Child Case Study: Depression and Abandonment
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Internship and Case
Working with the public-school system makes it difficult to practice my theory practice, due to the lack of therapeutic support in the Philadelphia public schools. But I have made do; I have been working with the client that I am going to discuss since the beginning of the school year and it has been a pleasure, to not only build a trusting relationship with her, but to also provide her with the advantage that she needed/needs.
My case pertains to a 14-year-old female African-American 8th grader. To ensure anonymity, I will refer to this student as "Amber". Amber was born in Philadelphia and currently resides with her grandmother. Five years ago, she lost her mother at the tender age of 8. Due to infidelity, Ambers parents divorced when she was 5 years old.Â Shortly after, her father remarried and moved to Georgia. Currently he resided with his wife and two step-children. Despite geographical barriers, Amber maintains a relationship with her through weekly phone calls. From time to time Amber is able to visit her father when she is on summer break. School records do not show mental health treatment or treatment for substance abuse issues for this student. Despite what records show, Amber has admitted to smoking marijuana when stressed.
Amber presents with depression and feelings of abandonment and resentment. From my previous sessions with Amber, she disclosed that she misses her mom and is frustrated with the relationship she has with her father. Amber shared that her father is verbally abusive during their phone conversations. The inability to maintain a harmonious relationship with her father has had a negative impact on her grades.Through my interactions with Amber, I have come to the realization that she wants to mend the broken relationship with her father. During my sessions with Amber I have utilized Cognitive Behavior Therapy (CBT) and Gestalt Therapy, to appropriately assistance cope with her stressors.
Overview of Theories Practiced
School social work has been the base of my practice. My desire to work with children in the future has allowed me to use most, if not all the theories listed above (CBT, Narrative Therapy, Emotion-Focused, Experiential/Gestalt, Ego Psychology, Self-Psychology, and Object Relations Theory). Though all of these theories have specific techniques that work well with my client population. There are two theories that have made an impact throughout my practice these past few months/years of graduate school, work, and internship:Cognitive Behavior Therapy (CBT) and Gestalt Therapy.
When working with my client population I have mainly used CBT and Gestalt Therapy, due to their effect on the client's awareness of self and thoughts. These two theories have a lot in common when it comes to their effectiveness and techniques used. From my experience, I have noticed that both theoriesfocus on the client's present state of mind.They both take into consideration the past of the person being served, and how it relates to their future. Together the CBT and Gestalt therapy focus on visual descriptive aspects and self-awareness; with Gestalt using the chair therapy technique and CBT using the rational emotive imagery technique.
Concepts and Assumptions/Goals and Plans
CBT is a is a type of psychotherapy that accentuates the critical part of reasoning by the way we feel and what we do. It is also problem-focused and helps people see the connection between beliefsand emotions. Through CBT, individuals discover that their observations directly impact their reactions to circumstances. In other words, a person's thought process illuminates his or her practices and activities. CBTis not aunique treatment technique; rather, it is a general term which alludes to a gathering of treatments that have certain similarities in therapeutic philosophy.
Psychological behavioral specialists trust that by altering our thought process, we can straightforwardly impact our feelings and conduct. Aaron T. Beck, the psychiatrist broadly thought to be the father of CBT. Beck believed that a person's thinking pattern can become established in youth and that what we feel is influenced by what we think, and in order to feel better we need to avoid dysfunctional thoughts. Using this therapy, I able to properly assess my younger clients in order to provide them with the best care. CBT assessments are easily comprehended by clients while helping them to develop an understanding of the effect that their condition has on them.
Gestalt therapy is an experiential and humanistic psychotherapy generally known for its strong focus on the client's immediate experience as a way to enhance an awareness of how an individual lives in the world. Gestalt specialists and their consumers utilize innovative and experiential systems to upgrade mindfulness, flexibility, and self-healing. "The word gestalt originates from the German word meaning shape or frame, and it references the character or embodiment of something" (Wagner-Moore, 2004).The person's actual experience is determined by the Gestalt, rather than the parts. "The way in which multiple data are shaped is based on the individual's needs, appetites, and impulses"(Wagner-Moore, 2004)."Based on evidence that the whole individual is greater than the sum of its parts" (Wagner-Moore, 2004).
At the center of Gestalt therapy is the holistic perspective that individuals are unpredictably connected to and impacted by their surroundings and that all individuals endeavor toward development and adjust. Gestalt therapy is like individual focused therapyin this way, and in its prominence on the therapist's utilization of sympathy, comprehension, and unqualified acknowledgment of the client to improve therapeutic results. Gestalt therapy also perceives that convincing someone to change ironically results in further misery and fracture. Or maybe, change comes about because of acknowledgment of what is. Therefore, treatment sessions concentrate on the personfiguring out how to end up distinctly more mindful and to acknowledge and confide in their emotions and encounters to ease trouble.
My role as a school counselor intern,who uses CBT techniques involves a lot of sitting and talking to my clients. This approachhas allowed me to ensure that myself and the client are both focused on thegoals of the session, guaranteeing that the time spent in treatment is beneficial. The individual in treatment will then profit by a cooperative relationship in which he or she can uncover individual issues without judgment and is helped to comprehend the current issues without being told which decisions he or she ought to make.
My use of Gestalt therapy throughout my experience at my internshipconsist of direct contact between myself and the student. Through our sessions, we focus on the on the 'what and how' and how the client is dealing with the 'here and now'. Together, the client and I assess what is going on now and what is required as an outcome. I usually avoid translating occasions, concentrating just on the now, including the physical reactions of the client. While helping the client to understand the inner-self, so they can eventuallygrasp theirbehaviors, actions, and reactions. Gestalt therapyaids to take steps into mindfulness with the goal that they can recognize and acknowledge these patterns.
Values and Ethics
One of the many ethical standard and responsibilities as Social Workers to our client is Self-Determination. The Code of Ethics of the National Association of Social Workers, states as, "Social workers we are to respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals"(DiFranks, 2008). This ethical code depicts exactly the work that is done when using CBT in therapy sessions. CBT focuses on practical problems and goals that can be achieved using your own personal story and 'self'. This self-determinationapproach increases the effectives of therapy and endurance of the outcome.
As for Gestalt therapy, the Code of Ethics of the National Association of Social Workers, states, "Social workers should be aware of the impact of the political arena on practice and should advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice" (DiFranks, 2008). To me this ethical code is consistent with Gestalt therapy because through my research I have learned that,to properly perform Gestalt therapy the therapist must be able to focus on all the client's conditions to provide the proper care for the client. And by providing the proper care for our clients ourselves, we are in fact already advocating for them and promoting "social justice".
According to Aaron Beck, CBT is known to be best working for most clients/problems/situations. My research and personal use of CBT has also backed this theory. CBT is generally used for people, with mood disordersuch as depression, anxiety disorder, and PTSD. It is additionally used to help individuals with substance use disorder, eatingdisorder, dietary issues, personality disorder, sexual issues and psychosis. It is effectively conveyed in individual, group and couple's situations.
Similar to CBT, Gestalt therapy can work well for most clients/problems/situations. nearly anybody can profit by this specific approach to treatment, a few people are particularly appropriate to a Gestalt approach because of their specific battles or restorative needs. For instance, people who lack self-awarenessor people who suffer from anxiety, substance use, post-traumatic stress, depression and other mental issues that can keep individuals from living to the full.In general, individuals who take part in Gestalt therapy tend to feel more self-assured, calm and content with themselves.
Not So "Good" For
When it comes to who CBT is not suitable for, research states that "CBT may not be suitable for patients with significant cognitive impairments (patients with traumatic brain injury or natural cerebrum sickness, for instance) and people who are not willing to play a dynamic part in the treatment procedure are not generally great candidates for this treatment" (Beck et al., 2004).Although CBT has been utilized with kids as youthful as seven to nine years of age, it's best with kids more than 14. At this age, kids have developed more cognitive skills. Adolescents ad adults respond better to the strategies used in CBT. Individuals who experience feelings of unhappiness, may also have limited triumph with CBT.
Gestalt therapist are very vigorous within the therapy sessions and so, notice must be taken that they have qualities that includeinventiveness, sensitivity, empathy, and respect for clients. These qualities, alongside ethical practice, are dependent on preparing, background, and judgment of the therapist. The dominance of the treatment may not be appropriate for all patients, and even problematic for a few, despite the ability of the therapist. There is also a lack of logical research evidence supporting the effectiveness of Gestalt treatment.Furthermore, some observers of Gestalt therapy have indicated that, this therapeutic technique is not appropriate for group therapy work.
Based on my own personal experience and research, there has been no modifications made when working with clients of different gender, race, ethnicity, class, age, mental or physical capacity, religion, or sexual orientation. Both theories have not been limited to any specific kind of person. The conditions may very when it comes to appropriateness in using these theories, but the kind of person has no effect on the results.
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