Case Study

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    • 00:00

      DR. RICH PARSONS: Hello, and welcome.I'm Dr. Rich Parsons, professor of counselor educationhere at West Chester University.And today, I'm joined by two colleagues, Dr. Matt Snyderand Dr. Lynn Zubernis.In chapter 11 of our textbook, wegive you a case, as well as a verbatimon the initial session.And what I thought would be useful is to have counselors

    • 00:21

      DR. RICH PARSONS [continued]: with different orientations, different life experience,different professional experience look at that caseand maybe share with us around two issues, the first issuebeing, did they perceive any particular special challengesif they were the counselor working with this client?And secondly, how might they approach differentlythan that presented in the case?As you may remember after reading the cases,

    • 00:42

      DR. RICH PARSONS [continued]: the is case Samantha, a four year old,is having trouble separating from her parentsin order to start her school experience.Samantha throws tantrums, is very disruptive.And the counselor in place in the bookdecides to use a behavior strategy.She decides to work with the parentsto set up a token economy to try to reinforce Samantha's

    • 01:02

      DR. RICH PARSONS [continued]: prosocial separation behaviors while at the same time,ignoring, or extinguishing, if you will, the temper tantrums.So Matt and Lynn, let's just start informallyin terms of it's a four-year-old.And I, personally, would've had troubledealing with a four-year-old.That's not the population I'm comfortable with.Did you see any special challenges-- that or othersthat you would confront working with this family

    • 01:23

      DR. RICH PARSONS [continued]: in this situation?

    • 01:24

      DR. LYNN ZUBERNIS: I think that's alwaysa challenge when you're working with a four year old,especially if that's not the primary developmental levelthat you're working with.One of the things that I think the counselor in the chapter,Miss Kim, did a really good job of was putting herselfon Samantha's level.

    • 01:39

      DR. MATT SNYDER: Mhm.

    • 01:40

      DR. LYNN ZUBERNIS: Both so that Samantha would understand her,and so that when she talked to Samantha,Samantha actually understood her goalsand what she was trying to accomplish.

    • 01:49

      DR. MATT SNYDER: Mhm.

    • 01:49

      DR. LYNN ZUBERNIS: And she went back and checked periodicallyto say to Samantha, does that makes sense to you?Do you understand?So I thought that was really sensitive to herin working with this age group.

    • 01:58

      DR. MATT SNYDER: Yeah, I agree.Coming from a cognitive behavioral perspectiveand working with lots of different population ages,one of the things that I think people discountis that we can't about thoughts, because she'sonly four-years-old.But in reality, they have thoughts.They just might be developmentallyappropriate for that age group.

    • 02:19

      DR. MATT SNYDER [continued]: So one of the challenges, I wouldthink, with just using behavioral approaches is youmight not get a real sense for whatSamantha's really worried about and the thoughts thatare going through her head.So one of the things I do is encourage parents,or if I'm talking to the clients, I say, well,

    • 02:39

      DR. MATT SNYDER [continued]: when are you most anxious?Or when is Samantha most anxious if I'm talking to the parent?And then say, ask her, what is she worried about?What thoughts are going through her head?And if we know that, then we could tie thatinto our behavioral approaches.But we can also maybe correct some misperceptions.But we do have to make sure that we're developmentallyappropriate, looking at the thoughts that

    • 03:01

      DR. MATT SNYDER [continued]: are going through a typical four-year-old's head.

    • 03:03

      DR. LYNN ZUBERNIS: And that's alsocrucial in developing rapport with Samantha.Even though this is a behavioral intervention,I think the counselor also did a good jobof establishing rapport with Samantha, as wellas with the parents.

    • 03:14

      DR. MATT SNYDER: And gaining an understanding.

    • 03:15

      DR. LYNN ZUBERNIS: Mhm, by not talking down to her,by really being very affirming and empowering,and speaking on a level that Samantha can understand.

    • 03:22

      DR. RICH PARSONS: Yeah.I want to come back to that idea of the cognitive approachor any other approach you would use here.

    • 03:27

      DR. MATT SNYDER: Mhm.

    • 03:27

      DR. RICH PARSONS: But I'm struck by whatyou said about getting down to her level.

    • 03:31

      DR. LYNN ZUBERNIS: Mhm.

    • 03:33

      DR. RICH PARSONS: If you can't-- if that's just notyour training, your experience, or your inclination,I just can't get on the floor, and I can't relate.

    • 03:39

      DR. LYNN ZUBERNIS: Well, I didn'tmean necessarily literally.I can't get on the floor.

    • 03:44

      DR. RICH PARSONS: OK, but that's a really good point,because I would think some counselorsor therapists would say, no.You should get on the floor, and youshould engage at her level physically, as well aspsychologically or cognitively.

    • 03:54

      DR. MATT SNYDER: Mhm.

    • 03:54

      DR. RICH PARSONS: And I don't know if you've ever encountereda client you just cannot connect with and what you do in thosecircumstances.So in this case, I'd have troublegetting on the floor metaphorically or in actuality,in reality.So I'd probably have to refer some of these clients.

    • 04:09

      DR. LYNN ZUBERNIS: That's what I was going to say.I think if you really can't work with someone effectivelyfor whatever reason, ethically, you do need to refer them.

    • 04:16

      DR. RICH PARSONS: Right.

    • 04:17

      DR. LYNN ZUBERNIS: But I think sometimes,people are quick to do that when they haven't tried it.

    • 04:21

      DR. RICH PARSONS: Got you.

    • 04:21

      DR. LYNN ZUBERNIS: People might say,I can't work with a four-year-old.I don't have any experience with four-year-olds.But once you spend some time with four-year-olds,you might realize it's not that differentonce you adapt your language.And you can sit in a low chair.

    • 04:35

      DR. RICH PARSONS: A low chair.You don't have to on the floor?

    • 04:36

      DR. LYNN ZUBERNIS: Right, exactly.

    • 04:38

      DR. MATT SNYDER: I agree with everything Elaine's saying,and I would take it one step further isthat you might have to change your perspective on whatcounseling is.So you might have to work more with the parents.You might have to work more with teachersor be more mindful of behavioral intervention.So in typical counseling, you mightbe able to get very present with the problem

    • 04:60

      DR. MATT SNYDER [continued]: by speaking about it with a client directlyafter it takes place.So a typical client you're like, how was your week?That kind of thing.For this particular case, it might be moreworking with the parents to say whenthis happens with Samantha, these are the stepsthat you need to take.And you might have to think of more outside of the office,

    • 05:22

      DR. MATT SNYDER [continued]: so to speak, in your intervention philosophies.I think the other thing that you have to take into account too--and Lynn could speak to this probably,as well-- is that the tantrums are a secondary gain thing.

    • 05:34

      DR. RICH PARSONS: What does that mean, secondary gain?

    • 05:36

      DR. MATT SNYDER: Second games is basicallyit might be a perfectly appropriate emotional reactionto the anxiety or the stress that the child's going through.But the parents might reinforce a specific outcome by saying,all right.Well, then you don't have to go to school today,or we won't put you on the bus.

    • 05:52

      DR. LYNN ZUBERNIS: Or if you let them hug you for five minutes.

    • 05:55

      DR. MATT SNYDER: --or everything will be OK.It can be very subtle.

    • 05:57

      DR. RICH PARSONS: So let me just stop you for a second.

    • 05:58

      DR. MATT SNYDER: Sure.

    • 05:59

      DR. RICH PARSONS: So the frustration, or the anxietythat she's feeling may naturally give form in a tantrum?

    • 06:05

      DR. MATT SNYDER: Exactly.

    • 06:06

      DR. RICH PARSONS: But then in addition, that tantrumis earning something extra.That's the secondary benefit?

    • 06:11

      DR. MATT SNYDER: And getting reinforced.

    • 06:12

      DR. RICH PARSONS: Gotcha.

    • 06:14

      DR. MATT SNYDER: And the other thingthat I talk a lot about with working with younger peopleis learning.

    • 06:19

      DR. RICH PARSONS: Right.

    • 06:20

      DR. MATT SNYDER: And again, it's a different wayto take a look at counseling.But a lot of the work I'm trying to dois have them unlearn or relearn specific outcomesand behaviors.And that's why it's important to tiethoughts, and behaviors, outcomes together.But getting back to your point.Like Lynn said, the parent picks up the child and says,

    • 06:42

      DR. MATT SNYDER [continued]: everything is going to be OK.Then the child learns that not only isthe tantrum an appropriate responseand they're not going to get in trouble, quote on quote,but that they're going to gain comfort.

    • 06:54

      DR. LYNN ZUBERNIS: Right.

    • 06:55

      DR. MATT SNYDER: And that tantrum behaviormight then generalize to the supermarket,or to going to bed, or to other times in which they might pullout the behavior as a learned experienceas in a response to a stressful situation.

    • 07:09

      DR. LYNN ZUBERNIS: And the other problem with thatis that because it's reinforced, thisgets the parent and child stuck in an escalation cycle.

    • 07:16

      DR. RICH PARSONS: Mhm, gotcha.

    • 07:18

      DR. LYNN ZUBERNIS: So the child tantrums.The parent does what the child wants.The child learns, OK.Well, if it worked well, the tantrum, this much,then if I have to keep going this much,I'm going to keep going until I get the reward that I'mlooking for.

    • 07:29

      DR. RICH PARSONS: OK.

    • 07:29

      DR. MATT SNYDER: So they get stuck.The parents and the child get stuck in this cycle, whichI was going to say is the other challenge, I think,of working with this age group is that you're rarely workingwith just a four year old.You're not just working a child.You're working with the parents.And in almost every case of separation anxiety,the parent's anxiety is also figuring into the framework.

    • 07:51

      DR. MATT SNYDER [continued]: So just working with the child without addressing the parent'sambivalence about separating from the childis going to be problematic.

    • 07:59

      DR. RICH PARSONS: Now, our counselor, Miss Kim,seemed to do two things.She focused a little bit on Samantha.She tried to interact with Samantha.And she talked about the transtheoretical model,trying to get Samantha to be more aware of what's going on.But then she clearly went outside and gauged the parentsas, for lack of a better word, cotherapist or cocounselors,and can use that behavioral model, correct?

    • 08:20

      DR. LYNN ZUBERNIS: Mhm.

    • 08:21

      DR. RICH PARSONS: Now, what you seem to be suggesting-- maybeI'm reading into it-- should it be more work donewith the parents?

    • 08:26

      DR. LYNN ZUBERNIS: Actually, I thinkthat Miss Kim did some very subtle, but very effectivework with the parents by including themin the conversation with Samanthaand by repeatedly pulling out and empowering Samanthaand saying, well, I watched you.You seemed to be having fun.And Samantha's saying, yeah.I love Louise, or I love her.

    • 08:45

      DR. RICH PARSONS: Gotcha.

    • 08:46

      DR. LYNN ZUBERNIS: The parents were sitting right there.That was as much of an intervention for the parentsas for Samantha, because their anxiety went downas they saw their daughter say, oh, yeah.I had fun.I colored with this person.So I thought that was brilliant.She relieved Samantha's anxiety, but the parent'sanxiety at the same time.And they probably didn't even realize it,but you could see it happening.

    • 09:05

      DR. RICH PARSONS: Would you guys add anything differentlyto the intervention?Would you have done anything?Again, it's a very brief description.

    • 09:12

      DR. MATT SNYDER: Right.

    • 09:12

      DR. RICH PARSONS: A lot to read into, but--

    • 09:14

      DR. MATT SNYDER: Yeah.I don't think I would have done anything differently.I think she started off well.I think the way that I think we'dbe able will be the next step, and Ithink what a good counselor would door what somebody could do in this case is to reinforcethe kind of interventions, the [INAUDIBLE],

    • 09:34

      DR. MATT SNYDER [continued]: stopping by replacing behavioral interventions,and then really make sure that like you said,that the parents can be the co-counselorsor parents, really.That's good parenting.And I think good parenting for Samantha is to go a long way--

    • 09:48

      DR. RICH PARSONS: Gotcha.

    • 09:49

      DR. MATT SNYDER: --in not only helpingextinguish those behaviors, but also,help for her to have more positive thoughts, and morepositive experiences, and keep her going down that path.

    • 10:03

      DR. LYNN ZUBERNIS: I like the factthat the replacement reinforcementfor the new behavior of not tantrumingwas directly tied into the initial problem.It was more time with the parents,more quality time with the parents.

    • 10:16

      DR. RICH PARSONS: Gotcha.

    • 10:16

      DR. LYNN ZUBERNIS: So we already knowthere's intrinsic motivation for Samantha to wantmore time with the parents.What a beautiful thing that as sheis able to say goodbye and interact with her peers,she gets more time with her parents.

    • 10:28

      DR. RICH PARSONS: That's good.

    • 10:29

      DR. LYNN ZUBERNIS: The only other thingthat I might have done is at leastin some initial assessment with the parents,find out if there's been any recent loss, or illness,or some kind of stressor going on in the family, which oftenkicks up separation anxiety.

    • 10:43

      DR. RICH PARSONS: OK.

    • 10:44

      DR. LYNN ZUBERNIS: Or an anxious temperament runs in the family,just because that's related information.

    • 10:48

      DR. MATT SNYDER: But that actually goesback to your original question whichis, depending on your theoretical take,or the way you were, that would bean example of maybe looking for deeper past experiences or--

    • 10:60

      DR. RICH PARSONS: Or family system--

    • 11:01

      DR. MATT SNYDER: Family system issues.

    • 11:03

      DR. LYNN ZUBERNIS: Yeah.

    • 11:03

      DR. MATT SNYDER: So again, I thinkthere's a lot of different ways you could go with Samantha.Obviously, this is a very solid start.But certainly, the way you case conceptualizeand how deep you can go, and depending on how long youcan see Samantha, and--

    • 11:17

      DR. LYNN ZUBERNIS: And the intervention may be the same.I think I would like that piece of information for my own--

    • 11:23

      DR. RICH PARSONS: Rule it out?

    • 11:23

      DR. LYNN ZUBERNIS: Exactly.But the intervention itself might remain behavioral.

    • 11:27

      DR. RICH PARSONS: Just as we're coming to a close, whatdawns on me is a couple things.You notice there's a lot of experience here,as well a lot of training that we've had.And you're using terms like replacement behaviors,and secondary gains, and reinforcement,and trying to find a sense of loss or trauma, caseconceptualization.There are terms that we just roll off our tongue.

    • 11:49

      DR. RICH PARSONS [continued]: Students who'll be watching this tapeare students who may be taking this book upas one of the first in their first steps in their journey.And they're probably overwhelmed and concerned aboutthat they can sit straight, and nod, and focus.So by the time you get to the end of the bookand you start reading how seasoned counselors wouldaddress in case.

    • 12:09

      DR. RICH PARSONS [continued]: They may be impressed.They may be in awe.They may be overwhelmed.

    • 12:12

      DR. MATT SNYDER: Mhm.

    • 12:13

      DR. RICH PARSONS: So from this case,is there anything in particular youthink a beginning student ought to focus on or puta highlight to, if you will?Because there's so much.Anything at all?What'd you suggest that they focus on?

    • 12:27

      DR. LYNN ZUBERNIS: I think one of the most accessible thingsin this chapter that even beginning students couldfocus on and learn a lot from is the use of languagethat the counselor uses.I think it was really, really well done,and it's something that even a beginning counselor canfocus on their language and how they interact with a client.I think that comes across.

    • 12:47

      DR. RICH PARSONS: Super.

    • 12:49

      DR. MATT SNYDER: And I would just add to that by saying,one of the things that I do and learnto do is look at behaviors, cognitions,and affect, and really try to tie everything together,but look at those three basic things,and realize that everything is done for a reason,and try to understand the reason.I think that will help you a long way to figuring out

    • 13:10

      DR. MATT SNYDER [continued]: what interventions to use, or what is the next step.

    • 13:14

      DR. RICH PARSONS: That's great.Well, I appreciate you guys sharing bothyour time and your expertise.I know it's a busy day.And I'm hoping that perhaps the professor who'sshowing this or the students who are seeing itwill take our discussion as a jumping off pointand maybe elaborate a little bit moreon how they would've approached the case.

    • 13:30

      DR. LYNN ZUBERNIS: Mhm.

    • 13:30

      DR. RICH PARSONS: So thanks.I do appreciate it.

    • 13:31

      DR. LYNN ZUBERNIS: Thank you for the opportunity.

    • 13:32

      DR. RICH PARSONS: Thank you very much.

Case Study

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Abstract

This case study of a 4-year old who has trouble separating from her parents includes a discussion of the escalation cycle, special challenges, analysis of the counselor’s decision, and what a beginning counselor/counseling student should focus on in this scenario.

Case Study

This case study of a 4-year old who has trouble separating from her parents includes a discussion of the escalation cycle, special challenges, analysis of the counselor’s decision, and what a beginning counselor/counseling student should focus on in this scenario.

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