Week 1 Discussion


COUN 6346 Child and Adolescent Counseling

Week 1 – Getting Started

NARRATOR: Marine Corps Sergeant Patrick Harris is the husband to Alice Harris, and the father to eight-year-old Sara and 16-year-old Rick. Sergeant Harris was again deployed for a third time overseas. This time, however, something is different. Alice has brought her family to counseling, because she is worried about her daughter's sadness and anxiety, and is equally worried about her son's irritability and anger outbursts. She herself is also experiencing intermittent anxiety and sadness, and is worried about her own ability to cope. For this demonstration, you will observe a counselor working individually with the three members of the Harris family, each with an adjustment issue. Typically, having a single counselor working individually with family members could result in complex confidentiality and boundary issues; an alternative approach would be family therapy. However, the purpose of these demonstrations is to focus on the specific techniques that the counselor utilizes. These techniques are based on the age and developmental differences in the way the clients experience and express their distress. To begin viewing the individual counseling sessions, select one of the clients from the photo. When you have reviewed each of the sessions, advance to the assignment using the link at the bottom of the page. [PHOTO OF THE MOTHER AND CHILDREN CHANGES TO BLACK AND WHITE. WHEN YOU MOUSE-OVER THE INDIVIDUALS IN THE PHOTO THEIR NAMES APPEAR. STUDENTS ARE INSTRUCTED TO WATCH EACH OF THE CORESPONDING VIDEOS PRIOR TO COMPLETING THE ASSIGNMENT.] ALICE Alice is a 36-year-old mother who is experiencing emotional burdens associated with her husband’s military deployment and her current interactions with her children, Rick and Sara. Alice has been married to Patrick for 18 years, with 2 years until his retirement from the military. As the session begins, the counselor has already reviewed an intake questionnaire. Be sure to watch for behaviors and dynamics that you see as unique or distinct to an adult during this brief example.

COUNSELOR: Alice, thank you for coming in and for filling out the questionnaire at the beginning. And I want to just welcome you to counseling, and to let you know that I know it takes a lot of courage and strength to come in for counseling. But before we get started, I just wanted to go over a couple of things that were on the questionnaire, but that I should also tell you one-on-one. And that is, what you say here stays here. It's private, personal information. As you read on the questionnaire, there are some limits to that. The limits have to do with protecting people, making sure that nothing dangerous might happen; abuse, if you were suicidal, those kinds of things, not that I suspect that's the case, but I am supposed to let you know that at the beginning. ALICE: Sure. COUNSELOR: OK? ALICE: Mm-hmm. COUNSELOR: So again, thanks for filling out the questionnaire. I read on there that your husband is deployed, and that one of the reasons that you've come in is that even though he's been deployed before, this time it seems like it's been a lot harder, and there are some issues with your children and also some issues with you. Is that correct? ALICE: Yes. COUNSELOR: And so you can start wherever you would like. ALICE: I just need some help coping right now. I've had some scary thoughts and ideas that I just can't get out of my head, and it's driving me crazy. And my son and I are at each other all the time. I love him-- he is a great boy, but he's just so angry. And my little girl, she seems more quiet than usual, and withdrawn from everyone. And I just don't know what to do. My family and I are looking for some help. We're just having trouble dealing with my husband's deployment this time. My husband is a career marine. We've been through many deployments before, but this one is the worst. COUNSELOR: So there's something about this one that makes it worse. And then also it sounds like you're really juggling a lot of things, and a lot of thoughts are going through your mind, and you're trying to handle your son and daughter. And even though you love your son and he's a great kid, he's a challenge right now. ALICE: Yeah. My son and I are just not getting along. He's having the worst time, and I don't know how to help him. And he makes me angry all the time. I'm also terrified that my husband won't make it back.

COUNSELOR: So if we start kind of organizing and making a list of things that we might focus on here, one definitely has to do with you and your son, and maybe helping that relationship a little bit. Can I write that down on the list? ALICE: Yeah. COUNSELOR: OK. And then another one has to do with, it sounds like, some of the fear that you're feeling inside, some of the anxiety and fear? ALICE: Absolutely. I mean, he's made it through two deployments in the desert already, but I'm just afraid his luck will run out. And I'm also worried that he might come home injured, but I'd rather have that than the alternative. COUNSELOR: A lot of those thoughts are going through your mind day-to-day, through a lot of the day; thoughts of him maybe being injured or not coming back? ALICE: Yeah. COUNSELOR: And that seems different from the time before. On previous deployments, you haven't had so much of this? ALICE: Uh-uh. COUNSELOR: What is it that feels different this time? ALICE: My son and I are just not getting along. Can we talk about how to handle my son, and discipline with him--because my husband and I always go round and round about discipline, and he's the fun guy and when he's gone-- when he's home, he wants to spend as much time with the kids as possible, and have as much fun with them as he can, which I totally understand. But then when he's gone, I'm the disciplinarian and I have to have rules and schedules for the kids, and they think I'm mean. COUNSELOR: So you get put into this role of being the disciplinarian, and that's really hard. And right now, with you and your son in particular, you want to talk about him and-- ALICE: Yeah. I can't handle everything. I mean, so I'm pushing my son to help out around the house, and the more I push him, the more he resists. And it's almost like, for him, it's all about trying to pretend everything is fine, and that he doesn't need to do anything different with his Dad gone.

COUNSELOR: Now, I'm going to ask you a hard question. And that is just, if you could, give me a specific example of maybe a time recently with your son when you tried to get him to do something, and he resisted you? I'm wondering if you can think of one? ALICE: Well, I mean, it happens every day. I tried to tell him to take out the trash last night, and he just acts all indignant and angry, like I'm asking him for something awful. And so then I get upset and I yell and I cry, and then he just refuses to talk to me. COUNSELOR: So if I were a mouse in the corner of the room, what happens is, you asked him, "Would you take out the trash?" And then he-- what exactly did he say back? ALICE: He's just like-- he just looks at me like I asked him something impossible. I forget-- some smart remark like, "I don't have to do that, that's not my job." All he cares about is himself and his sports, and if I try to get him to do something, it's impossible. COUNSELOR: That sounds really hard. ALICE: It is. And I just worry about him so much, because I know that he's hurting on the inside. And I want to be able to help him, but I don't know what to do. COUNSELOR: Yeah. And so really, two things, at least, going on there. One is you want him to cooperate and help you because there's so much to do, and on the other hand, you also want him deal with his emotions over here. ALICE: Yeah. I want him to be open and deal with it. But I'm worried he might be using drugs. COUNSELOR: So even that is going through your mind, and you're not sure. Maybe he could be using drugs, maybe there's something wrong with him. Maybe-- ALICE: I just wonder what I'm doing wrong. [CRYING] COUNSELOR: As I listen to you, Alice, I hear that you're feeling so much pressure, an enormous kind of pressure yourself. And one of the things that I think, I definitely think we need to talk about you and your son, and both how you can work to get him to be more cooperative, but also how we can help him deal with some of his emotions. And so that's important. But it's a little bit like that airplane thing, you know how the flight attendant will say to parents to put your oxygen first? And so as you talk about the enormous pressure you feel, I'm thinking maybe we should focus a bit on you first and try to help you manage this enormous stress that you're feeling. Does that sound OK then? We'll talk about you and the stress, and then we'll move to talking about your son and maybe your daughter eventually, too.

ALICE: Yeah. I just feel so sad and angry at myself. I did something stupid recently. I watched this public television special on the Walter Reed Medical Center, and all those brain-injured and amputee soldiers coming home from Iraq and Afghanistan-- I just shouldn't have watched it. Now my head's going nuts. COUNSELOR: Sure. Some of those images can get into your head-- is that? ALICE: Yeah. I mean, I talk to my husband all the time online whenever we can, just to know he's safe. And I know he's getting tired of reassuring me, and I'm even getting tired of being reassured. But it's crazy, I just-- COUNSELOR: How does that work for you when you do talk with him? It sounds like the Walter Reed special that you saw certainly got lots of anxiety and scary images in your head. And then when you do talk with him and he reassures you some, does that help calm things down a bit? ALICE: I just can't get these images out of my head. I feel like I'm going crazy. I should never have watched that show. And I'm just afraid his luck is going to run out. I'm just terrified. COUNSELOR: Feeling bad about having watched the show, getting those images stuck in your head, and worried that maybe this time, even though he's been there before and come home safely, that this time it feels like maybe his luck might run out. ALICE: Yeah, just before he can retire. The pressure I'm feeling just, it's enormous. COUNSELOR: One of the things that I would like to do to start is for us to explore what makes the pressure worse, and what makes the pressure better. In other words, what helps? And so I'm wondering, in your day-to-day life, what kinds of things do you find that help just a little bit, that maybe reduce the amount of stress or pressure that you feel? [VIDEO FADES TO BLACK AND THEN BACK TO THE BLACK AND WHITE PHOTO OF THE MOTHER AND HER TWO CHILIDREN.] RICK Rick is a 16-year-old boy who doesn’t see any value in talking to a counselor. As you watch this session, look for distinct ways in which the counselor works with Rick to help him open up about how he feels and what his thoughts are. Also, focus on how Rick describes and expresses his thoughts, feelings, and behavior.

COUNSELOR: Hey, Rick, thanks for coming back. My guess is this is probably not how you wanted to spend your time today. RICK: Hmm. Yeah. COUNSELOR: Pretty much, huh? Hey, I know-- this kind of a conflict for me-- I don't want to be the kind of guy who says, "Hey, knock off that texting," but we're doing counseling, you know, and it often-- hey, thank you. I appreciate that very much. What happened to your arm? RICK: I fell skateboarding. COUNSELOR: Yeah? So do you wear those-- you don't wear elbow pads? RICK: No. COUNSELOR: Probably just the nerd skaters whose moms make them wear those things are the ones who wear those things, huh; and helmets? I'd like to start off and let you know that what you say here stays here. It's private, personal information. If you do anything or were to say you're going to do anything dangerous, obviously, I would have to report that; probably talk to your mom, stuff like that. But otherwise-- we'll check in with your mom once in a while-- you and I are just talking privately here. I also know a little bit about you, because I spoke with your mom. And she told me that your dad has been deployed; he's been deployed before. It seems a little harder this time. She said that you're-- she said-- a great kid. And so I take that to mean she really likes you, loves you. And then she also said you do really well in school; you've adjusted to lots of changes in your life, But you seem a bit angry this time. And so that's what I know, but I'd love to hear from you about what's going on. RICK: My mom wants me to be here, I don't. This is stupid. I don't need to talk to no shrink. I can handle it all just fine. COUNSELOR: So you feel like, "I can handle this fine, I don't need to talk to no shrink." And I've got to say; talking to shrinks is kind of an odd thing. RICK: I mean, Dad is deployed again, big deal. This has just been going on for years. COUNSELOR: "It's happened before. He's been gone, he's been deployed before, it's not a big deal." That's what I hear you saying. You can handle it.

RICK: Yeah. COUNSELOR: And so you seem like, actually, the kind of guy who probably can handle things pretty well. What are you doing now to deal with the situation? RICK: I just take care of my business. This is my third school in two years; I just do what I need to do. COUNSELOR: Three schools in two years is quite a bit. What kinds of things do you do? What do you enjoy? I heard, actually, that you're a pretty good athlete. RICK: I guess, I don't know. I'm into basketball. And I try to focus on that. But, we never stay long enough anywhere for me to make any new friends before we have to move to a new base. COUNSELOR: So that's tough. What position do you play in basketball? RICK: Guard. COUNSELOR: Guard, dribble, shoot the three. RICK: I try. COUNSELOR: Yeah? Your Dad's not around, you're into basketball, you kind of take care of your business. What's it like not to have him around? RICK: I mean it sucks. I wish he could come to my games. He's never even seen one of my basketball games, and it's what I do best. COUNSELOR: So zero games. If you could imagine that he did come, what would you want it to be like? What would you hope that he saw? RICK: I mean I dominate on the court, and then when it's over, he's just grinning. He loves sports, too. We've got that in common. COUNSELOR: Yeah, so he'd be pretty proud of you. RICK: I don't why he's got to go and do this whole war thing. I mean I know it's about being a good man and doing the right thing, and I know I shouldn't be so pissed off about this, but I am anyways.

COUNSELOR: Yeah, it pretty much sucks. And I hear you saying, you know, you know you shouldn't be so pissed off. But when I think about it, I mean, here you have your dad gone and you're playing basketball, you've been in three schools in two years. I'm thinking you have plenty of good reasons to be pissed. RICK: Yeah, I'm pissed. I'm sick of it. My mom is a basket case. And she gets all whiny and cries. And I'm just-- I just hate it when she does that. COUNSELOR: Yeah, that even makes it worse. I imagine, when I think about it, that what you're saying is you miss him, you wish he wasn't gone, and then when your mom gets emotional, it even feels worse for you. It makes the whole situation worse. And that's one of the reasons that you get angry. RICK: Wouldn't you? I mean, it's all bad enough. He could get hurt, he could get killed; he could come back and never be the same. Why cry about it? It's bad enough without crying. If my mom would just stop all that shit, it would be so much better. COUNSELOR: So it's already bad enough, and it's just like when your mom gets emotional about it, that makes things all that much worse. RICK: Yeah. COUNSELOR: Well, you know, in counseling, one of the things we do-- just like we're doing now-- is that I'm just going to try to be helpful. But we'll also talk about some strategies or plans for-- maybe one thing we could focus on is how we can communicate to your mom that when she gets emotional and upset, that that actually sort of pushes buttons for you, and even makes you more pissed and makes it more difficult for you. And we might be able to figure out some ways for you guys to communicate that goes more smoothly. Does that make sense? RICK: Yeah. COUNSELOR: Is it OK if we talk about some of those kinds of things? RICK: Yeah. COUNSELOR: All right. Cool. [VIDEO FADES TO BLACK AND THEN BACK TO THE BLACK AND WHITE PHOTO OF THE MOTHER AND HER TWO CHILIDREN.] SARA

Sara is an 8-year-old girl who is unsure as to what is going on in her family. As you watch this session, look for distinct ways in which the counselor works with Sara to help her open up about how she feels and what her thoughts are. Also, focus on how Sara describes and expresses her thoughts, feelings, and behavior.

COUNSELOR: Hey Sara. I'm glad that you could come in and we could spend some time together today. I know we met before-- your mom and I and you-- just briefly, and your mom and I decided it would be nice for the two of us to spend a little bit of time together talking, drawing, getting to know each other a little bit. So thank you for being here. So one of the things that we're going to do, to start with, is just to do some drawing. And so we're both going to do a picture of our families doing something. And you can use whatever colors you want, and I'm going to draw one at the same time. SARA: OK. COUNSELOR: OK? All right. [BOTH SARA AND THE COUNSELOR USE MARKERS TO DRAW PICTURES ON PIECES OF PAPER AND CONTINUE TO COLOR THEIR PICTURES DURING THEIR ENTIRE CONVERSATION.] COUNSELOR: So I know your dad has been gone for a while now. Can I use that brown there? Thanks. How has it been at your house with your dad not home? SARA: Bad. I miss him, and I don't want him to get hurt. COUNSELOR: So it's been feeling pretty lousy, huh? Pretty bad? SARA: My brother and mom have been fighting. COUNSELOR: Yeah? So it's been bad, your dad's not home, and your mom and your brother-- and your brother is of bit older, right? SARA: Yeah.

COUNSELOR: And they've been fighting? SARA: Yeah. COUNSELOR: What kind of fights do they get in? SARA: They yell about going out late, and texting. COUNSELOR: So there's a lot of yelling going on. SARA: Yeah. COUNSELOR: I'm using a lot of yellow; kind of goes with yelling. What do you miss most about your dad? SARA: I miss playing with him. My dad is so much fun. He always plays with me when he's home. COUNSELOR: Yeah? He's a pretty fun guy? What kinds of fun things and what kinds of things you do to play together? SARA: Piggyback ride, horse, all kinds of stuff. COUNSELOR: He gives you piggyback rides? Are those the ones way up on, like, his shoulders? So you're way up in the air and he carries you around? SARA: Yeah. COUNSELOR: Well, that sounds like fun. And then horse-- you're a horse, or he's a horse? SARA: He's a horse. COUNSELOR: And then are you a horse, too? So do you both play like you're horses, and you kind of gallop around? SARA: Yeah. COUNSELOR: So he's a pretty fun, happy guy. SARA: Yeah.

COUNSELOR: I can see why you would miss him. You know, I hate it because sometimes when I'm trying to draw things; they don't come out exactly the way I want them to. This person looks like is more angry than I really wanted. I put some eyebrows on there. And who's this here? SARA: My brother. COUNSELOR: Oh, that's your brother? SARA: He's stupid. COUNSELOR: Yeah? What makes your brother especially stupid? SARA: He yells at my mom, and they fight. He's mad all the time. My mom is mad a lot, too. COUNSELOR: So they're both mad a lot but, your brother, he yells and stuff? SARA: Yeah. COUNSELOR: I notice he's got an orange thing coming out of his head. SARA: Yeah. COUNSELOR: Because he's stupid? Yeah? And he's got red hair. Does he really have-- does he have red hair? SARA: No. COUNSELOR: No? Maybe his hair is red because it's on fire because he's so angry. SARA: Yeah. COUNSELOR: I think I'm going to make one of my people have red hair, too, if that's OK. Sorry. I took several of the colors at once. If you want any colors, you just tell me, OK? I'm using them. What do you think of this one? How's that for red, spiky hair?

So when your brother and your mom, they yell at each other, what do you do? SARA: I go up into my room until it stops. COUNSELOR: Yeah? So you get away from them. SARA: Yeah. COUNSELOR: That probably sounds like a good thing, because it sounds like if they're yelling at each other, I mean who would really want to be-- who would want to hang around them, right? SARA: Yeah. COUNSELOR: So you just go to your room? SARA: Yeah. I have a sweatshirt of my dad's in my room because it smells just like him. COUNSELOR: So when you go back to your room, and your brother and your mom are yelling at each other, you hang out there. And do you hang out with your-- and you kind of snuggle with your dad's sweatshirt? SARA: Yeah. COUNSELOR: And I'm guessing-- but I don't know this for sure-- but it sounds like that might feel pretty good, it might make you feel better? SARA: Yeah. COUNSELOR: So you know what, Sara? I'm hearing some interesting things. It sounds to me like what you're saying is that you do some things to take care of yourself when your brother and your mom start fighting. So you get away from them, first of all, which sounds like a smart thing, because who wants to be around two people who are fighting? And then you also snuggle with your dad's sweatshirt because that helps you feel better. SARA: Yeah. COUNSELOR: And in counseling, one of the things we try to do is we sometimes try to-- well, we draw, and we talk, and sometimes we try to make little plans that might help things go better in your family. And so I'm impressed that you have so many smart things that you do. And I'm thinking that maybe one of the things that we can figure out

and we can work on together, but maybe also with your mom and brother, would be to help them not yell at each other so much. SARA: Yeah. COUNSELOR: Because that seems like it's really not very fun. SARA: No. COUNSELOR: No. Ooh, what's that? SARA: A cloud. COUNSELOR: Ooh, that's a funny looking cloud, very nice. So that's your stupid brother, and next to him is? SARA: My dad. COUNSELOR: Your dad. And next to him is going to be? SARA: My mom. COUNSELOR: Your mom. And she's got red hair, too. SARA: Yes. COUNSELOR: She yells a lot, too, huh? SARA: Uh-huh. COUNSELOR: And you dad and brother have very similar shoelaces. Your dad does not have an orange thing growing out his head. That's a good sign, because he's a pretty happy guy. SARA: Yeah. COUNSELOR: Big smile. [VIDEO FADES TO BLACK AND THEN BACK TO THE BLACK AND WHITE PHOTO OF THE MOTHER AND HER TWO CHILIDREN.]

ASSIGMENT After you have viewed each of the three counseling session, respond to the following prompts for this week’s assignment:

Explain two ways the counseling approach used with Sara differs from the counseling approach used with Rick and why.

Explain two ways the counseling approach used with Sara differs from the counseling approach used with Alice and why.

Explain two ways the counseling approach used with Rick differs from the counseling approach used with Alice and why.

Explain which difference you believe is the most important to consider when counseling Sara and why.

Explain which difference you believe is the most important to consider when counseling Rick and why.

Explain one way you might address one of the key differences for Sara or Rick in your counseling approach. Be specific and use examples to illustrate.