Child and Adolescent Bipolar Disorder, Essay Example

Determination of Family History

Naturally, a number of therapy sessions immediately come to mind when it comes to deciding the most appropriate and effective therapeutic intervention that will resolve the psychological problems that Jeff and his son Roger are battling with. Given the case at hand both the Cognitive Behavioral Therapy (CBT) and the Interpersonal Therapy (IPT) will be able to offer significant help, however within the context of this essay, they are considered not to be exclusively effective because of their respective limitations when it comes to maximum impact assessment (Meyer, 2004). One of such limitations associated with the cognitive behavioral therapy has to do with its absolute emphasis on thoughts as the primary driver of negative emotions and feelings. Indeed, given the case in question thoughts cannot be left out as part of the psychotherapeutic process, but it will fail to touch the human element component in contributing to the process of triggering the psychological crisis in Jeff’s family; consequently, reducing the efficacy of this strategy as a therapeutic intervention.

Taking a superficial look at the interpersonal therapy strategy, it may sound convincing because unlike the cognitive behavioral therapy it stretches to cover the real challenges that threaten the stability of any interpersonal relationship as can be seen between Jeff and his son Roger. It also explores areas that will significantly bring to fore the patient’s life history, in a way that will highlight the real hot spots in the relationship leading to the initiation of a process that will come out with corrective measures (Geller, 1997). Adopting this path alone will conceal some basic yet vital details that are necessary for the arrival of the right diagnosis and subsequent prescription of intervention measures.

Having said this therefore, does not in any way suggest that there is no ideal psychotherapeutic strategy that will work for the Jeff family. It is against this background that this paper remains convinced based on justifiable grounds that the most ideal approach is what McCullough (PhD), an authority affiliated to the Virginia Commonwealth University, described as the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) (MCullough, 2006). It is a strategy that clearly has the potency to address the various dimensions of the complexities in the Jeff family.

Suffice to state that the cardinal reason for the choice of this strategy has to do with the fact that it deals directly with the chronic depression that cuts across the family. It also proves effective in bringing to light all the mood disorders that affects both adults and teenagers as is the situation in the case of the Jeff family. It should also be noted that there is a history of bipolar syndrome which often than not has the greatest impact during puberty. Its core effects are felt during puberty because much of the mood instability that arises are the direct consequences of related interpersonal psychological anxiety and insecurity culminating into a state of interpersonal withdrawal and avoidance at the very least (Carlson, 2006).

In summing up, the main factor influencing this therapeutic strategy is that, it has the capacity to bring to light the family history and of course how that is playing into the current psychological state of the members under treatment. Of particular concern is the fact that it will reveal the intricacies of the genogram of the family. This is absolutely necessary because it is gathered from the narration that besides Jeff and Roger, Jeff’s ex-wife, who is also Roger’s mother was diagnosed of a particular psychological disorder which cannot be left out, granted the case has to be treated in the most congenial manner that it deserves.

Examining the Relationship between Jeff and Roger within the Context of the Case

For good reasons this section will begin by explicitly examining where Roger and his son Jeff stand with regards to their interpersonal relationship. A point that cannot be denied because of its usefulness to the case is that both father and son are depressed by obviously different reasons. Yet these different reasons share a common root. It is reported that Roger has on a number of occasions enquired about his mother from his father. His questions though very genuine do not seem to go down well with Jeff, this evidence in the response he gives to his curious son. The questions posed by the boy to his father clearly points to an unstable psychological state. He is perhaps craving for the affection of his mother, granted he has ever had that. Its absence coupled with the derogatory remarks about his mother from Jeff has pushed the poor boy down the path of depression. Undoubtedly, Jeff has his own fair share of depression which can be said to be chronic judging from the time period that has elapsed.

Within the above context, two possible reasons can be assigned for the state of depression that both father and son are experiencing. Both father and son are crumbling under the weight of lack of safety in their relationship. Observe that in the first instance the state of insecurity does not appear from nowhere, but it represents a historical trend of traumatizing experiences, closely followed by the bitter impact it has had on the relationships by triggering a series of unpalatable occurrences such as absolute emotional and interpersonal rejection, unfounded rigidness, needless scrutiny amongst other things. Roger, Jeff’s son is definitely suffering from the highest brunt of the negative developments. An important question to ask, is why Jeff will utterly be committed to wipe out of the mind of Roger any trace of his mother’s memory?

On this account, there is reason to believe that Roger being the main connecting rod between the past relationship between Jeff and his ex-wife is by all standards the glorious trophy of the relationship which is no more. But Jeff’s visible lack of safety is has reasons to believe that keeping Roger psychologically encapsulated to him provides the most ideal way of consolidating what has been left of the wrecked marital relationship. It explains why he will stop at nothing to achieve this objective. In relation to the case involving Jeff and Roger it is not farfetched to contend that the etiology as that kind of provides the sound breeding ground for the crisis as seen in the case history has much to do with the interpersonal relationship. The interpersonal relationship is suffering. Any therapeutic approach that fails to highlight and deal with it accordingly will definitely be culpable of failure.

Nonetheless, this case cannot be treated in isolation to the bipolar disorder history in the family genogram and especially how this can be directly or indirectly taking its toll on the teenage Roger. Identifying and extracting further information along this line will justifiably do the case some great good. Prior to doing so, it will be prudent to create a foundational orientation into the scope as well as etiology of this psychological condition. It also helps to create a distinctive correlation between the individual and remote factors gathered from the details of the family history profiling will be of relevance to the ongoing therapeutic process, both in the long or short term framework.

Bipolar disorder is a psychiatric malady that is characterized by regular or intermittent occurrence of a series of changes in the clinical optimum state of an individual’s mood (Goldstein, 2005). Depression and its related symptoms are a regular feature of individuals who have this psychiatric condition. It is known that the period of puberty is most often than not the most congenial time frame to observe the main symptoms of bipolar disorders. Available statistics indicate that close to a figure of 1 out of every 46 American adults are suffering from bipolar disorder (Kessler, 2005; Frederick, 1990). Going by this, Roger being in his teenage years can be examined to determine if he may possess any if not all the symptoms associated with the malady (Kessler, 2005). Reaching a sound clinical diagnosis for the malady is not so straightforward. There is no universally accepted list of symptoms associated with bipolar disorders, further compounded by the unavailability of laboratory chemical tests that can facilitate the arrival of a diagnosis.

According to Kessler et al 2005, bipolar disorder can also be attributed to the influence of factors that are purely genetic in nature; this is often in addition to the subtle role played by minor yet significant environmental factors. Like most psychiatric patients, individuals diagnosed of bipolar disorder are vulnerable to prejudice, rejection and stereotypical attitudes by the society (Kessler, 2005; Frederick, 1990). Jeff using derogatory words to describe his ex-wife in the process of answering Roger’s questions about his mother can be cited as a classical case in point. It cannot be said in all certainty that Jeff was indeed tongue-lashing his ex-wife as a direct consequence of the pain in their relationship or he is exhibiting a casual prejudice against his ex-wife based on her psychiatric state. Head or tail, the baseline is that his attitude towards her is expressive of the vulnerability patients of bipolar disorder are exposed to.

Implementation of the Chosen Therapeutic Strategy

This section begins by acknowledging what McCullogh (2006) describes as the need to adhere to a process that diligently ensures that barring all unforeseen circumstances the cardinal objective of the therapeutic process should be hinged on the need to create a platform that will engender a healing process in the fractured interpersonal relationship between Jeff and his son Roger, the principal characters in this discussed in this case (Carter, 2008). To achieve this, Roger and Jeff should be able to reach a common altitude that reconciles their respective perceptions and behaviors into the practical terrains of their environment leading to a translation into their fractured relationship. It should be admitted that in this case the greatest onus rests on Jeff granted this goal will be achieved. Prior to engaging in this task, it will serve the interest of the therapeutic exercise to understand some of the remote factors that have also been associated with Roger’s psychological state.

It is worth recalling from the case history that Roger is reported to have taken solace in a solitary life that is characterized by him being stuck to playing video games for several hours. A worrying part of this trend is the fact that a good number of the games he plays are highly concentrated with violence. Certainly, this has far reaching effects on the therapeutic process for the following reasons: Evidence gathered from a recent study conducted by Herman et al (2008) reveals that children who are exposed to audiovisual scenes that have a lot of violent scenes are more inclined to adopt violent attitudes that can even be carried into adulthood. Of course, this fact is not alien to behavioral scientist because of a precedence of earlier studies that proved that violent scenes in movies are not always in the best interest of children (Huesmann, 2003). It clearly points out to a potentially destructive force on the personality of the teenage Roger.

In addition to the foregoing, it is also understood from the case history that Roger has steadily deteriorated in his academic performance. Research has proven that the academic performance of a child is a product of factors that transcend beyond what takes place in the conventional classroom setting. Psychological elements play an equally important role, by dint of the fact that a stable psychological state is an impetus for positive academic output (Butler, 1987; Churchill, 1965). By the same token, a troubled state of mind will reflect in the performance of the child in the classroom, through poor grades. One thing that is sure is that, Roger’s declining performance is a recent phenomenon that is the consequence of his psychological state. Against all odds, Roger’s recent poor academic performance cannot be treated in isolation to his emotional withdrawal tendency. It is against this background that Herman (2008) was quoted as saying that,

One of the main ways children can get others to like them in school is by being good students. Children with poor academic skills may believe that they have one less method for influencing important social outcomes, which could lead to negative consequences later in life. Children’s individual differences will always exist in basic academic skills, so it is necessary to explore and emphasize other assets in students, especially those with lower academic skill relative to their peers

On this account, the guiding premise under which this paper advocates for a workable therapeutic measure is gauged by the conviction that should any positive development emerge in the relationship between Jeff and Roger, then the focus should be on the interpersonal factor in their relationship. Jeff should be encouraged to chart a progressively new path in his relationship with Roger. That means spending extra time with him, shift from dictating instructions and summoning queries as is the case with a superior and subordinate relationship pattern. Filling the emotional void in the mind of his son will inadvertently have resonating effects on his being filled inevitably. Indeed, this approach is the cradle of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) that best suits this case (McCullough, 2000, 2006).

In addition, an in-session focus will work to engineer an aura of safety that will facilitate the dissolution of associated fear stimuli that is witnessed in the character of both Jeff and Roger that has always been keeping them poles apart. This should be done with the full awareness that chronic mood depression such as the current case in question have got subtle connections with a stimuli of subconscious knowledge that both patient’s are dealing with.

References

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Carter, E.A., McGoldrick, M. (2008). The Expanded Family Life Cycle: Individual, Family, and Social Perspectives. Allyn & Bacon.

Goodwin, F.K., Jamison, K.R. (1990). Manic-Depressive Illness Ch. 7, Epidemiology. Oxford University Press.

Geller, B., Luby, J. (1997). Child and adolescent bipolar disorder: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry. 36 1168-1176.

Goldstein, T.R., Birmaher, B., Axelson, D., Ryan, N.D. (2005). History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk. Bipolar Disorder. 7 525-35

Herman K.C., Reinke, W.M., Lambert, S.F., Ialongo, N. (2008). Low academic competence in first grade as a risk factor for depressive cognitions and symptoms in middle school. Journal of Counseling Psychology; 55 (3): 400

Huesmann, L.R., Moise-Titus, J., Podolski, C., Eron, L.D. (2003). Longitudinal relations between children’s exposure to TV violence and their aggressive and violent behavior in young adulthood: 1977 – 1992. Developmental Psychology, 39 (2), 201-221.

Kessler, R.C., Chiu, W.T., Demler, O., Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiat 6: 617–27.

Keller, M.B., McCullough, J.P., Klein, D.N., Arnow, B. (2000). A Comparison of Nefazodone, the Cognitive Behavioural-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression. New England Journal of Medicine. Volume 342:1462-1470.

Meyer, S.E., Carlson, G.A., Wiggs, E.A., Martinez, P.E. (2004). A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder. Developmental Psychopathology. 16 461-76

McCullough, J.P. (2006). Treating Chronic Depression With Disciplined Personal Involvement: CBASP. Springer Press.

McCullough, J.P. (2000) Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Guilford Press.