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Case Conceptulixation of Ann

Mental Status

Who is Ann

Engages in excessive

underage drinking

14 year old female

Displays powerful aggression

1 of 4 children

Who is Ann

Teenager

  • Joe Ann’s father. 43 years old, he grew up in an abusive environment

  • An alcoholic father, he was forced out of his home at the age of 15
  • Turned to alcohol as a copping mechanism
  • Dealt with feelings of rejection and abandonment
  • Joe is the father of 4 been married for 20 years
  • Separated from his wife on 3 different occasions
  • Physically and psychologically abused her
  • Joe has recently found Christianity
  • Decided to work on him slef and his marriage .

Grew up in a

dysfunctional home

environment

Unresolved grief due to her mother suicide

Beatrice is married and a mother of 4

Separated multiple times

Recently Beatrice has adopted Christianity

attempting to work on her marriage & other personal issues

Beatrice Ann’s mother , 40 years old,

she has sisters (number unknown)

Unstable home environment

Physically & Psychologically Abused

Abandonment, parental loss

Presenting Problem

Presenting Problem

According to

the Parents

According to the Parents

Ann’s problems are the sudden aggressive behaviour, excessive underage drinking and the participating in high risk behaviour.

According to the

Counsellor

According to the

Counsellor ( In Traning )

  • Grief over the loss of her Grand/Great Aunt who provided love, care and support throughout her life.

  • Unresolved feelings of abandonment and fear that were exasperated by her aunt’s death and the other changes in her life.

  • Powerful aggressive behavoir towards parents and others

  • Alcohol consumption as a coping mechanism

  • Engaged in high risk behaviour

Personality

Dynamics

Patient

History

Personality Dynamics

Personality Dynamics

Cognitively and Behaviourally Ann is currently making destructive life choices and adopting unhealthy coping mechanism i.e her chocie to drink excessively at a young age and the participation in high risk activity.

Emotionally Ann is displaying powerful aggression towards her parents and others, she may also be experiencing feelings of grief and loss over the death of her great aunt.

Patient History

Patient History

Ann is 1 of 4 children she grew up in an abusive / broken family environment.

Her family environment was one of fear lacking love, sentiment and stability, as a result she has a rocky relationship with her parents.

Ann has siblings but the relationship with them is unknown. Ann has often witnessed her mother being physically & psychologically abused by her father during her life and has experienced feelings of neglect and abandonment during the periods of their separation.

Lastly, Ann as never received previous counselling/treatment and despite her current abuse of alcohol she has no personal issues with drug or alcohol. However, she has witnessed alcohol being abused by her father who used it as a coping strategy.

As Ann’s parents will also play a substantial role her therapeutic journey it is helpful to get a brief history of them also.

Beatrice

Beatrice is a mother of four she as previously suffered physical and mental abuse from family members and her spouse. When she was young her mother committed suicide, this affected her family environment and she was often moved about. Beatrice had strong feelings of abandonment and fear in her childhood and suffered unresolved grief in relation to her mother’s death. Beatrice has never received professional help and has never engaged in drug or alcohol abuse.

Joe

Joe was abandoned at the age of 15 and forced to fend for himself. Prior to this he was abused by his alcoholic father and experienced feelings of rejection and abandonment. Joe has a history of abusing alcohol and physically and psychologically abusing his wife. He has abandoned his family on multiple occasion and has not been the best role model to his children. Joe has never received professional help.

Provisional Diagnosis

Diagnosis

Main Diagnosis

Main Diagnosis

  • Provisional diagnosis is a Trauma/Stressor related disorder.
  • Adjustment Disorder with disturbance of conduct.

  • There are 5 requirements criteria for an adjustment disorder.

  • The Specifier ‘disturbance of conduct’ in this scenario addresses Ann’s powerfully aggressive behaviour to her parents and others.

Secondary Concerns

Secondary Concerns

The DSM-V refers to this as “other conditions that may be the focus of clinical attention” and states that these may otherwise affect the diagnosis, course, prognosis or treatment of patients disorder (Diagnostic and statistical manual of mental disorders, 2013).

  • Relational Problems
  • Parent-child relational problem
  • Upbringing away from parents
  • Child affected by parental relationship distress

  • Abuse & Neglect
  • Suspected psychological abuse
  • Confirmed neglect Ann faced in her childhood

Justification

of Diagnosis

Post-Traumatic Stress Disorder

Acute Stress Disorder

Justification

of Diagnosis

Conduct Disorder

Adjustment Disorder

Normative Stress Reactions

Normative Stress Reactions

Normative Stress Reactions

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder

Acute Stress Disorder

Acute Stress Disorder

Conduct Disorder

Conduct Disorder

Adjustment Disorder

Adjustment Disorder

Theoretical Orientation

Theoretical Orientation

The Family systems theory has eight interlocking concepts was created by Murray Bowen a psychiatrist using systems thinking ("Family Systems Therapy", n.d.)

Bowen’s core assumption is that the family is an emotional unit and when working with an individual it is critical to understand the complex interactions in the unit (Kerr, 2000, Corey, 2015).

The approach is better suited to Ann as her problems originated within and because of a dysfunctional family unit.

Treatment

Plan

Treatment

plan

Goal 1

Address Ann’s anger issues, excessive underage drinking and high-risk behaviours

Goal 1

Objectives

Objectives

a. Identify the source of Ann’s anger.

b. Address the possibility that Ann’s parents and the overall family environment contributed to the anger directed at her parents.

c. Address the possibility that Ann’s childhood feelings of abandonment, neglect, fear contributed to her anger.

d. Help Ann develop anger management skills & other coping techniques.

Interventions

Interventions

i. Use a genogram to further explore relationships between family members and possible patterns.

ii. Use exaggeration, role play, role reversal or re-enactments with Ann and/or her parents to act out situations where Ann express aggression.

iii. Discuss, and analyse core issues that arise from the interventions above.

iv. Use probing and open-ended questions to explore the motivation behind Ann’s drinking habits and high-risk behaviours. Have the father talk about his relationship with alcohol and the disadvantages and consequences (this will be suggested to the father prior to the session).

v. Discuss the effects of Ann’s anger on her and those around her.

vi. Teach Ann and her parents anger management techniques like relaxation through deep breathing or knowing your triggers symptoms and being proactive, identify situations that anger you and work out a solution.

vii. Enrol Ann in two after school activities a team sport like basketball, volleyball etc and physical activity that channels her aggression like karate, kickboxing or mixed martial arts or one that incorporates both

Goal 2

Address the death of Ann’s great aunt.

Goal 2

Objective

Objective

a. Identify Ann’s relationship with the great aunt

b. Identify how and if and is properly dealing with the death of her great aunt

c. If necessary help Ann properly grieve, go thru grief techniques and ensure Ann gets closure.

Interpretation

Interpretation

iii. Use the Empty chair technique or have Ann write a letter to her great aunt to help her get closure if necessary

iv. Have Ann and her parents do or recreate a similar positive activity that Ann and her great Aunt did.

i. Using Art supplies or puppets (if necessary) have Ann tell a story or two about her great aunt. It could be good, bad or memorable anything she chooses

ii. Have Ann’s parents share scenarios of loss and how they dealt with it (discuss with parents beforehand to avoid surprises)

Goal 3

Address some of the uncertainty of the future.

Objective

Objective

a. Discuss the implications of the parent’s new faith on the family.

b. Discuss the implication of the parent’s restored marriage and the family dynamic.

c. What positive changes can Ann and her siblings expect. What is going to change what is going to remain the same in the family environment.

d. Strengthen communication between family members.

e. Teach parenting techniques.

Interventions

Interventions

i. Use one or two Team building activities to foster cohesiveness among family members for example the “family gift technique” or “toss the ball”.

ii. Teach the family proper communication techniques like active/empathetic listening.

iii. Have Beatrice and Joe research parenting styles, positive and negative punishment and positive and negative reinforcement (done in a Parent only session).

iv. Have Beatrice and Joe discuss and roleplay 3-4 situations the faced in the pass with the children and their responses. Discuss new behaviours responses to those old situations what would the change and why what would remain the same and why (done in Parent only session).

Diversity Considerations

AGE

Ann is testing her boundaries, breaking ties, establishing a new identity, forming new friendships and engaging is social activities. She is attempting to understand who she is, her goals in life and life’s over all meaning (Corey, 2015).

AGE

Gender

Women experience the world around them differently because of their gender (Puri, 2011)

Gender

Family Enviroment

Growing up in a fearful, abusive, neglectful, environment would have impacted the physical, psychological, cognitive, and behavioural development of Ann.

(Understanding Child Abuse and Neglect, 1996)

Family Enviroment

Grief

Grief is individualistic in that it affects all individuals differently (Sheddon, 2012). Symptoms can manifest physically, emotionally, behaviourally, spiritually or psychologically (Bass, 2017).

Grief

Legal & Ethical Issues

Legal & Ethical Issues

The first ethical issues would be receiving informed consent from Ann’s parents this would include discussing the duration of therapy, its cost, benefits and con’s, alternatives etc (Welfel, 2012). The second issue would be receiving Assent from Ann, although I’ve received consent form her parents receive ascent form will ease the therapeutic process. The third issue would be explaining the concept of confidentiality to Ann and her parent’s ensuring that they both understand it’s limits. Furthermore, because Ann’s disorder has placed her at a higher risk of suicidal behaviour (Diagnostic and statistical manual of mental disorders, 2013)I would emphasise the possibility of breaching confidentiality should she threatens to harm herself in any way. Lastly, there should be no dual relationship conflicts however if the parents sought to engage in counselling unrelated to Ann’s case I would recommend them to another counsellor to avoid dealing with both cases in their own counselling.

Prognosis

Prognosis

If all goes well and there is proper care and a healthy change in the home environment Ann is likely to progress, adjust properly and improve for the better.

If Ann is unresponsive to therapy and the family environment does not improve it is likely that Ann will decompensate

  • A reduction in Ann’s anger use the techniques learnt.

  • Engagment in sporting activities

  • Making new friends thus creating a peer support system.

  • Engagement in high risk activities and drinking should cease.

  • Dealt great aunt’s death in a healthy manner

  • Stable family environment and home life

  • Beatrice and Joe should have some confidence in their ability to parent.

Ann's refusal to actively participant in therapy.

Beatrice and Joe refuse to participation in and support the process.

Beatrice and Joe's insistance to only focus on the excessive underage drinking, high risk behaviour and aggression

Obstacles

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