Client Presentation Year-Old Beth Presented

¶ … Client Presentation

year-old Beth presented to her school guidance counselor with several themes. The child reportedly presented with low affect, poor self-concept, and low self-esteem. Beth is said to have made comments to support these displayed characteristics. There has been additional information provided to suggest that although the minor has matriculated in the school for several years, she has found it difficult to establish and maintain friendships; and has recently suffered the loss of one of her only peer relationships at the school. Beth's peers have reportedly bullied her for attention seeking behaviors; and although the bullying was 'addressed' Beth has reportedly made minimal effort to connect with peers. Although able to connect with the school guidance counselor, Beth is said to continue to present as mistrustful and withdrawn to others. Beth is required to attend before and after school care due to her mother's employment.

Despite this presentation, the child is reported to be self-reliant, academically achieved, meticulous in her school work and appearance. Beth seems comfortable in parallel relationships with her peers as evidenced by her reading on the playground or in the library, while others are playing or engaged in activities around her. There is a parental divorce in the minor's history, some three years ago. Both parents are actively engaged in their careers and neither has re-married or re-partnered.

Although Beth presents with varied and seemingly dichotomous, much of what the minor is displaying can be viewed as the symptomology associated with the underlying issue of parental divorce. Policy makers, clinicians and parents are all concerned about how the experience of divorce affects children's adjustment (Lansford et al., 2006).

Although there are some contradictory findings in the research literature regarding how and whether divorce affects a child's adjustment, there is some general consensus that children whose parents divorce are at increased risk of a variety of negative developmental outcomes than are children whose parents remain together (Amato, 2001; Amato & Keith, 1991; Cherlin, 1999). Moreover, there are several reasons to consider why the timing of divorce will be systematically associated with individual differences in a child's trajectory of adjustment (Hetherington & Clingempeel, 1992). Some critical thought has been given as to whether or no the farther along the trajectory the divorce occurs, the less likely the divorce will have long-term effects and potentially deflect the path of the trajectory; as well as the more involved the child is outside the context of the family, the less likely it will be that the divorce will have long-term adverse effects (Allison & Furstenberg, 1989). Both arguments suggest that divorce will have more adverse effects on the adjustment of the young vs. An older child.

Empirical findings suggest that inter-parental conflict and marital discord may be a more significant predictor of adjustment problems for girls than for boys (Cummings & Davies, 1994; Davies & Windle, 1997; Unger et al., 2000; Zaslow, 1989), particularly in middle adolescence (Davies & Lindsay, 2001). Moreover, girls' greater susceptibility to divorce during adolescence is particularly likely to be manifested in elevated depressive symptomology and other difficulties in emotionality (Gore et al., 1993; McGee & Stanton, 1992; Roecker, Dubow, & Donaldson, 1996). Emery (1982) posits, girls may manifest their feelings in a way that is more appropriate to their gender role, namely, becoming withdrawn or anxious, or perhaps "very well behaved" (p. 317), introspective rumination, perceived inadequacy, and excessive worry (Gjerde, 1995).

Therapeutic Process for Initial Assessment

Beth seems to have established a trusting relationship with the school guidance counselor. As such, it might be beneficial at the beginning of the session for the child counselor to make some reference to the school counselor to help Beth to relax and feel more comfortable about talking to someone new. Before delving into the details of the referral, the child counselor may begin the assessment process by asking some close ended questions that do not require too much information being shared from Beth, as they begin to develop a rapport with each other. Also, it may be helpful if the child counselor explained to Beth that it may be necessary for her to take notes, if done by hand, or if using a recording device, to explain the purpose and secure Beth's permission, to further assist the child in becoming more comfortable with the process (Sommers-Flanagan & Sommers-Flanagan, 2004).

Beth should be allowed to freely talk about herself, particularly during the initial assessment with minimal external direction and structure, as this is one suggested way to build rapport (Rogers, 1951; Luborsky, 1984). By allowing Beth to speak openly and freely in an atmosphere "characterized by acceptance and empathy, personal growth and change can occur (Rogers, 1961). At the same time, the child counselor should practice active listening, positive reframing, as well as empathic response; ensuring that his or her body language is encouraging with an open posture (Tolan, 2003).

Theories to Inform Counselor Assessment

Theories that may serve to inform the counselor assessment are client centered (Rogerian), Strengths Based, and Cognitive Behavioral Therapy.

Tolan (2002) suggests, amongst other experts, that no one theory has to provide the totality of the contextual framework; rather, an eclectic mix determined most appropriate to meet the clients' needs and presenting problems may better serve the (134). Client-centered counseling theory was selected because it focuses on the counselor providing a therapeutic environment that fosters and promotes client growth; with the client being able to be free to discover as he or she desires and needs to. The prevailing characteristics that foster client growth such as unconditional positive regard, genuineness, acceptance, and active listening, may bode well with an 11-year-old child (Rogers, 1995).

Strengths-based counseling was selected because it focuses on what is going well in the clients' life. There are some very positive aspects about Beth that need to be acknowledged and encouraged; and she and the counselor can work together in determining past and present successes, as well as current and future challenges (Carr, 2004). Lastly, cognitive behavioral therapy was selected because it takes a systematic look at the activating event; in this case the divorce; current beliefs; Beth's low self-esteem, negative self-image, derogatory self-talk, and whether these beliefs are rational or irrational; and consequences; her feelings, what she does and her thoughts (Fall, Holden, & Marquis, 2004).

Assessment Questions for Parents

The self structure is initially developed according the injunctions and values of parents and other caregivers (Tolan, 2003). Because Beth has made self derogatory statements, "I feel like an alien," "I hate myself," it may be helpful to attempt to ascertain from the parents where these self constructs came from. "Conditions of worth are transmitted to the child, who learns that s/he is acceptable or lovable if s/he behaves, thinks and feels in certain ways (p. 4).

Beth's locus of evaluation and quite possibly some aspects of her locus of control rest outside herself, and the parents may be able to provide some insight with regard to this issue.

Moreover, Beth's symptomology seems to have parental discord and/or divorce as the underlying issue. This was not a predictable situation for her, and with unpredictability comes a sense of a lack of safety. The self structure provides the safety, as it diminishes or shuts out awareness of unpleasant experiences that make one feel unsafe (divorce) (Tolan, 2002).

Just as Beth had to be engaged in the therapeutic process, so do the parents. Rapport needs to be established so that each individual parent feels comfortable in addressing the issues that brought the child into counseling; inasmuch as addressing Beth's presenting problems will undoubtedly bring up issues and concerns for the parents. The counselor should use a mix of closed and open ended questions to effectively engage the parent's and utilize skills of active listening, empathetic response, and positive reframing.

Appropriate questions to ask Beth's parents may include:

1. Does s/he understand why Beth was referred to counseling?

2. What, if any behavioral or attitudinal changes have s/he noticed in their child?

3. What does s/he think the causes of the changes are?

4. Has there been any attempt by s/he to talk about their concerns with Beth? If so, what was her response?

5. How long were they married? When did the relationship begin to deteriorate? Was Beth exposed to any discord? How was she told about the divorce? Did or has she expressed any feelings about it?

In addition, there should also be questions about options to address the long hours Beth is separated from either parent via before and after school care.