The objective of this work is to provide viable research techniques to use in order to help a child and her family. This report represents a summary of Alicia Thomas, a nine-year-old African-American 4th grader with a series of legitimate medical as well as possibly psychosomatic physiological and psychological concerns. The young lady has been specifically diagnosed as having a duodenal ulcer with the inherent gastrointestinal symptoms including vomiting and intermittent pain. The pain has been linked to increased absenteeism from school, four hospitalizations, adverse sleeplessness, nightmare experiences with detail of dismemberment and professed fears of death for herself and for her family members.
The family consisted of eight total children and an intact parental situation but of these members, there has also been a history of mental retardation, depression and one sibling who has since deceased but in life was a main care provider. There is also a history of the young lady's father being hospitalized for an extensive period of time which entailed being absent from the home and work. The parents feel that these external stresses are severe but not the root causes for Alicia's ulcer. However, the pediatrician suggested that there may have been prior symptoms of the true causes of the ulcer that the parents were either not looking for, may have overlooked or simply dismissed. The pediatrician also had the symptoms starting approximately fourteen months ago.
In my opinion, the problems diagnosed for Alicia Thomas do fall within the scope of the marriage, family and child counseling license. The main causes of her medical problems seem to stem from inherent psychosomatic symptoms and internal and familial interpretations. Basically, this was Alicia's ticket to her family's attention. Of the plethora of issue for example, night terrors could clearly be treated in therapy. The fact that depression runs in the family also needs to be addressed and may suggest that antidepressant treatment may be needed with counseling. Another situation is the overall family setting and their being overly enmeshed so I would recommend that both parents and the other family members capable of understanding the situation should also be required to seek additional counseling for two reasons: to help them deal with their own interpretations of the situation and so they can help create an atmosphere in the home that promotes recovery for the entire family. Examples include the facts that they are still sleeping together which should be considered inappropriate.
Marriage, family and child counseling would also help them establish clear familial boundaries which in turn could create a sense of individualization within the confines of the family. One very important area where counseling could be of assistance is in the area of the family facing their grief. There is no doubt that they were adversely affected by both the mental retardation as well as the loss of a son and brother. In addition, Alicia's parents could use some assistance in their ability to communicate with each other and with their children. Counseling would provide a forum for each of the members of the family to discuss their many losses, the roles of birth order and the fact that the older brother was seen as a parent.
Thus, the family qualifies under the license of counseling but any treatment should consist of a multidisciplinary health care approach in order to touch upon all aspects of the situation. A team consisting of a counselor, pediatrician and ulcer specialists as needed, as well as representation from the school so as to take advantage of any assistance that they can provide would all serve to create a more realistic recovery. Together, this team of external help and family support would be in a position to provide the medical, emotional, spiritual, psychological and physiological support the patient might need.
From the overabundance of traumatic events that she and the family have experienced, internalized and perceived as stressful, an initial physical diagnosis for Alicia could be that she has been suffering from Post Traumatic Stress Disorder. These events may include but not be limited to the deaths of her brothers, her father's hospital stay and other nuances such as being over looked in a large family setting. "PTSD is primarily an anxiety disorder and should not be confused with normal grief and adjustment after traumatic events. For most people, the emotional effects of traumatic events will tend to subside after several months. If they last longer than that then consideration should be given to diagnosing a psychiatric disorder." (Wikopedia, 2005)
The therapeutic goals would therefore be to resolve the combination of family related, physical and mental issues for this child and her family. It is important to address the Post Traumatic Stress Disorder because it impacts psychosocial functioning independent of any comorbid conditions. For example, in the case of Alicia, her symptoms include profound and pervasive problems in her daily life such as problems with interpersonal relationships at school. As noted, it is also important to counsel the entire family to create an atmosphere in the home that promotes recovery. But maybe more important would be the many boundary and communication related symptoms within the family.
A third important issue to address right away would be the physical discomfort suffered by the patient from her previously diagnosed ulcer. Her symptoms include headaches, gastrointestinal complaints, and immune system problems. In other words, her duodenal ulcers should be treated simultaneously from her pediatrician so that she can associate her physical recovery with her mental recovery. The vomiting and nausea are symptoms of the ulcer and can be medically controlled with the multi-disciplinary approach and the nightmares and sleeplessness can be controlled with various mental exercises and patterns being established. The end result will be fewer psychological and physiological symptoms that currently keep her out of school and in the hospital. In additional, as part of the multidisciplinary approach, the school can also provide additional assistance so that Alicia maintains her grades throughout the recovery period as well as providing feedback regarding the recovery.
Counseling and the quality of the therapeutic relationship directs how meaningful the interpretations will be for the client and her family. The counseling would have an objective of providing a basis for some behaviorally measurable objectives so it would be crucial to establish treatment goals and objectives that provide a sound and measurable target for recovery. "In contrast to Freud, Adler expressed the view that human behavior is holistic (nonreductive), teleological (goal-driven), and socially oriented." (Ferguson, 1989) Counseling would provide an expanded breath of knowledge that would help Alicia and the family. This help would come in the form of the best possible interventions as they pertain to reestablishing familial boundaries, readdressing roles and providing new opportunities for open and honest communication with proven efficacy. The counseling session would need to be as open to as many options as possible and later hone in those that specifically seemed to work for Alicia. "If any single fact has been established in psychotherapy research, it is that a positive relationship between patient and therapist is positively related to therapy outcome." (Yalom, 1980)
The systematic theoretical orientation that I would select for treatment for Alicia specifically would be play therapy. Play therapy is a psychoanalytic tool based on an assumption that a child's internal concerns are tied to various unconscious conflicts and all deficits can reveal themselves during play sessions. "Through their play, their verbalizations, and their relationship to the therapist, children can be helped to understand what is troubling them. A child's behavior (problematic or not) is taken to be an attempt at meaningful communication of underlying thoughts and feelings, and, through therapeutic understanding of the child's communications, resolution of problem behaviors can occur." (Annunziata, 2005)
The therapy usually incorporates parents so as to allow for a therapist to become familiar with the parents in this case would assist in the understanding how Alicia feels. It would be important to establish a methodology to understand her. The involvement with her parents would relieve a methodology for both the child and parents to create tools and strategies to help resolve issues in their home. "In psychoanalytic play therapy, the child takes the lead in producing "material" in the form of play. It is a nondirective approach in which the therapist follows the child and not vice versa." (Annunziata, 2005)
In this case, the counselor's objectives would be to understand and interpret Alicia's actions, feelings, and inner thoughts by what would be portrayed during her play sessions. As presented by Nemiroff & Annunziata in 1990, the following factors should apply and would be considered for Alicia:
how long the problem has persisted if the problem is interfering with family life if the child is experiencing significant internal distress, even though overt symptoms may be subtle if attempts have been made in the past to help the child overcome the problem how disruptive the problem is to the child's daily functioning if the problem is interfering with academic performance if the problem…