The parents are worried about Savannah's well-being after she cut her left arm. Although the cuts were minor, the situation still managed to cause panic for the parents. This case involves an adolescent girl undergoing stress and did not know how well to deal with it. Savanah is the kind of person who values her achievements, and when it comes to academics, she has to get an A. She had a large project that her younger brother Milton destroyed, and this tipped her off her scale. She just locked herself in her room and started cutting her arm. NSSI (Non-Suicidal Self-Injury) is purposefully injuring oneself mostly through cutting. It is an indication of extreme distress. Most of the time, a person may hurt themselves so that they do not feel any emotional pain. At times NSSI occurs for one to feel control of their life.
In this case, I intend to use Cognitive Behaviour Therapy(CBT) as a theoretical orientation that will enable me to analyse the case and develop a treatment for it. CBT helps change behaviour, thought patterns and beliefs that are negative and likely to cause self-harm. People sometimes dwell on faulty thinking, leading to disturbances in behaviour and emotions. Therapy process using CBT includes questioning, thinking, decision-making, doing and making a decision again. Therapy, in this case, is a learning process which enables one to learn a new skill and alternative ways of effectively dealing with a problem or dire situation.CBT requires a therapist to be highly directive, teaching clients to change their cognitive. A collaborative relationship should be able to exit between the therapist and the client. CBT requires a therapist to indulge a client in a Socratic dialogue, which helps clients in ruling out their dysfunctional beliefs and enable the client to change their way of thinking. A therapist using CBT can apply techniques such as emotive, behavioural and cognitive (Kabir, 2017). I believe that CBT will enable Savannah to overcome her anxiety.
Dialectical Behavioural Therapy (DBT) is a kind of CBT that over the years has been successfully used to treat self-harm. DBT can be partaken in groups or individually, and it teaches one how to be mindful of their thoughts. It helps one to recognise the strong emotion triggering situations. It makes one be able to effectively communicate their feelings and overcome self-harm compulsions (Kabir, 2017). Apart from DBT, other treatments could include family therapy and group therapy. Sommers and Sommers (2007), explain that group therapy is where one can discuss their situation with others suffering from similar conditions, hence reducing loneliness and stigma that comes as a package with self-harm. They elaborate on family therapy as a means for stress management relating to life at home. In the treatment of young clients, it is often advantageous to use family therapy over individual therapy. In a case where a child has problems, a therapist is there to make the family understand how to help the child's functioning. Direct observation of family dynamics can be used to identify and address problems.
Savanah was stressed due to her project being destroyed by her brother Milton. Although this completely messed up her thoughts, it wasn't the only contributing factor to Savannah's self-harm episode. When I analyse the whole family, its set-up, and how they conduct their daily activities, it is evident that the whole family played a role in escalating things. Taking a look at Savannah, I realise that not only is she obsessed with getting straight A's, but she also has an eating disorder. She keeps exercising and weighing herself numerous times in a day to keep a calorie count. She always has to be in control. Junker, Bjorngaard and Bjerkeset (2017) were of the view that unfavourable health conditions most of the time, indicate psychological and physical symptoms in adolescents. Savanah seems to be suffering from Anorexia Nervosa, which is an eating disorder that apart from being psychological, has the potential to threaten life. Hers is the restrictive type of Anorexia Nervosa which makes her highly self-disciplined. The reason is that she restricts food quantity, calories to an extent where she cannot maintain a healthy weight. Self-starvation and the obsession to always be on top and in control could be termed as one of the underlying problems that led to her self-harm episode.
The parents, Susan and Matthew, also play a critical role in setting up Savannah's self-harm experience. Susan and Matthew have a marital conflict that emanates from their sources of finances and the roles each one of them has. Susan spends long hours at work in the computer division of a telephone company. She makes approximately four times her husband's salary. Susan is achievement-oriented. Matthew, on the other hand, runs a private business out of their home as a graphic artist. He takes care of the family and their children's daily needs. The way the roles have been placed, not forgetting that Susan is a year older than Matthew, irks Matthew, who is overly sensitive to the place he holds in his family hierarchy. This squabble the two are having could have been an underlying problem in the sense that they each are immersed in their worlds and could not see what was happening to Savannah. The parents are also perfectionists, a character trait that Savannah inherited. Being a perfectionist explains why Savannah is obsessed with over-achieving in her academics and weight loss, the cause of her anxieties.
The child, Milton, who was the ultimate blow to Savannah, is another underlying problem. Milton is described as slightly overweight and one who does not understand the word "No". Numerous cases have been laid against him at school, such as not paying attention, slapping other students, calling his teachers, names and not completing his homework. At home, he plays violent video games and pesters his neighbours. From my perspective, Milton is doing all this to seek attention from his family. He feels left out when he is the youngest member and expects to get all the attention and love. His lack of care is an underlying problem that led to Savannah's crisis.
The client, in this case, is Savanah. The main contributor to Savanah's self-harm problem is Milton, Savanah's brother, who most of the time is careless of his environment and only seems to care about himself. He is unmindful of other people's feelings and does not take no for an answer. He often misbehaves with his fellow students, teachers and even the neighbours. Her parents are also contributors because they did not pay attention to Savannah's anxieties. Milton and both parents could also be identified as clients. Milton is a client because of his constant misbehaviour and lack of regard for others as a means to seek attention. The parents are also clients because Susan, the mom, seems to have put her husband, Mathew on edge in regards to who is boss. Mathew is oversensitive about it. This has led them to have strife in their marriage, and this could harm their family in general. The family needs to be counselled as a whole. The parents need marriage counselling to resolve their conflict so as not to affect their upbringing capabilities. Only after they are on good terms, will they be able to solve their children's issues.
Each family member has a unique need. Susan craves for achievement and to be a strong independent woman. Mathew wants to be treated as the head of the family no matter how much salary he earns. His wife, being older and having a bigger salary than him, has led him to think that she might be heading the family instead of him. In my view, Milton causes trouble for everyone else, even his own family because he is seeking attention from them. The only way to get that attention according to him is through his violent acts. His mother is always working and his father though at home most of the time is busy brooding about family hierarchy. Savanah, his sister, is barely home for if its not books, its band practice or exercise and calory count. Her focus is on getting the best grades ever and not getting fat. Milton feels lonely, and no one is there for him. The family needs to work together if they are to overcome their problems, fulfil their individual needs and become united.
The family has a culture of perfectionism. They are determined in whatever they do and are result-oriented. Savannah and Susan are both overachievers. It is also mentioned both parents are perfectionists; a trait passed down to Savannah. Milton, who seems to make trouble, has a motive behind it that always produces results. He makes trouble to seek attention. Every time he misbehaves, he gets his dad's attention. This culture brought up a lot of pressure on Savannah. When it comes to gender roles, Savannah as a sister and daughter feels she should be the best at both. Milton, playing the youngest and only son, thinks that the spotlight should be on him. Susan, as a working mother feels the need to balance both worlds perfectly. Matthew expects that as the father, he should be able to provide the family with all its obligations without his wife's help. All the expectation from their respective roles made them act up the way they did. Parents became aloof of what was happening in their children's lives even though they could see. Savannah's anxieties grew with no one to guide her. Milton got worse since no one was addressing his attention; instead, everyone wanted him to change. In the end, the crisis was inevitable.
Savannah, as a teenager presumes that the society expects her to be thin and keep track of her calory count, the reason why she has anorexia, reason why she fell into the pit of self-harm. Savannah also sees the society to favour overachievers; hence her thirst for maintaining straight A's, also another contributor to her anxieties that led to self-harm. She also makes a point to be the best role model for her brother, that is why failure is not in her vocabulary, and that led to her anxieties.
As a father, Matthew feels like society expects him to be the head of the family, the one who earns more, spend more hours at work. The situation is the opposite, and it bothers him that he has to stay at home and look after the kids. His oversensitivity made him unable to see what was happening under his nose. Milton, as a child sees the society to expect that a child should be pampered and adored by the family and all the focus should be on the child. Hence, he acts recklessly if he doesn't get what he wants. Susan, being a working mother, deems the society to expect her to have everything in control but in reality, she doesn't because her husband is upset and she does not get to spend ample time with the kids. She gets immersed in thinking about this situation that she cannot see her children in dire need.
Societal systems and cultural values influence adolescents' development through peers and family. Values moderate the relationship between adolescent outcomes and the environment. In three things are to be expected: effects of parent-adolescent conflict, parental warmth, being self-reliant from the parents. Parental warmth which includes expression of fondness and praise, hugs and kisses bring about positive psychosocial results such as academic achievement and self-esteem. If parental warmth is lacking, depression, misconduct and aggression among children and adolescents are to be expected. Traditional cultures tend to be deemed parents are warmer than socially complex and industrialised cultures. Peers are associated with the misconduct of children and adolescents most of the time. A culture that encourages children to spend more time with peers than parents is likely to produce adolescents with significant misconduct than a culture that promot...
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