Counseling Sean: Therapeutic approaches for childhood abandonment trauma

¶ … Child and Adolescent Counseling

Child & Adolescent Psychology

Golden, L.B. (2002). Case Studies in Child and Adolescent Counseling

Sean

Sean's early life was exceptionally fragmented, leaving him with substantive levels of abandonment and fears regarding his well-being. The life his family led before he went to live with his grandmother was not ordered or structured. Sean did not develop the ability to make predictions about what happens in life, in games, and in the behavior of others because this area was essentially a void in his young life. Because he did not have a normal background against which to compare his life events, it was difficult for Sean to identify that he was angry with his mother for her neglect, disappointed in his father for his harshness, or devastated by the death of his grandmother.

Sean was not able to articulate the feelings he was experiencing nor was he able to detect normal life patterns adequately to trust the world. As a result, Sean dealt with unformed emotions that swept through him causing him great anxiety. In order to attempt to deal with this anxiety, he employed magical thinking, which was also a desperate effort to exact some measure of control over his life.

It does not appear that family therapy played much of a role in Sean's therapeutic plan. This may have been because the dysfunction was too great or because the parents were unwilling to participate. Regardless, the stressors in Sean's life seemed to have been left to play out causing him greater harm over the long-term. Typical approaches to child therapy were employed, such as drawing, acting out scenarios with toys, playing board games, and talking about his fears and concerns. The strategy to use board games seemed to be a particularly brilliant match because of all the typical reasons -- taking turns, following rules, predictability, making choices from available options, and the like -- but also because it underscored the need to adapt to less than favorable outcomes and turns of events. The board game could, in essence, function as a microcosm of society in which Sean learned to use his wits regarding strategic decisions and to make the best of situations he could not control. However, given his fragile ego and the presence of some ineffective ego defense strategies, Sean may have only been able to benefit from these games to a limited degree.

Though Sean was seen by the long-term therapist as not truly learning disordered. Rather his presenting behaviors appeared to result from emotional trauma. Sean did not exhibit strong emotional control. Rather, he would careen from one extreme or inappropriate emotional response to another. Certainly mood lability was an attribute Sean displayed, though not in the classic sense as the emotions he expressed certainly had a basis other than a biological trigger. Sean's overall approach to daily life was one of high levels of anxiety coupled with fearfulness. A diagnosis of situational depression could certainly be considered, and there could be some underlying learning disability. Also, the issue of when his mother began drinking is a fair question since Sean was small when he was born. It is possible that Sean shows signs of fetal alcohol syndrome, however mild, as this can present without the physical and facial abnormalities so often associated with the disorder.

Case Study #3 - Ed

The approaches used by the therapist included Adlerian psychology, Rogerian person-centered therapy, and reality therapy. The therapist also employed several projective techniques to establish rapport and to turn Ed's attention to the task-based nature of their sessions. As the therapist had hoped, eventually Ed disclosed a bit of his perspective about his life. Over the course of several sessions and various strategies, it appeared that Ed distrusted the world and was disappointed in his relationship with his father. Hostility and sarcasm were two very off-putting defense mechanisms that Ed often utilized.

The counselor worked with Ed to change his tendency to blame others when things went wrong instead of considering his part in events and circumstances. Ed relied on a hearty array of defense mechanisms that allowed him to continue making poor choices and served to alienate others to such a degree that any progress toward resolution seemed doubtful. One strategy that the counselor used to help Ed become more self-aware was the use of an Adlerian technique in which negative talk is recorded as a tally in an ongoing measure of negativity or projection. Ed found himself engaging in negative talk or employing his favorite defense mechanisms 19 times in one week. Though not an astronomical number, it may well represent only those instances when Ed actually "caught" himself in his non-preferred behaviors, which included hostility, sarcasm, denial, rationalization, and displacement in order to avoid assuming responsibility for his own actions, behaviors, and responses. School staff might assume that Ed was conduct disordered due to the severity of his behaviors when, in fact, Ed was engaged in protecting his ego and self-concept from further insults that appeared to result from his difficulty with some kinds of school work and his damaging relationship with his excessively critical and judgmental father. Person-centered therapy and reality appeared to be a good match to Ed's needs and are certainly approaches that I would have utilized in this situation.