Case study methodology and applications

Therapies

Alternative Theoretical Approaches to Therapy for Drug Abuse in a Female Latina Adolescent: A Case Study

Rosa, a fourteen-year-old adolescent female of Latina heritage who usually performed incredibly well academically and in her extracurricular activities, was observed to have slipping grades and reduced interest in her other activities by her parents. This led the eighth-grader's parents to administer a drug test under the care and advisement of a pediatrician, and Rosa tested positive for recent marijuana use. The pediatrician has recommended Rosa for outpatient treatment for this instance of drug abuse, and it is up to the counselor to determine the best therapeutic theories to apply to this situation given the information at hand. Two alternative theories are outlined here, with the strengths and weaknesses of each theory in relation to Rosa's case outlined with evidence from current empirical studies.

Client Centered Therapy

The basic tenet of client centered therapy, developed in the middle of the twentieth century by psychologist Carl Rogers, is that the therapist does not lead the client to healing, but rather provides an encouraging environment wherein the client's natural tendency towards healing is allowed to fulfill its full potential (Cornelius-White 2007; Ready et al. 2010). This approach to therapy has distinct advantages and disadvantages in the case at hand, allowing total freedom of expression and self-understanding during a very formative period for Rosa yet perhaps not maintaining enough control in this crucial phase of her development.

A contemporary incarnation of Rogers' original client centered therapy with certain changes was utilized to treat a group of Vietnam veterans for post-traumatic stress disorder, and the results of this study show that such personally empowering therapeutic techniques are at least as effective as other more recently developed simulation therapies (Ready et al. 2010). More to the point, other research has shown that a person- or client-centered approach to classroom management is especially beneficial in adolescent years in terms of improving/maintaining academic performance, attendance, and graduation rates (Frelberg & Lamb 2009). This has direct implications on the appropriateness of utilizing this counseling theory with Rosa; as it has already been demonstrated as successful in large-scale settings, it appears as though it would also be appropriate in one-on-one therapy, allowing for the same self-direction in a safe environment that makes this theory so successful in the classroom.

At the same time, despite a proven efficacy in affecting behavioral outcomes in many age groups (Cornelius-White 2007), there are primary concerns regarding the health and continued success (and thus the possibility of future success) of Rosa, held by both her pediatrician and her parents. These concerns will not be addressed as directly and as quickly as might be desired by the parents, leaving Rosa vulnerable to a disruption in therapy and indeed increasing her health risks should her drug use continue. Client-centered therapy can take some time before desired outcomes are reached, and though these outcomes are generally seen as well-sustained the time issue is a definite consideration here (Ready et al. 2010).

Family Systems Therapy

Family systems therapy expressly acknowledges the fact that human beings are not truly self-contained in terms of their personality and their worldview, but rather that all individuals function within certain social networks, filling specific roles and adjusting as those that surround and influence them adjust (Wysocki et al. 2007; Eisler et al. 2005). This perspective allows for an assessment of the broader situations that clients in therapy are facing, and in the case of minors such as Rosa also permits greater inclusion of parents and other family members in the decisions and directions of therapy, to a limited degree. The benefits of including family in therapy sessions extend far beyond addressing the parents' concerns in this situation, however, and can help to identify underlying problems that led to Rosa's drug abuse and potentially provide more highly effective long-term solutions to these issues.

Adolescent females were the subject of one study that specifically examined the efficacy of family systems therapy interventions in cases of anorexia nervosa, and the efficacy of this approach compared quite favorable to other therapy techniques (Eisler et al. 2005). Especially noticeable in this study was an increased expression of emotion by all family members, leading to greater openness and a greater ability and willingness to share problems and support each other (Eisler et al. 2005). This effect would likely be highly beneficial to Rosa and her family as well, as there is almost certainly an underlying stressor that led to Rosa's drug abuse and overall decline that has not been discussed with her parents.