brown, 2005). Culture is important when defining family. In Africa, we have nucleus family and extended family. Nucleus family consists of mother and father and children born or adopted by them; extended family is that which included uncles, aunts, nieces, nephew, brothers, sisters, cousins etc.
Strategic family is similar to structural family setting only with variance on problem solving. Strategic family setting focused also on how culture is play a role in determining the affairs of the family. It laid more emphasis on community role and respect for elders in cultural environment. The oldest person is looked upon and respected; the therapeutic approach in working with this type of family is holistic using psychodynamic theory. Sometimes roles are shared and instructions pass down from top to bottom.
Systemic family therapy focuses on the family belief system and cultural values associated with behavior (Gunn & Fisher, 2005). Each member of the family knows what the expectation are and what is required of him. There are different levels of relationships that exist among these families thus we have boundaries. Boundaries are those limits or borders that indicate who is to be trust, love, loyal, respect and also be in the inner circle of family business. In the western culture, families are more nucleuses than extended. I have been to a home of Muslim man who asked me to remove shoes outside the door before coming in. In such type of setting the boundaries are defined and anyone who violates it overstayed his/her welcome. Children in this type of home have certain mannerism that is already defined by religious culture.
There are different factors, which instigate, reinforce, and revolve behavior around the families. Depending on which side of family structure one finds himself or herself or system of family practice one upholds, symptom maintenance are influenced by cultural values, environmental factors, internal factors and external factors etc. Behavior is learned and so are other components that form families.
Every family is unique in its own way. Attribution of meaning is giving excuses for one’s behavior due to factors patterning to culture, race, religion, gender etc. Every family have expressed and implied rules that guide it. As a therapist, working with individuals who are disruptive in behavior, I tend to look for that attribute which reinforced positively or that reinforces behavior negatively. Understanding this factors which assist in therapist in reaching out for solution.
Family Rules – The essence of setting boundaries is to make and enforce rules. They understand that each family has within themselves guides every single individual to uphold their value in time of conflict. Setting rules and limit children and adolescent in the household is not only healthy for the children but keeps the family circle in check. The essential feature of Generalized Anxiety Disorder is excessive anxiety and worry occuring more days than not a period of at least 6 months (DSM –1V). Due to the ugly and contentious nature of the divorce Shayla mindset will be anxious. She doesn’t know who will gain custody of her and twin brother. She is bothered by the thought that her twin brother may be separating from her since mom and dad are fighting for their custody. The anxiety and worry are also accompanied by three additional symptoms from a list that includes restlessness, being easily fatigue, difficulty concentrating, irritability, muscle tension, aggressiveness, and disturbed sleep (DSM –1V). No doubt Shayla exhibit serious aggressive behavior towards other children at the daycare. In the other hand Major depressive disorder is not better accounted for by schizophrenia, delusional, psychotic not otherwise specified by recurrent episode. One cannot fully diagnose Shayla as depressed but concern should be addressed.

Shayla’s Diagnoses AXIS 1: 300.02 General Anxiety Disorder (separation) AXIS 1: 296.00 Major Depressive Disorder AXIS 11: None AXIS 111: none AXIS 1V: (aggressive behavior, parental divorce) AXIS V: GAF = 48 Treatment: Shayla can be treated using cognitive behavioral therapy. The hallmarks of cognitive-behavioral therapies are evaluating apparent cause and effect relationships between thoughts, feelings, and behaviors, as well as implementing relatively straightforward strategies to lessen symptoms and reduce avoidant behavior (Barlow, 1988). For Shayla, a critical element of therapy is to increase understanding whom she will be in her custody and if her twin brother will be the same place with her. Without providing such answers and reassurance for Shayla he anxiety episode will recurrent. It is the duty of the therapist to reassure client for safety no matter whose side she is. At this time this writer does not think that Shayla need any medication at this time. Shayla is also depressed because of the way things are going in the family. Children are passive listeners and tend to internalize feelings. This write contend that Shayla should express her feelings, thoughts and emotions. There is legal ramification involved with Shayla’s case study. The therapist should be aware of Shayla’s interest and whom she would like to go with in the custody battle. Even though she may have no choice as to where or who goes with pending legal rulings, success to treatment will depend on her interest and who she like to be with in her family. In legal and ethical issues Confidentiality of information is a vital component of this business of counseling. Individuals and population we work with entrust therapist and counselors with secrets and information that are very confidential and need to be protected. The Department of Health and Human Services provides information contained in the patient protection rule called HIPPA. –An acronym for Health Insurance Portability and Accountability Act of 1996(Public Law 104-191). This law requires the rights of an individual who is a subject of individually identifiable health information should have the procedures that should be established for the exercise of such rights. The uses and disclosures of such information should be authorized by the individual or required by law.

Informed consent is another ethical principle that is involved in counseling practice. On my first day of meeting the family I am going to work with, my counseling approach is to establish boundaries and review parties who have right to know information regarding client. Encompassing the client’s parents/legal guardians is a must, would is the first step towards achieving ethically and sound practice (Prout, DeMartino and Prout (2005). This writer contends that not every body deserves to know the mental business of my client. That brings me to another piece of this approach, which is group therapy. During my observation and assessment, if I determine that client parents need to be present for the purpose of achieving positive result for my client, certain information need to be revealed in the presence of my client and his parents.

Right to Transport client is an area where liability is on the increase. Family of the client needs to consent for their child to be transported from home to any place of service. Upon arrival on the case, family needs to sign form or waiver that authorizes the counselor to transport client from point “A” to point “B”. This form protects the therapist from lawsuit or liability in case of accident. The family has the right to refuse transportation

In conclusion, this writer has examined two theories in Shayla’s case using developmental theory and cognitive theory. Shayla was diagnosed with generalized anxiety disorder and major depressive disorder. The strengths and weaknesses of these theories in treating Shayla aggressiveness was explored and tested. The writer emphasized the importance of family structure, individual differences, community involvement, and cultural factors in providing successful treatment for Shayla. The writer also considers legal and ethical ramifications with Shayla regarding confidentiality, rights and privileges, and informed consent. For Shayla to receive adequate psychotherapy treatment “confidentiality, right to privacy, and informed consent will need to be breached.”

Reference
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