CNL-605 Topic 6 Case Study: Rebecca Is A 15-Year-Old ✓ Solved

CNL-605 Topic 6 Case Study: Rebecca Rebecca is a 15-year-old

Rebecca is a 15-year-old Caucasian patient brought to your office for counseling by her mother. The intake documentation identifies ongoing struggles with anxiety and depression. Your initial impression is that Rebecca is a shy teenager, very much into the Goth culture. Her hair is dyed pitch black, she wears thick black mascara and eyeliner; in spite of the hot Arizona weather, she wears a long-sleeved black shirt, black jeans, and high black camo boots. Her fingernail polish is also black: all contrasting her very white skin tone.

Her mother does most of the talking; Rebecca avoids eye contact and presents disengaged. Rebecca’s mom reports that the reason they sought your services today was because “she cut again.” Her mom grabs her arm; reluctantly Rebecca pulls her sleeves up to reveal several fresh superficial scars but also multiple older scars, which span from her wrists to her elbow joints. The nonsuicidal self-injurious behaviors began approximately 2 years ago, a difficult time for Rebecca when they moved across the country for the fourth time since she started school. Rebecca explains that her dad is in the military and they move a lot. She reports that she was bullied a lot by her new peers in seventh grade and that, at that time, a girl at school taught her about cutting.

In addition to being bullied, peer pressure among the teenage girls became difficult to cope with. Some of the boys in her class were interested in her but the more dominant, established girls brought about some serious competition. They constantly found ways to prank her or to comment on her looks or weight. The same girlfriend taught her to count calories, exercise a lot, how to use laxatives, and how to purge after a large meal. She worries a lot about her weight, grades, and her looks, and about not being liked or loved by anyone.

At times, she tried cannabis and drinking alcohol to alleviate her stress—but this is rare, as her parents monitor her closely. Cutting is easier to hide…and cheaper. She insists that she has never considered taking her own life, explaining that when she cuts, the pain “outside” alleviates her pain “inside.”

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The case of Rebecca, a 15-year-old adolescent grappling with anxiety, depression, and self-injurious behavior, highlights the complexities of mental health in youth. Adolescence is a pivotal developmental stage characterized by profound changes physically, emotionally, and socially. Recognizing the indicators of distress, such as those manifested by Rebecca, is crucial in providing timely and effective interventions.

This case presents several critical issues: Rebecca's struggle with self-injurious behavior, the influence of bullying, and her coping mechanisms. Self-injury, often a coping mechanism for emotional pain, requires understanding and appropriate psychological intervention. The American Psychological Association supports the notion that self-injury is often a method to manage overwhelming emotions, and it frequently correlates with other mental health issues such as depression and anxiety (American Psychological Association, 2013).

Rebecca's history of moving frequently due to her father's military career has likely contributed to her sense of instability and lack of belonging, important factors in her mental health. Research suggests that frequent relocations in childhood can lead to difficulties in forming lasting peer relationships and can increase the risk of behavioral issues (Graham et al., 2014). For Rebecca, the transition to new schools has marked her with isolation and bullying, catalyzing her feelings of anxiety and depression.

Bullying remains a significant concern. Studies indicate that victims of bullying may develop long-term emotional and psychological issues, including low self-esteem, depression, and anxiety (Nansel et al., 2001). The impact of social comparison in adolescence, particularly among girls, is profound. Girls often face societal pressures surrounding appearance, leading to behaviors such as eating disorders and self-harm (Grabe et al., 2008). Rebecca's preoccupation with her weight and the influence of peers in encouraging harmful behaviors, like using laxatives or engaging in purging, exemplifies how peer dynamics contribute to mental health struggles.

Rebecca's engagement with self-injury, described as a mechanism to cope with internal pain, reveals a critical need for therapeutic support. Research emphasizes that adolescents may engage in self-harming behaviors as a response to emotional distress, typically with the underlying aim of self-regulation or relief from overwhelming feelings (Suyemoto, 2015). Therapeutic strategies should focus on helping Rebecca develop healthier coping mechanisms, improve emotional regulation, and address underlying issues such as low self-esteem and feelings of isolation.

Given Rebecca's situation, an integrated approach involving family therapy, individual counseling, and possibly school-based interventions would be beneficial. Family therapy can help improve communication and support systems within her household, while individual counseling can allow her to explore her feelings in a safe environment, process her trauma, and build resilience. Evidence suggests that Cognitive Behavioral Therapy (CBT) is particularly effective for adolescents dealing with anxiety and depression (Hofmann et al., 2012). It can provide Rebecca with tools to challenge her negative thoughts and develop adaptive coping strategies.

It is also crucial to involve Rebecca's school in her recovery process. Schools can offer supportive environments where staff is trained to recognize and respond to mental health concerns. Programs focusing on anti-bullying, mental health awareness, and fostering inclusivity can provide essential support for students like Rebecca who experience peer-related issues.

Lastly, parental support and understanding are foundational in recovery. Educating Rebecca's parents about the complexities of mental health, the implications of bullying, and the importance of open communication can empower them to provide a nurturing home environment. Strengthening familial bonds through shared activities and communication can alleviate some of Rebecca's feelings of isolation and boost her self-esteem.

In conclusion, Rebecca's case underscores the need for a multifaceted approach to address the interplay of anxiety, depression, bullying, and self-injurious behaviors in adolescents. Interventions should promote emotional well-being, resilience, and positive coping strategies, drawing support from both familial and school systems. By fostering a supportive environment, we can help adolescents like Rebecca to navigate their challenges and promote healthier outcomes.

References

• American Psychological Association. (2013). Understanding self-injury. Retrieved from https://www.apa.org
• Graham, E. D., & others. (2014). The effect of military family structure on adolescents' behavioral development. Journal of Adolescent Health, 55(2), 165-171.
• Grabe, S., Ward, L. M., & Hyde, J. S. (2008). The Role of the Media in Body Image Concerns Among Women: A Meta-Analysis of Experimental and Correlational Studies. Psychological Bulletin, 134(3), 460-476.
• Nansel, T. R., & others. (2001). Bullying behaviors among US youth: prevalence and association with psychosocial adjustment. Journal of the American Medical Association, 285(16), 2094-2100.
• Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Meta-Analysis. Cognitive Therapy and Research, 36(5), 427-440.
• Suyemoto, K. L. (2015). The significance of self-injury: A metaanalysis. Journal of Clinical Psychology, 71(8), 835-847.