Question:
Write a case study demonstrating your understanding of the mental health difficulty presented.
To help you to write the case study, consider the following questions:
• what kind of ‘diagnosis’ would be most appropriate for this case? Explain why.
• Identify the predisposing, precipitating and maintaining factors at play in the case you are exploring.
• Plot this onto a case formulation model
• Use a diagram or table if appropriate
• Outline an intervention plan. What intervention would you use, with whom, and why?
There are many different ways to deal with mental disorders among children at a certain age because they differ a lot from adults in terms of their experiences in the areas of physical, mental and emotional progress of change which takes place through their natural growth and development. The children are also in the learning process of hoe to adapt, cope with and also how to relate to the world and the people around them (Kassaw K(2002). This happens in a way as each child matures at her or his own pace and this adversely affects their behavioral patterns and also their ability to deal with it. Hence for any type of mental disorder there must be a way to diagnose it so that it can consider how well the child functions at home, at school, within the family and also among his peers.
In the later paragraphs the case study of Sarah a 12 year old girl who has recently started showing a very abnormal behavior like losing interest in her friends, school work and various other leisure activities. She also has started to complain about frequent and severe headaches accompanied by aching limbs. She is feeling a sense of loss and loneliness from the time she lost her father who died two months back when he was diagnosed with a cancerous brain tumor. Sarah is facing trouble in her school as well. Her teacher complains that she is very moody and aggressive with the other children and she gets irritable and also verbally aggressive at times this is making her feel left out in class as no one in her class wants to relate to her and does not know what she is actually going through. This way she feels extremely isolated and different from her friends. This behavior of Sarah’s has worsened after the second year of her father’s death. She is losing her warm and supportive relationship that she shared with her mother and becoming distant from her in the last few months because of these qualities. Sarah also is very disappointed with the recent decision of her family who is going through severe financial crisis and is planning to sell off their family home to overcome these difficulties. Although Sarah is not showing this anger and trying to appear that she understands her mother knows that she is very angry and upset about this decision.
It must be carefully observed that the child’s behavioral patterns and how she is responding to situations. These many include symptoms like the child very often losing her temper, getting into frequent quarrels with her peer groups, often refusing to comply with adult’s requests or rules set by the teachers and school, becoming extremely irritable and annoying to the surroundings and deliberately annoying them, having various mood swings and trying to blame others for her mistakes. Usually the child becomes very angry fast and resentful in nature. Another major symptom of Sarah’s behavior is selfishness attitude which is the result of regular reactions in anger. This leads to make the child very weak in his or her personality which later is responsible in determining relationships in one’s own way. These constant fights make the child very scared and soft that they would easily get frustrated and not be co operative with others as well as with parents or teachers which in turn leads to anger and misbehavior.
There are three ways or methods to deal with the child’s anger where parents help in providing valuable assistance and also be a great help to children to understand about the three ways in which they can cope with anger. These include expressing the anger, denial and forgiveness. The area of denial is the most common method in early childhood to deal with anger and aggressiveness. The dangers which come along with this method is that it causes emotional harm to the child, the child feels sad about certain things, shame and guilt and also the way the child shows resentment towards others. The other method studies the different ways of dealing with anger which is either expressing it and also take it out in a softer way and in a more aggressive manner. In this the therapist may take into account the child who is affected to test it and further to examine these behavioral patterns. Most of the parents also usually take part so as to help in the evaluation process in which the test of the child’s anger could be completed which is related to their daughter in this case she being Sarah, and hence give therapist with all the information on the status and extent of the child’s anger. It is also useful in helping them to view the shown anger in three of the following ways that is appropriate, excessive and misdirected. Therefore it is important to analyze when they do not manage their anger from a particular hurt for example how Sarah has been hurt after the loss of her father, they may later fail in showing this resentment towards the other children or family members. Such angers may damage their friendships, interfere in how they adapt themselves to learning, cause harm to their family and relationships and also reduce their participation in any field of sports and extracurricular activities. And finally the most effective way to stop anger is by forgiveness. It is seen that most of the children need to adapt the following issues and learn mostly how to forgive as it is not about only the tolerance level but also in enabling people to express their anger. This shows that if one is weak in manner or does not have healthy relationship and it also does not mean trusting with the ones that are insensitive. Therefore most of the children are extremely happy to learn how to forgive and also how it can help them control and resolve their angry feelings.
Case formulation in nature is a more ambiguous term that is used to reflect the lack of agreement on its definition. This term includes the clinical case formulation, the diagnostic formulation and the psychodynamic formulation approach that is used for formulation of the case study. It is described as an integrative process that enables a person to understand the difficulties and interacting factors which are implicated for the development of a patient’s problems that are present. Case formulation also takes into account the strength and capacities of the child and its family which further helps in identifying the potential approaches for effective treatments and solutions. The case formulation also can be described as an explanatory type of model which introduces new and different ideas of the way to deal and remove certain options that are not fit for the model (Engel GL (1980). The formulation deals in the things which are wrong, and the reason of it going wrong and finally the solution to deal with it. Hence case formulation is very static in its nature and unfolds itself throughout the clinical process along with more information and is modified in the very formulation. There is also another socio-cultural aspect of a case formulation that has gained increased attention with the identification that culture is very often ignored or not handled in the right way through personal bias on the part of the therapist. In child psychology cultural issues play a very vital role in the styles of parenting, values and the goals of the family, the procedure of these symptoms are seen and also the attitude involved in the treatment process. The cognitive theory of Case formulation helps in examining the patient’s feelings, thoughts and also their behavioral patterns which shows from where the problem arises and what makes it arise and shows the various symptoms of the patient’s problem. Finally the connections of an incident in the child’s life are made with the centre of beliefs about oneself. Therefore the therapy of the pattern of behavior in children is a result of the reinforcements of the surrounding environments. Many of the therapists mainly focus on the way the patterns of behavior function with a result of the forces of the environment and the way they apply these behavioral principles that include classical conditioning so as to make the required alterations. These case formulations are multitheoretical in nature and make way for integration of different styles of therapy. This explains the concepts which are selected because of the way of applying it to the case and to guide individually the different treatment approaches that are given to the patient at a particular time.
The process of case formulation includes the different interviews that take place with the children as well as the parents and gather all the information and reviews of the sources. Therefore all these areas are very different in nature that depends on the age of the child, the nature of the problem that is presented and even the other related factors. Therefore in this process the child needs a balance between the limit of information and its observations made directly (Novins D, Bechtold DW, Sack WH, et al(1997). This is a vital factor for the children who have less capability to speak out about the differences that exist. The examination helps in directly observing and also assessing the functional areas of the child who requires different formulas of diagnosing the illness. The mental status examination uses various techniques that include activities that express the child, interaction and also play. Therefore this study gives information on the capabilities of the child and the way they relate to the others who are involved with them.
Predisposing factors of mental illness of a child are the areas of vulnerability that increase the different types of risks involved in presenting the problem. These include biological predisposing factors that involve constant genetic flow for affective illness and also for parental exposure to the regular fights and the losses of finance.
The factors that precipitating involves are usually considered as a typical thought of events or stressors which could be positive or negative in their nature and also that have a limited relationship with the start of these symptoms. These include psychological precipitating factors of identity, conflicts or even separation that often arise due to developmental transitions such as graduating from high school.
The maintaining factors include many different processes of the patient and his or her family or society to give a better aspect for knowing the reason of the conflicts between the parents and the child and the learning and educational needs. The families that are under the constant strain of death of a certain family member due to illness or any other reason can be maintaining to a kind of mental illness that involves anxiety and also requires great parenting skills.
To outline an intervention plan it is very important to plan, implement and evaluate an intervention particularly for someone who has never been involved in such a kind of an effort. This can be done by following a few steps like firstly how to analyze the problem at the young community and surroundings face and then recognize the participants who want to do the intervention, then identify the possible settings through which you could reach out to the intended participants, then set the goals and objectives of that intervention and finally select one or more solutions that could most appropriately address the set goals and objectives of the plan. Therefore before planning an intervention it is important to prevent violence that can be committed by children of the community. Therefore it is essential to first know what the exact problem is and this further helps in identifying who is affected by this problem and the main reason of the problem and its intervention. This also helps in developing aims for the intervention and will also provide a basis to measure the progress. Hence the information that can describe the problem can be obtained from different sources. Quantitative data is taken from different organizations and sectors and this data can help in attaining a lot of qualitative information. And this interpretation is done with many different statistics reports that are obtained through surveys and this is further analyzed and interpreted before using this information. After understanding the entire procedure of data collection it can be compared to the state and community (Connor DF (1997). This comparison will provide some information that the community leaders can give. The data collected about the society will guide the target of the decision. This group is usually specific or general in nature of the problems in the society and the available resources. Here the family experiences criteria of the various reasons of the violent behavior of the child. Therefore, it is important to develop interventions that are related to the family, parents and siblings. These interventions of the family are often carried out in the various schools and their surrounding environment (Mellman L (2003).
It is very important to understand the nature and clarity of the case study regarding children who go through a phase in life in which they are mentally affected by the problems faced by them due to a loss in the family or a sudden financial crisis that has taken place. They also contribute to the thoughts, perceptions, social pressures and also environmental stressors which are seen among the children. There is also the absence and presence of the consistency of love, core values and also self worth which in turn help in contributing in the psychological uniqueness of every human being. (Bergner RM (1998). There is not one particular aspect that is the only cause of mental disorders it is that which result from a varied set of forces that make an impact on the individuals. Therefore the different elements or factors that contribute to the cause of the illness require a lot of patience of the health experts and the family members.
Mental health professionals, school counselors, employers, and family members may struggle to understand what is wrong and how to best help. Behavioral therapies have proven useful. But they require great efforts for the child who is affected. Psychiatric medications have also proven useful, although they can be expensive and their side effects include worsening or occurrence of new psychiatric symptoms, possible addiction, slowing of growth in children, physical discomfort, circulation problems, and heart problems that can result in death.
Conclusion:
To sum up it can be said that many factors can be the cause of Sarah’s mental stability and the reason for her behavior with her family and peer group. Also it can be said that her aggressiveness nature could lead to a lot of complications for her as well as her family if it could not be taken care of in the right way. Therefore to put this entire case study into a case formulation it is very essential to know that it the role lies in making a treatment for planning up the psychology of a child (Eells TD (1997). It thus helps in synthesizing up the factors that are very complex in to the hypothesis that is the main reason of the problem. The comprehensive figures help to translate the diagnosis in to a means that is to use a therapeutic resource at a specific treatment stage. This approach is psychological and social and helps to facilitate the clinician attention to all the major parts. This process involves a complex, dynamic and on going process that involves a story that is modifiable if the information is added. The children must be look up along with the family, school, neighbors and the adult psychology is more context and it depends on multiple perspective that are taken up from a long interview. The case formulation model is not taught in extremes in the psychiatry residency program and even the GPs do not have the case formulations daily. The GPs recommend that large amount of time is spent in teaching and constructing models of formulation in supervising and case conference. Integrating multiple theories and explaining the theory can be a help in applying the formulation of the case theory. This theory explains the aspect of the models and the usage of supervision so as to make elaborative and comprehensive case formulations.
References:
Connor DF, Fisher SG. An interactional model of child and adolescent mental health clinical case formulation. Clin Child Psychol Psychiatry 1997;2(3):353–68
Bergner RM. Characteristics of optimal clinical case formulations.Am J Psychother 1998; 52(3):287–300
Eells TD, editor.Handbook of psychotherapy case formulation. New York: Guilford Press; 1997.
Engel GL. Theclinical application of the biopsychosocial model. Am J Psychiatry 1980; 137(5):535–44
Kassaw K, Gabbard GO.Creating a psychodynamic formulation from a clinical evaluation. Am J Psychiatry 2002; 159 (5):721–6.
Mellman L, Beresin E. Psychotherapy competencies: development and implementation. Acad Psychiatry 2003; 27 (3):149–53.
Novins D, Bechtold DW, Sack WH, et al. The DSM-IV outline for cultural formulation: a critical demonstration with American Indian children. J Am Acad Child Adolesc Psychiatry 1997;36: 1244–51
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