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1989-1990 antidepressant medications were not approved for use on nine and ten-year-olds and this poor kid is put on antidepressants immediately after his father dies. Then of course the kid experiences mood swings which get worse and he is eventually diagnosed with bipolar disorder (of course no one considers that a fairly common side effect of antidepressant medications is mania). Secondly, we have a troubled young man that comes from an unstable home who is immediately tossed into grief therapy right after the death of his father. I cannot think of a more obvious way to tell a nine-year-old he is sick- that there is something wrong with the way he feels. So I guess no nine-year-old ever went through such an incident without professional help-I mean what did kids who experience tragedies do before we had professional counselors? I guess they all went crazy and then grew up as maladjusted adults. Third, the author says that grief is indistinguishable from major depression. I strongly disagree, although depressed mood is often part of grief, they are diagnostically distinct, that is why one is called bereavement and the other is depression. The author should at least read the DSM (here it would have been the DSM-II-R) if he is going to work with clients in a mental health setting. And then of course later they hospitalize the poor kid- too much.
Let's look at the description of Martin's home life before he was diagnosed with all these issues "chaotic due to his father's alcoholism and bipolar disorder" (Golden, 2002; p. 143). One is left to wonder how much of his issues were family related (a "revelation" that appears to occur to everybody after about two years of misguided treatments) and premorbid. The kid's father dies and mom decides to toss him into treatment even with all his premorbid issues? Where was the concern prior to all of this? We are also left to wonder about other potential disorders that may have complicated things such as ADHD that appear not to have been considered. Perhaps Martin's mother could have provided more attention and nurturing to him once his father died instead of shuffling him off to all these doctors (of course a little more love, attention, and care before his father died might have helped also). We will never know how a little understanding, love, and consideration would have worked for him. All in all this case is handled very poorly, but fortunately has a happy ending. This ending is more a result of Martin's resiliency than to the interventions involved.
The first issue here is the diagnosis of an adjustment disorder when the therapist acknowledges that Katie is going through some fairly normal adolescent changes/feelings. According to the DSM-IV-TR adjustment disorders are characterized by marked distress in excess of what would be expected given the nature of the stressor (American Psychiatric Association, 2000). Typically, insurance companies do not pay for V codes like relational issues, but certainly that is the real issue here. From the case study it looks like the mother could use a little therapy in addition to the family therapy. The mother is obviously projecting issues onto her daughter that result in much of the distrust and control that she exerts on her daughter. The mother does not realize this, and it would require some delicate maneuvering to get her into individual sessions, but perhaps disguising the session by bring in the wife and husband under the guise of helping them work with Katie would work. Again, many insurance companies are hesitant to compensate for marital issues, so this would need to be accomplished skillfully. It is clear that the therapist recognizes these issues, and addressing them with mother may have the effect of reducing future problems.
Having said that, the therapist in this case does a skillful job of increasing communication between Katie and her parents, especially her mother. It is important to establish that Katie is not suicidal, and this was performed early in the therapy and skillfully. Secondly, is important to help this family learn to say what they mean instead of lashing out or trying to hurt the other party. This was also…[continue]
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