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Engages in excessive
underage drinking
14 year old female
Displays powerful aggression
1 of 4 children
Teenager
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
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
Patient
History
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.
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 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 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
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).
Post-Traumatic Stress Disorder
Acute Stress Disorder
Conduct Disorder
Adjustment Disorder
Normative Stress Reactions
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.
Address Ann’s anger issues, excessive underage drinking and high-risk behaviours
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.
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
Address the death of Ann’s great aunt.
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.
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)
Address some of the uncertainty of the future.
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.
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).
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).
Women experience the world around them differently because of their gender (Puri, 2011)
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)
Grief is individualistic in that it affects all individuals differently (Sheddon, 2012). Symptoms can manifest physically, emotionally, behaviourally, spiritually or psychologically (Bass, 2017).
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.
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
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