This chapter presents a case study of a 4-and-a-half-year-old Caucasian male, who lived with his mother and his 3-year-old sister. The patient’s mother requested counseling services due to growing concerns surrounding his medical condition, cerebral palsy (CP). The patient had not been educated regarding his disability, which began to cause social and emotional difficulties for him. The school diagnosed him via early intervention services with only a mild impairment of cognitive functioning. The patient struggled with issues related to weak muscle tone and poor muscle control and coordination, and struggled to understand the changes taking place in his body. The author chose the intervention and theoretical orientation, child-centered play therapy (CCPT), because it provided an inherently creative approach to working with children. Providing the patient with information on CP allowed him to better understand what came to light about his body and why he experienced difficulty.
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This chapter presents a case study of a patient who received counseling for behavior-related concerns. The patient’s mother seemed ashamed to admit that her children’s father decided to be absent in their lives. This feeling appeared to be consistent with the patient’s feelings, as observed through her nonverbal behaviors of avoidance and silence during discussions about her relationship with her father. The mother appeared to feel guilty about the father’s lack of participation and tended to overcompensate by being involved in her children’s lives, especially in their medical and mental health treatment. The patient experienced difficulties with identity and relationships. The author chooses a cognitive behavioral approach, rational emotive behavior therapy (REBT). This approach focuses on the role of thinking and beliefs as the root cause of personal problems. The author felt good about the referral and the new opportunities for the patient to develop her self-expression skills.
This chapter presents a case study of a school student who is the oldest child in a family of five. The patient attended school regularly, and always made good grades in pre-advanced placement (Pre-AP) courses. Prior to his father going to prison, the patient had not experienced significant loss. The grief associated with his father’s sudden absence from everyday life left him feeling frustrated and disconnected. Unattended emotions surrounding his father’s incarceration impeded his academic success and damaged his relationships. As his professional school counselor, the author wanted to help him see the connection. Being able to identify emotions and understand that internal conflict carries external implications is a valuable life-lesson. The author helped an entire family by coordinating the services of a therapist in the community and the patient reported that he was doing well academically.
This chapter presents a case study which details a patient’s treatment and the sequence of her engagement in the counseling sessions. The patient functioned in the concrete operational stage of development. Children with concrete operational skills tend to demonstrate more abstract and inductive thinking. The patient’s entire family resided in a low socioeconomic community except for an extended family member who cut ties with the parents due to their involvement in drugs. The patient experienced a childhood riddled with abuse, loss, and addiction. The first strategy for promoting healthier emotional coping revealed sensory details that the patient could recognize and identify when she felt happy, mad, sad, scared, or disgusted. The chapter explores characteristics of healthy relationships using Miller’s “Five Good Things”: sense of zest; clarity about self, other, and the relationship; sense of self-worth; enhanced creativity and productivity; and desire for further connection with others.
This chapter presents a case study of a 15-year old White female. It outlines the process of finding healing through charting memories utilizing an evidence-based treatment. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment used to treat posttraumatic stress disorder (PTSD) experienced by children ages 3 to 18. As the name indicates, the theoretical base lies in the cognitive behavioral school of thought. The overall focus of TF-CBT is to build physical, emotional, and cognitive coping skills; bolster the parent-child relationship; gradually expose and desensitize; and create new meaning surrounding the trauma. Most importantly, it is used to help the child to not be defined by the trauma. Rather than proceeding chronologically or focusing on a specific traumatic event, exposure during the trauma narrative (TN) is focused on themes and difficult thoughts and feelings that arise out of the client’s trauma experiences.
Child and Adolescent Counseling Case Studies:Developmental, Relational, Multicultural, and Systemic Perspectives
This book aids counselor educators, supervisors, and counselors-in-training in assisting children, adolescents, and their families to foster coping methods and strategies while navigating contemporary issues. It promotes the essence of counselor growth, and deals with conceptualization of the client’s presenting problems along with personal and client goals, step-by-step accounts of the happenings in counseling sessions, and counseling outcome. Case studies were written in contexts that reflect the fact that children and adolescents are part of larger systems family, school, peer, and community. Systemic context, developmental and relational considerations, multicultural perspectives, and creative interventions were infused in the cases. Time-efficient methods, such as brief counseling, were used in some of the cases. The case studies selected highlight contemporary issues and relevant themes that are prevalent in the lives of youths (i.e., abuse, anxiety, giftedness, disability, social media and pop culture, social deficits and relationships, trauma, bullying, changing families, body image, substance abuse, incarcerated family members, race and ethnicity, and sexual identity and orientation). These themes capture both the child and adolescent perspectives and are designed to provide breadth and depth during classroom discussions and debriefing.
Family and fathers play a critical role in many African American communities and life; however, social-historical factors, such as racism, contribute to the multiple challenges they face as witnessed in the case of a patient’s family system, as described in the chapter. The need to protect the patient’s family, possibly from the violence he witnessed in his community, became a larger burden for him. He was willing share the reasons for his criminal behavior. While his physical health was generally good, his psychiatric evaluations revealed diagnoses of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, bipolar disorder, and intermittent explosive disorder. Being imprisoned physically did not concern him because it provided him some protection from the turmoil in his family and community. However, his psychological imprisonment seemed to impede his adolescent identity development. Overall, the patient worked toward physical liberation, but more so toward liberation of his multiple incarcerated identities.
The author presents a case study of a 15-year-old African American male, who attended a midsize suburban high school where, he successfully navigated his freshman year of high school. The patient described his school as attended by both Black and White students, along with some Hispanic students and was having difficulty being around his friends. His parents described him as an active child and teen who enjoyed playing baseball and hanging out with friends. The parents described him as an average student who did well in both academic and extracurricular activities. Treatment goals involved both individual and family counseling sessions to address and improve communication while decreasing family conflict. After counseling, the patient’s grades improved, he spent time with his friends more regularly, and he received no other suspensions or incidents of fighting.
This chapter presents a case study of a woman who finds a counselor for her 11-year-old son. The son’s family possessed many qualities characteristic of “growth-fostering relationships” defined in relational-cultural theory (RCT). The woman portrayed the son as a healthy young boy with few developmental problems or health concerns. The priorities for his counseling goals included: to assess the risk that he might harm himself and put in place interventions for safety; to determine what significant life events contributed to his anxiety and depression; to increase his feelings of connection to others; to reduce the occurrence of his nightmares; to support him in developing a stronger voice in order to ask for help when he needed it and to express his needs. Adlerian play therapy and mutual storytelling proved to be a good fit for him, and helped the author understand his view of self and his world.
This chapter presents the case study of a 17-year-old Hispanic male, highlighting the interplay of systemic, developmental, relational, and multicultural influences, and the many risk factors that ultimately contributed to his delinquency. His history of legal troubles included referrals for several public intoxications, theft, and violations of probation, resulting in referrals for expulsion, child in need of supervision (CINS) assessment, and contempt of court. The patient possessed great potential for growth, but his skill sets, social and emotional developmental levels, and systemic influences showed potential to hinder interventions and progress. The concepts, Patient-centered Acute Care Training (PACT) and “To Booth or Not to Booth”, challenged his faulty thinking and beliefs. He began to find his personal strengths, minimize his lack of trust and disconnections with others, and became engaged in the process of fostering his own social, emotional, and cognitive growth.
This chapter presents a case study of a 9-year-old Caucasian child who lived with his paternal grandparents in a small rural community. The patient attended a local private school where he received individualized education accommodations based on school-level evaluations, asserting that his learning is being impacted by behavioral deficits. Media outlets also played a large role in his life as he reportedly spent a large amount of his formative years locked inside of his bedroom with a television and video games. According to Erikson’s theory of psychosocial development, at 9 years of age the patient was in the industry versus inferiority stage of development. Based on his developmental level and age, the author used a child-centered play therapy modality to facilitate the therapeutic process. Based on his grandmother’s report of the patient’s behavior, he developed some of the skills needed for treatment to be considered successful.
The author’s approach to counseling is typically grounded in a systemic perspective, where he uses a directive approach, especially when family issues are involved. This chapter presents a case study of a 15-year-old Caucasian female from a middle-income family. Her parents were divorced and she had one sibling. The therapeutic challenge consisted of helping the patient process the difficult feelings she experienced toward her mother, and remain connected, or loyal, to their relationship. The patient attended counseling and focused on taking responsibility for her thoughts and feelings, and acting on them in an appropriate manner, regardless of how she perceived the behaviors of those around her. She recognized her growth and embraced it, knowing it meant she had to be responsible for herself after counseling, accepted her mother as a good person and understood that she received her mother’s best efforts.
The author met the patient, a 15-year-old boy, while providing counseling services as a contract counselor at a residential treatment center (RTC) in a large metropolitan area. The RTC contacted the author because they experienced an influx of adolescent clients with legal problems due to sexual offenses. During the first counseling session at the private counseling office, the patient’s biological mother voiced her concerns about his lack of friends, attention deficit hyperactivity disorder (ADHD), and poor grades. However, the patient never confirmed the abuse, and child protective services (CPS) records and reports indicated no past history of abuse. During his time in the RTC, the patient focused on his counseling work and appeared to be authentic and forthcoming in sessions. During the assessment phase, the patient and the author explored his family history, beliefs, and recollections of some events prior to his arrival at the RTC.
This chapter presents a case study of a 9-year-old girl whom the author met for weekly counseling sessions over a 4-month period in her private practice. Synthesizing developmental, relational, and systemic perspectives, the author describes her initial presenting concerns related to gender nonconformity, as well as how she conceptualized the patient and her needs within her familial, school, community, and cultural contexts. Additionally, the author describes the creative arts and expressive treatment approach she utilized within a relational-cultural framework, and the outcomes related to the patient’s developing gender identity. The patient’s struggles began with the school’s expectations that students begin changing into gender-specific uniforms for physical education (PE) classes. As a lesbian, gay, bisexual, and transgender (LGBT) affirming counselor with a specialty in working with children and adolescents, the author’s informed consent communicates her validation and affirmation of the full range of gender identities.
This chapter presents a case study of a 10-year-old Caucasian male. His family moved to the school community after a deployment in Germany. The major issues surrounding the effects of divorce on children occur in five stages: denial, anger, bargaining, depression, and acceptance. The patient appeared to be unable to accept his parents’ divorce. Due to his father’s military employment, the family moved frequently. The patient appeared to be functioning in the concrete operational stage of cognitive development. Being new to the school, he started the process of developing relationships with his peers at school and in his neighborhood. Military lifestyle impacts the family unit when it comes to everyday life and relationships. To engage the patient through developmentally appropriate techniques, the author established a goal to incorporate play therapy techniques. The patient enjoyed group counseling and said that he felt better with the situation surrounding his parents.
This chapter presents a case study of a 16-year-old high school student who was identified as biracial and a product of divorce. He reported living with his White mother, stepfather, and younger half-sibling, and frequently visited with his Hispanic father and stepmother. The patient was an academically gifted student with a keen interest in science and math, and informed his interest in pursuing medical school in the future. He reported that beyond his family, his biracial identity did not influence him much. The patient was diagnosed with social anxiety, which appeared to be a more appropriate diagnosis. To accomplish the therapeutic goals, the author utilized a mixture of cognitive behavioral and humanistic strategies along with mindfulness with the patient. The mix of strategies was useful for the patient as he enjoyed the cognitive behavioral strategies that reminded him of his areas of strength.
This chapter presents a case study of a Hispanic female of Mexican descent. To assist the patient in addressing social deficits and relationship issues, the author engaged her systems of family, peers, and school. Furthermore, her pediatrician diagnosed her with attention deficient hyperactivity disorder (ADHD), inattentive type, and prescribed Focalin XR. Specifically, the patient participated in a psychoeducational group for girls that focused on self-esteem, confidence-building, and social skills. The theoretical approach the author used for the treatment included solution-focused counseling integrated with cognitive behavioral and play therapy. Individual counseling sessions utilizing directive play therapy followed by psychoeducational group counseling appeared to provide the patient with the most success in developing a stronger sense of self, enhanced social skills, and reduced anxiety in social situations. She showed improved academic performance, increased positive self-esteem, and improved ability to describe and identify healthy social skills and relationships.
This chapter presents a case study of a Caucasian high school student, who came to counseling because of her anxiety about school, music, family, and relationships. Based on the initial interactions, the patient appeared to be an introvert with adequate social skills. Her hyperawareness of others’ opinions of her, her avoidance of criticism, her unrealistic expectations of herself, and her fear of not performing well contributed to an almost constant state of anxiety. She continued to process the anxiety she experienced when multiple stresses started piling up in her life. The patient agreed she needed to be honest with her mom about her stress. By counseling, she developed skills for managing anxiety, lessened her dependence, and strengthened her internal locus of control. The most effective strategy involved role-playing, because she needed concrete interventions, and it helped her build confidence in her ability to implement what one practiced.
This chapter presents a case study of a 14-year-old African American female. She had strong beliefs in the family system and felt protective of her children. She was in trouble at school due to bullying other students through social media comments. Her suspension from school for texting inappropriate pictures prompted her mother to bring her to counseling. The author’s initial concerns focused on addressing the patient’s feelings of sadness and hopelessness related to her low self-esteem. The therapeutic alliance is the foundation for counseling effectiveness. The counseling goal centered on increasing the patient’s self-esteem and decreasing her reliance on approval by friends via social media. Using brief solution-focused therapy with her was a good choice. By coming to terms with her feelings of sadness and hopelessness and recognizing the effect of her sexualized behaviors, the patient made positive changes in her lifestyle.
This chapter presents the case history of a 17-year-old Hispanic female, who was an A/B student and active in school and expressed interest in attending college. She shared about her history of moving quickly in and out of sexual relationships. Like mental health counselors, professional school counselors receive training to work with individuals, families, and groups to facilitate awareness and personal and social growth. As a director of guidance and counseling, there were occasions when the author’s support is required in the form of consultation, collaboration, or the provision of counseling services to students. The patient acknowledged that her home issues caused social challenges at school. Her goal centered on finding a way to live a life free of drama, to reestablish a relationship with her mother, and to find independence. After counseling, the patient maintained positive peer relationships at school, and reported that her home life was going well.
This chapter offers a conceptualization of a patient’s case which describes the process of play therapy with her, and identifies treatment outcomes. From a systemic perspective, the patient’s early experiences in her family seemed clearly fraught with difficulties. Her experiences of abuse and the time she spent in the foster care system exacerbated her growing attachment problems. From a relational perspective, her early relationship with her primary caretaker had been insufficient at best. Rather than offering the consistent and loving care and attention needed to build strong attachments, the patient’s mother remained inconsistent, often inattentive, neglectful, and sometimes abusive. For the past several years, the author has integrated a trained therapy dog into her play therapy sessions with children. The dog acts as an extension of her and offers children his attention and genuine, positive regard. Fortunately, the patient responded quite well to play therapy with her and the dog.
This chapter presents a case study of an 11-year-old male whose supportive parents brought him to counseling with concerns about how his anxiety significantly affected his daily life. He expressed feelings of fear about his life, and isolated and withdrew from others as a consequence. The patient’s school records indicated problems with focus, but with intervention, he made substantial progress in reading. He exhibited no physical issues at birth and as an infant. About a year later, he received diagnoses of attention deficit hyperactivity disorder (ADHD) and an anxiety disorder. He was aware of his inability to control his emotional reactions, and understood the impact this had on himself and others, but did not know how to implement change. The adults in his world reported significant problems with inattention and hyperactivity, depressed mood, and somatic problems, along with a broad executive dysfunction affecting his ability to regulate his own behaviors.
The author, a professional counselor, has worked with diverse clients ranging in age, development, identity, therapeutic needs, and clinical settings. In this chapter, he shares his clinical experience with a 15-year-old White male youth in a residential facility. Childhood traumatic experiences affected the patient’s ability to establish and maintain healthy relationships, which was evident both in his personal relationships and the therapeutic relationship. The patient had limited social interaction with others and was essentially socially withdrawn. In school, his infrequent attendance impaired his academic performance and he failed several grades. His behavior was another challenge for him in school as he had many disciplinary actions for defiance and disrespect. The patient began to find a reason to live and his transformation was obvious after few sessions of counseling. His story reflected the beauty of counseling as a gift that counselors must use responsibly.
This chapter discusses the counseling process of an older adolescent, and his family as they negotiated their boundaries, communication styles, and relational connections. It reviews how they learned to differentiate between enabling behaviors and loving support. Within his familial, peer, institutional, and educational systems, the patient learned to evade difficult moments, escape into oblivion, and disarm people with a charming smile. The adolescent began drinking at age 12, started smoking marijuana regularly at age 14, and began smoking heroin at age 16. He suffered from both substance dependence and major depression. The patient was prepared for treatment, and the treatment concentrated on aftercare planning, living arrangements, social support, and outpatient counseling to focus on family issues, grief, addiction, and mental health recovery. The chapter concludes that addicts show demonstrably different brain structures and functioning than nonaddicts and genetic differences predict addiction and these preexisting neurological differences predispose people to addiction.
This chapter discusses an 8-year-old White male student who lived with his mother, father, and two older brothers, ages 14 and 17. The student’s parents intentionally exposed their children to events/educational material that they believed furthered their children’s academic futures and expected him to be placed in a class for gifted children. The student excelled academically and struggled more socially and emotionally than his brothers. He displayed developmental characteristics similar to other children his age. He demonstrated all of the characteristics of students who identified as having an emotional-behavioral disorder, frequent physical outbursts, self-harm and harm to others, and an inability to control his emotions. The peer system intervention proved beneficial only in terms of teaching him positive social behaviors when he became anxious. The school environment system intervention also proved beneficial in providing a net of support, and offered him long-term support as he moved across grade levels.
This state-of-the-art of real-life case on counseling children and adolescents emphasizes the developmental, relational, and cultural contexts of working with this population, and incorporates innovative techniques across a wide range of approaches. This chapter discusses a case study of an 8-year-old, second grade White male, after his school placed him in an alternative school for children with behavioral issues. As a doctoral student, the author worked under a grant that provided playrooms and play therapy training. According to his teachers, the patient seemed smart and appeared impatient with other students who did not understand the material as quickly as he did. The family physician diagnosed the patient with attention deficit hyperactivity disorder (ADHD). The author taught basic play therapy language skills to patient’s mother and sister. The patient’s mother and sister began special play time with the patient, which he loved, and his behavior started to change after 3 months.
This chapter presents a case study of a 16-year-old male, who attended a Texas high school. The author came to know of the patient as his group counselor at an Intensive Outpatient Program (IOP) for substance abuse in Texas. Differentiation within a family system allows for family connection without loss of individual autonomy, and the Bowen model asserted that the degree of anxiety and differentiation in a family accounted for the variability in how a family functions. Adolescents in the patient’s age group are in the formal operation stage of development. The counseling relationship between the patient and the author developed easily. Both established trust early and both agreed to be honest about their actions. Narrative therapy seeks to find unique outcomes that cannot be accommodated within the dominant story of a person’s life. In the patient’s case, his dominant story is the life of a heroin addict.
This chapter presents a case history of a fifteen-year-old patient who participated as a member of the Peer Mentoring Program (PMP) at his junior high school, where counseling services are provided. The program focused on helping at-risk youth negotiate school life and develop life skills, such as communication, conflict resolution, and values clarification. In working with children and adolescents like the patient, it is important to consider ways of empowering them, while also providing a structure of support, psychoeducation, and opportunities for peer involvement using their creativity and imaginations. The author conceptualized the patient’s situation as that of a young boy developmentally sandwiched between two worlds-the world of the child, where there is a semblance of safety, and the more adult world that many students find themselves in. After counseling, the author felt that the patient continued to be a gentle spirit and found ways to work with life’s challenges.
The author worked at the largest high school in the South Texas as a professional school counselor. A 14-year-old White female, self-referred to his office concerning her anger management and anxiety issues. As a gifted ninth grade high school student, she experienced difficulty belonging and fitting in with her peers. After she enrolled in pre-advanced placement (Pre-AP) classes, the school implemented the Gifted and Talented (GT) program in a manner that students would be enrolled and serviced through GT classes. The patient appeared to be functioning within the social and emotional development appropriate for her age group. She tended to argue with her mother while, at the same time, seemed very caring and empathetic. Addressing her needs as a gifted student in individual counseling sessions and placing her in gifted classes aided in her growth. She also developed strategies to look at her reality and not her beliefs.