Child and Adolescent Counseling Cases Mood Disorders and Self-Harm
Cases Week 7: Case 1
Salena is a 16-year-old Native American sophomore girl at a local high school. Her mother, who accompanied her to the initial session, referred her for counseling.
During the first session you spent about 25 minutes with Salena and her mother and then about 25 minutes with Salena alone. While you are interviewing Salena along with her mother, you observe they appear to have a reasonably good relationship. Her mother is worried about her and primarily attributes Salena’s symptoms to the fact they recently moved from the Indian reservation to a more urban area. She believes Salena is having trouble adjusting to the new school and neighborhood. The move was prompted by the fact that Salena’s mother is in a new romantic relationship; Salena and her mother moved in with the mother’s boyfriend. Salena’s father has not been involved in her life since she was about 6 years old.
Salena’s mother reports that Salena is often irritable and difficult at home. This irritability has increased substantially in the past 3 months. Salena basically agrees with her mother on this point. They also both agree that Salena is engaging in fewer recreational activities and reporting little enjoyment from the activities in which she participates.
During the interview Salena’s mother describes one of her major concerns, “Salena keeps talking about not really caring if she’s alive or not anymore.” Salena interrupts at this point and says “Mom, you’re making way too much of that. It’s not that big a deal.” But her mother goes on and says, “What about the other day when you said, ‘maybe if I get hit by a truck I won’t have to take that algebra test,’ what am I supposed to do when you say things like that?” Salena responded that she was just expressing her feelings about her upcoming algebra test.
Based on your time with Salena and her mother and with Salena alone, you discover she has unintentionally lost 14 pounds and reports little appetite. She also recently quit her part-time job. Her grades have been going down (from low As to low Bs and high Cs) and her attendance has been poor recently; otherwise, she has a relatively positive behavioral record at school. Salena also reports to you that she is having difficulty concentrating and that school is “boring and stupid.” Also, Salena denies using alcohol/drugs, and this seems to be valid information as it is consistent with what her mother reports. Finally, there is no evidence that Salena is suffering from any medical disorders. She has no history of any mental disorders and no trauma history.
Week 7, Case 2
Monte is a 9-year-old white male who has been referred to you by a local school. In the referral, Monte was described as exhibiting several behaviors that are very difficult to manage in the classroom. Specifically, he quickly becomes verbally aggressive toward teachers, regularly accuses them of picking on him, and he verbally insults most of the other students in his classroom. The school counselor who has worked with Monte reports that Monte comes from a very chaotic family. He has two older sisters who are often left to care for him. He complains about his sisters being mean, but other than significant parental absence, there is no evidence of abuse in the family. The school counselor further notes that she believes Monte has a tremendously low self-esteem. She says that when other students are not around, he is clingy with teachers and seems to solicit their approval. She reports that Monte was doing better in early elementary school, but over the past 2 years his behavior has generally declined. She further reports that he has difficulty concentrating and that he states things like, “School is stupid. I always get bad teachers. Things will never get better for me.” In the past year Monte has displayed a pattern of overeating, and there is some concern about him developing a weight problem. He also complains of frequent headaches and his attendance at school is poor.