Anna, a Caucasian female living with her paternal aunt, her aunt’s husband, grandparents, and cousins is recommended for therapy because of the confusion she feels about her living situation. Since 2014 Anna who is eight years and her five-year-old brother have been living with her aunt and uncle after they gained legal custody of them. Their biological parents exposed Anna domestic violence and drug abuse, while her aunt suspects that she may have suffered from physical abuse too. Her parents’ drug problem resulted in the family being rendered homeless on at least one occasion while Anna was still staying with them.
Issues Presented
The issues presented in Anna’s case are the basis upon which the treatment plan and interventions will be formed. Anna’s family history of depression, anxiety, ADHD, alcoholism, substance abuse, domestic violence, and suicide is a potential contributor to her prevailing situation. Monroe, Slavich & Gotlib (2014) postulated that a recent major life event, a positive family history of depression and past episodes of depression are the most powerful predictors of depression. Anna’s parents exposed her to drug abuse and domestic violence. Her mother also attempted suicide by slitting her wrists. Therefore, Anna’s family history and her exposure to the aforementioned vices within the family are issues of concern. However, her family history does not qualify as a high-risk issue since she does not have any prior psychiatric history although the exposure to violence and suspected physical abuse are issues that require careful attention.
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Anna’s presenting issue is a low self-esteem which qualifies as a high-risk problem needing consideration while developing a treatment plan and therapeutic interventions. The low self-esteem probably arises from her hearing impairment which necessitates the use of hearing aids. The aids are a likely source of self-dissatisfaction since she views herself as different from the other children because of the hearing aids. Another immediate issue of concern is her eating and sleeping disorders. For her age, these two problems can give detrimental effects both psychologically and physically. Anna’s social, language and emotional development issues are highly risky and need immediate attention.
Family and Client Strengths
Obviously, Anna’s biological parents negatively impacted on her development. Although she reached developmental milestones normally, her current situation will not be aided by her biological parents who lost her custody due to neglect. However, her guardians are caring and supportive as evidenced by their concern over her physical and mental wellbeing. The family setting consisting of her cousins and brother can also be utilized to improve her current situation. Certainly, therapy will rely on her current supportive family to create a treatment plan for Anna. Anna also portrays certain strengths that will be influential through her therapy. It is the first time that Anna is undergoing therapy while she has no prior history of psychiatric problems or substance abuse. Anna’s mother also denies abusing drugs during her pregnancy. She has a normal physical and academic development and gets along with fellow children fairly well enough.
Assessment Tools
Two main tests were applied in this assessment, Child Trauma Screening Questionnaire, and the Piers-Harris self-concept scale. The Child Trauma Screening Questionnaire offers the advantage of self-reporting where the child responds with a ‘yes’ or ‘no’ answer to ten questions (The National Child Traumatic Stress Network, n.d). Typically, the questions assess the ability of the child to react to traumatic situations after exposure to a potentially traumatic situation. A score of five and above with the ‘yes’ answer indicates a high risk for the child to develop post-traumatic stress disorder (PTSD). Anna’s score of eight before the commencement of the therapy was indicative of a high risk of developing PTSD. Piers-Harris self-concept scale is also a self-reporting tool measuring the child’s perception of her prevailing situation (ELON University, 2018). The scale not only allows for measuring of the overall score but also provides for the assessment of subsection that enabling identification of the most problematic areas. Anna has an overall score of 39 which ranks as low implying that she perceived certain factors about her negatively.
Treatment Plan
Treatment Goals
The treatment plan took a holistic approach where the biological, psychological and familial issues that have been assessed were solved. The overall goal of this treatment plan was to overturn Anna’s perception of a perfect self. This perception that she should be at her best at all times was responsible for the shy, careful and withdrawn behavior. Regarding her hearing aids which she viewed as a form of imperfection, the goal was to teach her about self-acceptance. Thus, the set goals assisted in transforming her perception such that she viewed herself in a more positive way.
Immediate Risks and Goals
Addressing the immediate risks in Anna’s case was be crucial in averting the psychological effects relating to these risks. Anna’s sleeping and eating disorders were major risks with the capability to cause an escalation of her problem such as adversely affecting her self-esteem. Sleeping disorders in children are mainly caused by the presence of distractions like television, lack of established sleeping pattern and psychological and physical discomfort (Allen, Kuhn, DeHaai & Wallace, 2013). In this case, a familial approach ensured that Anna received the necessary care in an environment that facilitated sleeping. Psychological discomfort was eliminated through bedtime stories and supportive care by the parent. The goal was to ensure that the sleeping and eating disorders were eliminated within the first four weeks. Therefore, establishing a consistent eating and sleeping schedule was vital to assisting the achievement of this goal.
Long-term Needs and Goals
Low self-esteem in Anna’s case first requires instilling of the self- acceptance perception. Certainly, the low self-esteem is a high-risk issue due to the problems associated with it, either at the time or in future. The goal, in this case, was to ensure continuous improvement in Anna’s self-esteem through the twelve weeks of therapy such that her self-esteem is boosted and achieves normalcy at the end of the treatment. Thus focusing on the client's strengths such as her academic performances and physical attributes. This approach assisted in eliminating her negative notion that others are better than her. Again, making her feel loved in every setting was vital in assisting her to boost her self-esteem. The hearing aids which are a source of dissatisfaction since they make her view herself differently needed to be converted to a source of uniqueness. The moment she began viewing herself as unique due to her hearing impairment, she gained self-acceptance thus improving her self-esteem. Since self-esteem is a high-risk issue for Anna, a periodic assessment of the impact of the treatment plan assisted in monitoring her progress.
Anna’s social, language and emotional development issues are highly risky and needed immediate attention. The gravity of these problems becomes apparent as a child continues to grow to cause other developmental problems such as maintaining relationships. These problems most likely emanate from childhood trauma through physical abuse. Additionally, low self-esteem interferes with social interaction causing slow language development. The treatment plan for low self-esteem focused on enhancing social interaction and assisting in language development. Emotional problems are related to anxiety and stress (Sowislo & Orth, 2013), therefore getting the client to open up about her fears and concerns about her living situation assisted her in overcoming the problem. The follow-up plan involved encouraging a bond with family members such that she would easily discuss her concerns with them.
Assessment
The Child Trauma Screening Questionnaire (CTSQ) and the Piers-Harris self-concept were applied in guiding the treatment plan. The CTSQ was administered at six and twelve weeks to test Anna’s risk of developing PTSD. The score in this questionnaire portrayed the impact of the treatment plan. A score of 6 at six weeks showed an improvement at developing PTSD and three at twelve weeks indicated no risk of developing PTSD. An improvement in the Piers-Harris score was also crucial in determining the success of the treatment plan at the six and twelve-week stages. A score of 47 in week six indicated an average perception of herself and 57 in week twelve depicted a highly average perception. Hence the treatment plan was successful.
Therapeutic Interventions
Alfred Adler's theory of individual psychology presents an individual as a unity of personality. Implying that the individual has the ability to shape their own concepts and come up with perceptions according to their view of various internal and external factors affecting them (Ganz, 2013). The construct of Adler’s theory perfectly fits Anna’s case, therefore, conceptualizing her situation according to Adler’s assertion is appropriate in creating interventions for her situation. He advocated for the holistic understanding of the individual as opposed to viewing him or her as a construct of independent drives. Hence, Anna’s situation is tied to her individual perceptions, therefore, interventions must focus on creating positive perceptions about her life.
The Adlerian line of thought views an individual as a system that can only be studied in the social context (Mitchell, 2018). The person’s behavior is best understood when viewed from the way they interact with the environment. Anna lives in a family setting with her guardians, brother, and cousins. Her interactions with colleagues in school also offers a perfect situation to assess her perceptions. Her feelings of self-worthlessness are due to the notion of the other in her social environment are more important than her. This perception is partly responsible for her withdrawn attitude hence the best approach was to instill a sense of self-worth. This approach was applied throughout the length of the therapy with the aim of improving her self-esteem.
Adler postulated that individual is guided towards self-realization by the forces that they interact with on a daily basis (Mitchell, 2018). Anna’s search for self-realization led her to seek perfection. As a child, her past experiences erroneously led her to a misguided sense of self-realization where she thinks that she is imperfect in her situation. She believes that her hearing impairment and her stay with her aunt are forms of imperfection. Creating a sense of self-acceptance assisted in changing the mindset of her situation as regards to the skewed search for self-realization. This technique was applied in the initial phases of the therapy to guarantee her that there was nothing wrong about her situation before embarking on other techniques of boosting her self-esteem.
Furthermore, Adler observed that individuals always drift toward significance from a young age. The search for significance is guided by a sense of belonging such that is a person fails to gain the sense of belonging, he or she feels less significant. Thus, working with Anna’s family to make her feel accepted created in her a feeling of significance. This technique went on throughout the therapy since it was tied to her self-esteem. I general, Anna’s case is that of a child who received almost the worst foundation in life leading to misconstrued perceptions of her situation. However, the therapy assisted in changing this perception and improving her self-esteem.
References
ELON University. (2018). Piers-Harris 2 Self-Concept Scale . ELON-Tests and Measures . Retrieved 9 August 2018, from
https://blogs.elon.edu/ptkids/2015/03/15/piers-harris-2-self-concept-scale/
Allen, K. D., Kuhn, B. R., DeHaai, K. A., & Wallace, D. P. (2013). Evaluation of a behavioral treatment package to reduce sleep problems in children with Angelman Syndrome. Research in developmental disabilities , 34 (1), 676-686.
Ganz, M. (2013). The Psychology of Alfred Adler: and the Development of the Child . Routledge
Mitchell, G. (2018). Alfred Adler & Adlerian Individual Psychology . Retrieved on 9 August 2018, from https://mind-development.eu/adler.html
Monroe, S. M., Slavich, G. M., & Gotlib, I. H. (2014). Life stress and family history for depression: The moderating role of past depressive episodes. Journal of psychiatric research , 49 , 90-95.
Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin , 139 (1), 213.
The National Child Traumatic Stress Network. (n.d). Child trauma screening questionnaire . NCTSN . Retrieved on 9 August 2018, from
https://www.nctsn.org/measures/child-trauma-screening-questionnaire
