Alex is a ten year old boy with a diagnosis of a disorder known as oppositional defiant disorder. His parents concerns with his behavior include disrespecting attitude towards women, non compliance with adult requests and often throws explosive tantrums. Alex has been expelled from several schools and he resides with his grandmother and mother. In addition to this, his parents divorced when he was only five years old and their marriage was often marked with by many significant disagreements and tension. As a child, Alex witnessed these arguments between his parents and even on one occasion, he witnessed his father hitting and shoving his mother. The therapist will instead adopt the play therapy other than focus on a certain diagnosis or setting.
Alex’s father remarried and he is now a father to other two children. The custody agreement in this case states that Alex’s father should hold regular visits one day a week and all the weekends. However, his father has been quite inconsistent in this agreement as he misses the visits and often cancels the visits at the last minute.
Process descriptions of the actual client contacts
Alex: I do not think I feel like playing at all (Looking around the therapy room)
Therapist: Alex, you do not know if you want to do anything
Discussion: The therapist reflects and thinks about what Alex has said. This shows that the therapist is actually listening and is interested to hear what Alex will say. The therapist will not try to engage Alex in some of the games present in the therapy room as it is quite significant for the client that is, Alex to lead and the psychiatrist to follow.
Alex: (He continues to look around the room and walks over to the play bin and gets out some plastic play-dough. He also starts to make some cars from the plastic play-dough). Look at my nice cars!
Therapist: I see you have drawn three cars, two big ones and one small one.
Alex: These are a family of my cars (He then starts to pretend to drive them around.)
Therapist: Your family of three cars is driving around together and is close to each other. (During all this time, the therapist is keeping track of what Alex is doing and interpreting the play every time.)
Alex: (The biggest car crashes into the wall). That car was daddy’s car and it was mean and bad and that is why it has hit the wall. The car is no more! Dad should not have done that! He is mean and now the car is all gone.
Therapist: That car did not do well and it is no longer a car at all. (At this point, Alex seems to be seething with some kind of anger and he even crashes all the cars and turns them into balls of plastic play-dough. The ‘family of cars is now gone.
Alex: Now they are my bombs and I am going to blow them all up.
Therapist: All the cars that you have regarded as family have now become weapons and you want to blow up this place with them. (Therapist tracks Alex’s behavior and lets him show his all his anger.)
Alex: I am also going to blow you up. (He starts to throw the plastic play-dough at the therapist)
Therapist: I know that want to blow me up by throwing those at me. (This shows the therapists’ empathy with Alex. But you should not throw things at me and instead you can throw them at that bear). (The therapist shows Alex a cute bear in the left corner of the room).
Discussion: It is quite vital to set limits in the room when necessary. In this case, the child or client will not be able to injure himself, the therapist, destroy things or injure another person. An effective way to set limits is by first acknowledging what the client desires to do. In this situation, the therapist does this by stating, “I know that you want to blow me up with those bombs.” This certainly helps to empathize with the client and it is likely that the limit will be followed by the client. In addition to this, it is very important to communicate the limit to the client for instance, “You may not throw the bombs at me.” Lastly, give the client an alternative such as, “You may throw those at that bear over there”.
Alex: (Turns to the sitting bear and throws the ‘bombs’ at it). The bear is now all blown up. (He now shows a very big smile).
Therapist: I can see that you are now happy since the bear has been blown up. (The therapist appreciates Alex’s smile as being extremely happy and reflects this emotion in his interpretation)
Alex: The bear is still alive. (After a while, he goes and cradles the bear). He is only hurt and I do not know if he is going to die. (Alex then goes to find a bottle and pretends to give food to the bear).
Therapist: You are helping the bear because you are afraid that he will die.
Alex: He is now better so he is not going to die.
Therapist: At least you have nursed him back to health and he will be fine. (The therapist acknowledges his fear and anger that his anger can hurt some things. The therapist also acknowledges that his need to recognize that his anger will not demolish things).Alex, our time is over dear.
Alex: Just a few more minutes, I want to make sure that the bear is alright before I leave.
Therapist: That is wonderful of you and you can drop in next week to see how the bear will be doing.
The therapist gives Alex some limit if time. Alex’s feeling of not wanting to leave is empathized with the therapist and Alex is given a chance to an alternative. In this case, the therapist has adopted the non directive play therapy in an attempt to treat the patient. The therapist responded to the child in the play language by both non verbal and verbal means. This necessitates the therapist to learn the reason for the lost language of play that brings the therapy to the level of the child. However, this may prove to be a challenge to a therapist. Furthermore, play therapy can be an engaging way to approach the treatment of a child and adolescent.
CASE STUDY TWO
Albert is a fifteen year old teen who complains that he lacks the capability to maintain and develop friendships with his peers. He therefore does not have many friends and he even attributes this to their jealousy of his good grades but he also feels that this is because of his inability to make small talk with his fellow peers. His parents took him to see a therapist because he complained to them that he would like to have an easier time making friends with his peers. In addition to this, Albert told his parents that he often felt low, sometimes felt depressed and feelings of shame and guilt. Most of the things that made him feel stressed out were because he felt left out and he did not have many friends at all.
After having some small talk with Albert, the therapist comes to the conclusion that Albert has a hard time interpreting social signals and the client felt that this was the main reason for his inability to be comfortable talking with his peers. After a while, Albert would openly ask the therapist what he thought of his social skills and he even asked how the therapist felt about him and how his fellow peers might think of him. In addition to this, he would ask the therapist for his opinion on his actions and appearance and try to ask the therapist for some kind of advice on minor and major decisions. On the other hand, Albert seemed to only tolerate positive feedback from the therapist and he would show signs of agitation if he interpreted what the therapist told him as critical. Whenever he showed these sings of agitation, he prompted the therapists with questions such as “Well how would that make you feel? You have not had much experience as a psychotherapist, have you?”
Albert seems to have some kind of difficulty with being the patient or the client in the therapy-client relationship. In addition to this, he did not seem at all to tolerate the nature of the therapy and he even stated that his parents should help him look for another therapist, one that does not seem to be perfect. According to the Albert’s parents, he had some difficulty in his school’s social groups. Even though he tried joining these social groups, he often stops attending their meetings soon after as he says that he just feels uncomfortable and out of place than the other kids in the programs. Once in a social group he complained to his parents and stated, “I cannot believe that you think that I am like those other kids. They all have some kind of problems and they are even messed up somehow and I am not”. The therapist then persuaded him to join other programs and in the next session, he even stated that the kids in that program did not like him at all and that they all looked weird.
Defenses may develop during therapy and these defenses are usually used by the client against the possibility of re-experiencing again failures in the therapy that were experienced in the past. The three major defenses used by clients such as Albert are denial, projection and distortion. Projection is explained as reacting to unacceptable inner feelings as if they are happening outside a person’s body. In most cases, these unacceptable feelings are usually attributed to another person. A client with this will often feel quite uncomfortable in the therapy. Projection is clear when Albert states that the therapist does not have a lot of experience as a psychotherapist. Denial is ignoring the awareness of painful facts and it differs from projection because it ignored external reality. Albert was fast to state that some of his fellow peers looked weird and he denied the fact that he was unable to create some sort of friendship with them. Instead, it looked relatively easier for him to focus on how the other kids looked weird instead of facing his fear and trying to create small talk with them.
Towards the end of the therapy, Albert began to realize that he could be choosy with the other kids in school and he started to see that his frustration with his inability to quickly make friends was excessive in a way. Furthermore, he started to realize that he could try to make friends and that it was not hard at all. At the end of the therapy, Albert was able to make at least some few friends and this gave his ego a big boost.
CASE STUDY THREE
Amber is a sixteen year old teen who is incapable of loving anybody and has never even loved her mother even herself in her entire life. Her natural capacity to love and to return love to other people was all but abolished by her horrid childhood. In normal cases, people first practice loving first and foremost through their parents. If the parents of a person fail them and they turn out to be capricious, unpredictable, unjust and violent, the ability of a person to love can be stunted forever. In this case, this is what happened to Amber: the ideal figures of her childhood proved to be much less than best. In any child, an abusive and dysfunctional family is quite a poor ground for any child to breed health emotions and this probably explains why Amber acts in a selfish manner and does not even want to show any kind of affection to her family.
Granted, Amber is quite a manipulative and brilliant girl that she is, she perfectly knows how to absolutely emulate and simulate love. She sometimes acts very lovingly but this is usually a mere act and it should not be confused at all with the real thing that is love. Amber usually shows love to achieve things she wants such as new clothes, money and adoration from her parents. Once these goals are readily available from other quarters, she abandons her parents in a cruel and abrupt manner. In addition to this, Amber has the characteristics of a narcissistic that is, adoring, non critical, approving, submissive, approving and wide eyed. From these descriptions, Amber is a disturbed young teen who values intelligence and sometimes uses bad language to vent out her frustrations. In addition to this, Amber also states that she is quite judgmental to her classmates often without merit and hates all individuals though she may call upon them if she needs something and in such a case she is not manipulative and exploitive at all. And when she does not need anything at all, Amber does not call her ‘friends’, not even her mother. It is quite evident that in this case, all emotions are a deplorable weakness.
In Amber’s pursuit of selfish gratification, there is no place at all for any kind of hesitation as she will even do nothing for other people and nothing matters to her if it is not for herself. The result of this is that Amber often lets people down including her family and friends and even refrains in an almost religious manner from keeping any kind of obligations and promises to them.
In this case, the therapeutic goals and strategies will be: improved interpersonal relationships, try to eradicate the distressing symptoms, alter the disturbed patterns of behavior, help the client better cope with the stresses of life, facilitate further personal growth and maturation in the client. The therapist will aim to improve the relationship between Amber and her parents although it seems will be a challenging task. The therapist will consider advising Amber on how to stop appearing selfish and how to gradually learn how to love her family. When prompted by the therapist, Amber states that she sometimes acts mean to her family in an attempt to get their attention and love.
The therapist adopts the self psychology techniques as a form of psychotherapy. The process involved with this technique is the process of uncovering the underlying conflicts on the client. However, there are some limitations to this form of psychotherapy. First of all, this technique overlooks the guilt of the client, which is quite vital in the whole therapy process. This is probably due to the fact that a client’s guilt may be the cause for certain negative reactions in the course of therapy.
After several sessions with the therapists, Amber shows some significant changes in the manner in which she even interacts with different people and her family appears to be supportive of her.
Golden, L. B. (2002). Case studies in child and adolescent counseling. New York, NY: Prentice Hall