Cole Barkley I Plan to Retain Cole

Cole Barkley

I plan to retain Cole as a client. Cole exhibits substance abuse behaviors that threaten to worsen is he does not receive effective treatment in a timely manner. Further, Cole denies that his substance abuse is detrimental and downplays it as just having fun with friends. His substance abuse includes drinking to the point of drunkenness, smoking marijuana, and taking various prescription drugs. Cole's substance abuse issues have been recognized for about a year and they reached a crux this school year when Cole was expelled from school for smoking marijuana on the campus grounds.

Cole and his sister are being raised by his grandmother as both of parents died when they were very young. Cole may have issues of abandonment, such that termination of a counseling relationship that has barely gotten underway may exacerbate those feelings in Cole. The therapeutic goals developed for Cole have not been met and it is crucial that therapy not end until Cole can point to specific, positive behavioral changes in his life that have resulted from his efforts in the counseling sessions. For the past three weeks, Cole has been attending a two sessions a week at a teen counseling center. The goal of the sessions is to determine the causes of his behavior. Although Cole has not opened up to the teen center counselor or other teens in the program -- or to me in his counseling sessions -- his attendance at school is improving. Cole's attitude, however, has not perceptibly changed.

Given the short duration of treatment compared to the seriousness of Cole's substance abuse, and the important juncture at which Cole finds himself -- following expulsion from his freshman year of high school -- continuation of his one-on-one counseling sessions is warranted. The importance of a stable counseling relationship as Cole comes to grip with the serious nature of the decisions he has made and the underlying, unresolved drivers of his behavior, Cole needs to be able to count on a relationship with a skilled adult who can help him navigate these road bumps and develop a workable plan for engaging in school and life without dependence on controlled substances.

James Hova

I plan to retain James Hova as a client. At age nine, James is already showing signs of being disengaged with school and mainstream social goals. He is being raised by his mother. James' parents are divorced and his father visits him on occasional weekends. James is disruptive in class and his attention-getting behavior may be functioning as a distraction from his poor academic performance. The adults who oversee James academic program and his homework sessions report that he is easily frustrated by schoolwork and other demanding activities. In his second year of elementary school, the disruptive behavior appears to have escalated and James rejects anything that requires academic effort.

James is participating in an after school basketball program which he enjoys and in which he is experiencing success. The after school sports program does offer a way for James to get more attention and to release some of the pent up energy he experiences, partly just because he is a nine-year-old boy and partly because he bottles up some of the frustration he feels due to his lack of success in school. He is also receiving tutoring in his schoolwork at a community center after school. The tutoring has not helped James to focus on his academic work, nor is it associated with any diminishment of his problem behavior.

James has been expressive in his counseling sessions with me and has articulated that he hates schools, just wants to hang out with friends, and always has to do things he doesn't want to do. In addition, James has expressed frustration that his mother does not understand him or his problems, and that his father is never around. James appears to be suffering from low self-esteem and his acting out behavior is a culturally accepted way to gain attention and feel more in control of his life situation.

A key need for James overall treatment plan is to determine if any learning difficulties or mental health issues are present. Because James' academic performance has steadily fallen further behind his peers with each passing year in grade school, there is good reason to suspect cognitive processing or learning disabilities. Further, although James' problem behavior appears predominantly associated with structured classroom activities and academics, his overall level of dissatisfaction is increasing. Ensuring that James receives any necessary teaching or learning supports in the foundational years of his formal education is crucial to heading off more serious problems -- of a social, psychological, or academic nature -- in the future. Because there is not a stable male relationship in the home, a secondary goal of the counseling sessions would be to assist James' mother to establish a formal "big brother" type of connection for James that could endure over this formative years. This objective seems particularly important given James' clear orientation to his male peers and the detrimental impact these associations seem to be having on his acceptance of a less-adventuresome lifestyle that requires discipline and constancy. Failing other remedies, lessons in sports that give James an edge could very well provide the motivation to work harder to do well in academics, and give James more self-confidence and a greater sense of personal success.

Natalie Dawkins

I plan to retain Natalie Dawkins as a client. Natalie is typical of many people in her age group who have lost a spouse after a long marriage. It has been two years since Natalie was widowed and she has very little progress in the interim toward dealing with her feelings of loneliness, uselessness, and depression. It is encouraging that Natalie self-referred, but beyond that initial step, she does not seem to be able to establish any additional and clear steps toward a more engaging lifestyle.

A factor that strongly influences Natalie's feeling of loneliness and disconnection is that her three grown children and five grandchildren all live out of state. Visits occur over the holidays, and more frequent contact seems difficult to transact. Just recently, Natalie has begun to meet with a social group for people over 65 years of age who have lost a spouse. The group typically meets each week to participate in planned activities. They go to the movies, take short trips to local attractions, and play card games. With only one activity a week to look forward to, Natalie finds the days in between to be a long and lonely ordeal to get through each week. Although she is encouraged by the prospect of making new friends and having some fun away from home, Natalie does not yet feel engaged with her community.