Read the following case study: Case Study: Steve is an eight-year-old boy recently referred to his school social worker for counseling. His mother passed away suddenly six months ago, and the teacher reports an increase in concerning behaviors in the classroom, including wetting his pants, being distracted, and decreased social interactions with his peers. The teacher reports that Steve is not turning in homework, is consistently wearing dirty clothes, and is fidgety. Steve’s father has been contacted and he appears concerned but states, “What do you expect? His mom just died.” Steve’s father has been refusing to bring clean clothes to the school when Steve urinates his pants, and stated, “He needs to face his problems and maybe being embarrassed will stop him.” After reading the case study above, respond to the following essay. Find an article on one of the theories that identifies different evidence-based techniques than those proposed by your colleague. Discuss how these other techniques can be applied to the scenario (and a client with the selected diagnosis). Take the discussion a level deeper in terms of theoretical interventions. Requirements: Length of response: minimum 250 words APA 7th edition, 12 point, times roman Cite: minimum of 1 scholarly source Essay to Respond to: In the Elimination Disorders diagnostic class, criteria appears to be met for Enuresis, which is characterized by repeated voiding of urine into bed or clothes, whether involuntary or intentional, occurring at a clinically significant level as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic, or other important areas of functioning. Chronological age must be at least 5 years, and the behavior must not be attributable to the physiological effects of a substance or another medical condition. The frequency of Steve’s wetting is not given in the case study, but the implication is that it has occurred on multiple occasions so I am inferring here that the frequency criteria would be met. I am also inferring that Steve’s father has already pursued primary care/medical diagnosis and none has been identified. However, in Steve’s case, if I were to do a diagnostic assessment and develop a treatment plan, my primary diagnosis would be Other Specified Trauma and Stressor Related Disorder given the sudden and traumatic loss of his mother, the subsequent behavior changes, and Steve’s father’s responses, including Steve having to attend school in dirty clothes and not being brought new clothes when he does have an instance of wetting. This wetting is also developmentally highly unusual at his age, even as a grief response, and I would certainly enter the treatment process with this client with an eye towards better determining the relationship between Steve and his father, and Steve’s safety in his father’s care. I would also have questions about the relationship between Steve and his mom prior to her death, and between Steve’s mom and dad, which may further influence diagnosis and treatment once explored in therapy. Theory I would begin treatment for Steve with an immediate referral to primary care if that had not already taken place, and would request a release be signed so I can coordinate care with his pediatrician. If the pediatrician were not able to determine a medical cause, I would hope that they would refer to more specialized medical care and/or I would coordinate to support that referral, while then beginning and continuing therapy. Of the three identified theories, Gestalt seems the most appropriate for use with Steve given his age and developmental level as well as the nature of his symptoms. In researching these theories, it does not appear that brief counseling is used in grief work, given the lack of available literature addressing it’s use in that context. Grief is typically a lengthy and substantive process, and given the traumatic . “sudden” loss of his mother, a more solution-focused approach would not be indicated here. Transactional theory appears to be most beneficial for clients who are capable of thinking and communicating at a developmental level beyond where Steve can be presumed to be. Clarke (2021) states that Gestalt therapy directly addresses the use of maladaptive or unhelpful coping skills when navigating painful life experiences, and operates from an assumption that all people want to be well and to regulate themselves, but that distress can cause dysregulation in the form of heightened emotion, isolation, sickness, or other maladies and challenges. Furthermore, Shultz (2021) states that a primary concern of Gestalt therapy is “unfinished business,” that is, something which needs to be processed mentally and emotionally, that the client has not yet been able to process. Grief, and grieving a loved one who has passed away, is specifically identified as an example of unfinished business. This suggests that Gestalt therapy would be of the most benefit when treating Steve. Techniques Clarke (2021) identified Body Language as one technique within Gestalt therapy, which is utilized when the therapist notices specific nonverbal communication patterns and invites the client into curiosity about those patterns and what they may indicate about thoughts or emotions. This would be highly beneficial for Steve, because children often lack insight into the mind-body connection, and benefit from learning to read their own bodies as well as the nonverbal communication of others. Furthermore, Steve is arguably experiencing somatic symptoms of grief and stress, and learning to tune into his body and use it purposefully as a tool for self-expression may help to alleviate the somatic symptoms of grief and trauma. Another technique identified by Clarke (2021) is Creative Arts, which can be interpreted and expanded upon to meet the needs and preferences of the client, with a particular focus on the present moment and on learning to express thoughts, emotions, and even physical feelings more fully. Hill and Lineweaver (2016) concur with the use of art and art therapy techniques in the treatment of grieving children, stating that expressive arts allow children to speak in the language of play and creativity that allows them to give full voice to their experiences, thus decreasing symptoms of grief and also increasing their subjective experiences of happiness or other positive emotions. Given Steve’s young age, and his likely preference for hands-on learning and activity rather than sitting and talking, using a variety of creative arts including bibliotherapy, drawing, and play, especially sand tray or play with action figures, puppets, or other toys that could be used for storytelling and communication of experiences might be very beneficial in therapy and may help Steve to be able to express emotions or beliefs he may not yet have the words to describe. Play might also be a beneficial experience to share with Steve’s father, provided the relationship is safe and trusting, and may allow Steve’s father increased insight into Steve’s thoughts and experiences as they both process their grief, individually and together. References Clarke, J. (2021 July 31). What is Gestalt Therapy? VeryWell Mind. Ferow, A. (2019). Childhood grief and loss. European Journal of Educational Sciences, Special Edition. doi: Hill, K. E. & Lineweaver, T. T. (2016) Improving the short-term affect of grieving children through art. Art Therapy: Journal of the American Art Therapy Association 33:2. Schultz, J. (2021 July 12). Gestalt Therapy Explained: History, Definition, and Examples. Positive Psychology. https://posi
