Collection of Case Studies Two Case Studies from The Life Span Human Development for Helping Professionals

s by Patricia C. Broderick and Pamela Blewitt July 12th, 2009 by David Kronemyer No Comments The following two case studies are based on the book The Life Span Human Development for Helping Professionals (2006, 2nd ed.) by Patriia C. Broderick and Pamela Blewitt. There also are occasional references to The Six Stages of Parenthood by Ellen Galinsky. Case Study # 1 Chapter 4 p. 142 Synopsis of the Case Study The case study illustrates the travails of teen pregnancy and its impact on family dynamics. It is eerily prescient of the recent contretemps involving Sarah Palin, the (former) governor of Alaska; her daughter Bristol; Bristols child, Tripp; and Tripps father, Levi Johnston. Teen pregnancy is a serious problem. A recent study shows that after improvement in the 1990s and early 2000s positive sexual behavioral change related to teen pregnancy has stalled or even reversed. Recent behavioral trends portend stagnant or even rising teen birth and pregnancy rates through 2008, Santelli, J., Lindberg, L., Dias, D. & Orr, M. (2009), Changing Behavior Risk for Teen Pregnancy in the United Stat es, 1991 2007. J. Adolescent Health, 44(2), S44 S49. Simultaneously Federal, state and local governments spend hundreds of millions of dollars on abstinence programs that require highly specific characteristics in order to contribute to the reduction of its incidence, Kirby, D. & Laris, B. (2009), Effective Curriculum -Based Sex and STD/HIV Education Programs for Adolescents. Child Development Perspectives, 3(1), 21 29. In the case study the daughter Angela (age 17) recently gave birth to Adam (age 11 months). They live with Angelas mother Sarah (age not given). Sarah has another child David (age 13). Sarahs husband (Angelas father) is absent, as is Adams father (Wayne). Angela has dropped out of high school and is having difficulty caring for Adam. She does not believe Sarah is giving her a required degree of support. Reciprocally Sarah believes Angela is not doing enough to help herself. Three theorists are important to assessing the case study, who are: Erikson; Bowlby; and Winnicott. (1) Erikson theorized that as humans age they undergo stages of psychosocial development. Successfully completing a prior phase is a condition precedent to transitioning into a subsequent one. Without having done so ones development is arrested. Each stage is ch aracterized by an antinomy, which presents the key issues that must be resolved. It also is characterized by a life-stage virtue, which is the outcome when this occurs successfully. Adam presently is at Eriksons infant stage. The challenges it presents are basic trust versus mistrust of primary caregivers. The child must have confidence that caregivers are reliable and will respond to her/his needs. When successfully resolved this stage results in hope. (2) Bowlby developed attachment theory. As the child separates from her/his primary caregiver, she/he goes through several stages of separation anxiety, which are: (a) the protest stage; (b) despair; and (c) detachment. During this process children and their caregivers develop different attachment styles based on the nature and quality of their interactions. They are crucial determiners of the childs subsequent psycho-social development. Based on research into mother-child dynamics Bowlby and his colleagues concluded there are four primary attachment styles, which are: secure; avoidant; ambivalent; and disorganized. (3) Winnicott was a key exponent of object relations theory. Object relations theory hypothesizes that inadequacies in ones relationships with primary care givers at an early phas e of life influences ones subsequent interpersonal relationships. This has several outcomes, which are: (a) splitting what happens when the child attempts to resolve the ambiguity presented by objects, which are somewhat good and somewhat bad. The mothers breast for example is a good object when it is available but becomes a bad object when it is not, even though it is one and the same thing. (b) the paranoid/schizoid position, which is what happens to the child after undergoing the splitting pr ocess. (c) the child also is vulnerable to the depressive position, which is the fear that the primary caregiver

(e.g. the mother) will retaliate by making the object (the breast) unavailable. (d) throughout the child experiences phantasies, which comprise its inner mental life. Key Developmental Issues of the Subject Child There actually are three children in the case study: Adam, Angela and David. The chapter on which the Case Study is based considers only Adam so I will do likewise. Adam faces significant developmental issues. These include: 1. Learning how to develop a repertoire of emotional styles and to deploy emotions as they occur to achieve real-world objectives (e.g. getting fed). This does not have to be (and most likely is not) a conscious process but rather a consequence of facile infant-mother emotional interactions. 2. Developing techniques to regulate and manage emotions and express an emotional response that is appropriate to a given social situation (e.g. associating the cessation of crying with receiving positive maternal attention such as the breast or being held). 3. Inducing Angela to supply sufficient contact and interaction with him by using expressive neonate behaviors to elicit nurturing care and attention. This particularly is important given Angelas depressive condition. 4. Unconsciously modulating his innate temperament in order to respond to Angelas mood and coping styles with the goal of facilitating a bonding experience. 5. Making sense of the world in the absence of adequate maternal cues. 6. Constructing a working model of himself and the world and evolving a secure attachment style, as hypothesized by Bowlby. 7. Successfully navigating the first stage of childhood development and establish a condition of basic trust and hope, as hypothesized by Erikson. 8. Devising a successful means of relating to Angela as whole object, as hypothesized by Winnicott. Answers to Discussion Questions QUESTION: Comment on the quality of the attachment relationship between Angela and Adam and between Sarah and Angela. Do you think that Adam is at risk for developmental problems? Discuss. ANSWER: (1) The quality of the attachment relationship between Angela and Adam is poor and Adam is at risk for developmental problems. It is unlikely Adam will develop adequate object relationships with Angela, his mother. It also is unlikely Adam will be able to replace the (absence of) his mothers affection with satisfactory object relations with some other caregiver. This impasse and lack of resolution will precipitate developmental issues (1) (8) identified above. From Bowlbys perspective I would characterize Adams attachment style with Angela as anxious -ambivalent. Adam cries and exhibits other signs of distress when separated from Angela, which shows he is insecurely attached. Reciprocally Angela does little to alleviate Adams condition with a more loving (or at least consistent) parenting approach. (2) The quality of the attachment relationship between Sarah and Angela also is poor. As characterized by Erikson, Angela is at the development stage of being a teenager. The two antinomies that characterize this stage are identity versus role confusion. Angela is unable to resolve the basic existential issues characteristic of this stage suc h as who am I, where do I belong and what do I want to do with my life? Simply put it is too early for her to be a mother, which at the least would involve progressing to the next state of young adulthood. She cant negotiate her own ways of being; she struggles with her personal identity; she and Wayne simply are enmeshed and constantly impinge on one another because they havent successfully completed predecessor life stages and arent yet ready for subsequent ones. She does not have a meaningful relationship with Wayne.

As observed by Galinsky (p. 63), Angela may not even feel as if Adam is her baby, or that she is a parent. The entire situation may seem unreal as she yearns for a return to a normal teenage life style. She may feel tension in her simultaneous roles as daughter versus mother and resentment at Sarahs efforts to help her raise Adam. Sarahs intervention (whether intended in good faith or otherwise) in turn may have lulled Angela into a role of indifference or learned helplessness, exacerbating Sarahs perception and frustration that Angela is not doing enough to help take care of Adam. At the same time Sarah is in the mid-life phase of generativity v. stagnation. Her life is organized by failure, not accomplishment. She is not satisfied with who she is or what she has become. She still has to care for David (Angelas brother). She doubts Angela can adequately care for Adam. She is not sure if she is a mother (vis--vis Angela) or a grandmother (vis--vis Adam). Because she cannot adequately resolve these issues she is unable to assist Angela, her daughter, who is part of a younger generation. As a result she experiences stagnation. QUESTION: Using the model of intergenerational transmission of attachment presented in this chapter, discuss the transmission sequence as it applies in this case. ANSWER: (1) Intergenerational transmission of attachment refers to similarities and differences in attachment style between parents and their children, in particularly, between young female adults and their mothers. The mothers adult attachment organization is highly related to the daughters attachment organization (though not so much the fathers). For example if the mother has a high degree of discomfort with physical and emotional closeness in a romantic relationship then it is likely the daughter will also. Mothers avoidance predicts daughters avoidance. (2) The transmission sequence as it applies in this case is as follows. Sarahs husband is absent from the scene, as is Wayne, Adams father. It seems highly likely that one of the main reasons for Sarahs disapproval of Wayne is the failure of her own romantic relationship with her husband. Factors like divorce, separation or estrangement are high predictors of avoidance. Sarah in turn has projected this onto Angela, whose relationship with Wayne at best can be characterized as indifferent. In this way Sarahs attachment style has been transmitted to Angela, who most likely also in time will transmit it to Adam. QUESTION: What kinds of interventions could you suggest to help the members of this family? ANSWER: I would recommend the following therapeutic interventions. (1) Angela should attend a parenting class so she can learn and rehearse better techniques and styles for relating to and dealing with Adam. (2) Angela and Sarah also need to devise, implement and sustain a strategy to keep Wayne (Adams father) involved as an active father -figure in Adams emotional development. Galinsky (p. 75) observes that paternal involvement is crucial to the development of satisfactory infant attachment relationships. (3) Sarah requires psycho-dynamic therapy. In this she could explore her early attachment relationships to her parents, issues in her relationship with her (absent) husband (Angelas father), and strategies for coping with the real-world situations in which she finds herself. (4) I also would recommend mother-daughter counseling for Sarah and Angela. This could explore (a) Angelas early attachment relationships, if not with Sarah, then with other primary caregivers; and (b) Sarahs and Angelas subsequent patterns of attachment and interactions with a view towards discerning how they have affected Sarahs relationship with Angela and the risk it will be intergenerationally continued from Angela to Adam. Case Study # 2 Chapter 7 p. 240 Synopsis of the Case Study Kevin is in the fifth grade, which would make him approximately 11 years old. Although intelligent and athletic he also is disruptive in class. He does not devote attention, energy or effort to homework assignments because he knows just enough to coast through without expending resources to understand the material. He is popular with other students and coalesces their behavior and activities, which (because of Kevins own orientation) tend to have negative outcomes. Kevins parents do not acknowledge there is a problem. They believe their job is to support their son, not the school administration. Matters came to a head when the school principal revoked Kevins participation in an

extracurricular field trip. His parents appealed to the school superintendent, which reversed the principals decision. As with the previous case study the theories of Erikson are crucial to understanding this childs predicament. Erikson had an epigenetic theory of passages through various stages of life. He believed that at each stage the ego faced an identity crisis as it attempted to resolve competing pulls between individual and social needs. He termed these ego syntonic and ego dystonic. The identity crisis (or psychosocial crisis) is a period of intense focus for the ego to resolve the syntonic/dystonic functions between individual and social needs. Resolution involves achieving a synthesis between the two, which Erikson termed an ego strength. Successful resolution of prior phases is necessary to confront the current stage. Kevin is in what Erikson termed the stage of industry versus inferiority. By this he means the child is reality-testing with a view towards discerning personal boundaries. She/he is observing the behavior of contemporaries. She he is learning to ascribe predicates to herself/himself such as I am smart, I am well-liked, etc. Doing so leads to the development of a theory of mind how do my counterparts think, do they think like me, what motivates them to act the way they do. The consequence of this is a concept of self and self-worth, i.e. this is how I think, this is why I act the way I do. Since the child is of school age and most likely attend ing school, most of this occurs in the classroom. As such it is dependent upon satisfactory interactions with teachers who now substitute for parents as primary care-givers. The child demonstrates industry if and to the extent it successfully negotiates world- and socially-imposed constraints in order to develop the positive self-construals outlined. The child demonstrates inferiority if and to the extent it cant. Industry versus inferiority resolve in the ego strength of competence, which the child needs in order to progress successfully to Eriksons next phase of being a teenager. Key Developmental Issues of the Subject Child 1. Distinguishing the boundaries of his personal space where it stops and where it starts, how it has the potential to impinge on that of other contemporaries. 2. Achieving a basic theory of causation in the sense that if I do x, then y most surely will follow, and applying this to his own behavior. 3. Learning what ascriptive predicates typically are applied to his beha vior, e.g. hes a good boy, hes a bad boy, and learning how to modulate his behavior in order to maximize the likelihood that positive predicates will be ascribed, leading to reinforcing outcomes. 4. Learning to modulate and regulate basic emotions (such as shyness, popularity, competency, assertiveness, effortfulness) and deploy them in social situations. 5. Developing a theory of mind that facilitates attribution of intentions to others, e.g. Im thinking this way, I wonder what she/hes thinking, given the same set of circumstances. This also will enable him to interpret others actions and behaviors in light of how he perceives their intentions, and compare them to his own intentions and actions. 6. Developing satisfactory peer-group interactions and learning how to be fair to other students. 7. Developing competence in basic academic subjects and showing/demonstrating enthusiasm for them so as to maximize the likelihood of successful interactions with teacher and receipt of positive, reinforcing feedback. 8. Coming to terms with any gender, racial or ethnic differences. If hes in a majority on any dimension, learning how to interact successfully with those who are off axis. 9. Acquiring a positive self-image and self-concept to serve as a foundation for later personal growth and development. 10. Developing a sense of right and wrong elements of morality and the emergence of a moral self.

11. Distinguishing pro-social behavior from anti-social behavior; acquiring strategies for engaging in the former, not the latter. 12. Developing a self-schema that successfully integrates all of the developmental concerns expressed to this point. 13. Successfully navigating the fourth stage of childhood development and establish a condition of industry and competence, as hypothesized by Erikson. Answers to Discussion Questions QUESTION: What are the issues involved in Kevins case? What assessment can you make of his moral development and his self-concept? ANSWER: (1) The issues involved in Kevins case are as follows. He presents a significant behavior problem. He is disruptive and unruly. Because of his personal charisma he is able to catalyze situations and engage less-assertive or more passive students, thereby multiplying the original adverse effect. He is bright but bored and unmotivated to perform at a grade-appropriate level, much less excel as he surely is capable of doing under the right circumstances. There has been a series of progressively-escalating misunderstandings with teachers. His home environment is not helpful in resolving the issues at school. By providing him with unconditional positive feedback his parents have empowered him and enabled him to disregard criticism and school-originated efforts to redirect his energy and initiative. (2) Here is an assessment of his moral development and his self-concept. I would rate his selfconcept as high. His home environment is unquestioningly supportive; his parents believe it is their job to stand up for their only son and support h im, even as they are unhappy about his frequent problems at school. Given a choice between these two polarities, though, his parents opt for support rather than discipline or remonstration. He has high ego strength, is impervious to criticism, and either believes he acts appropriately or doesnt care how his actions affect others within his circle of relationships. His moral development, on the other hand, is inferior. There is no evidence he attends church or church school. There is no evidence his parents have supplied other standards or criteria that would enable him to differentiate between right and wrong. Whatever theories of personal morality he has conceived he has picked up from school and peer-group interactions. From these he basically has learned that he can do whatever he wants to without consequence. Judgment of his behavior is situational in that while his teachers might disapprove, his parents will approve (or at least not disapprove to the extent of providing positive punishment). As a result he is insensitive in his dealings with other students and disrespectful in his dealings with teachers. QUESTION: If you were his counselor, what would you recommend to promote healthy development? ANSWER: It is unlikely Kevin has developed sufficient cognitive capacity so that psycho-dynamic therapy or CBT would be useful or appropriate. Counseling with parents might be temporarily palliative but this positive outcome is likely to be fleeting and it will lose effectiveness unless accompanied by genuine behavioral change. For these reasons it seems more likely that a course of operant conditioning would lead to a better result. According to Skinner it is not necessary to hypothesize the existence of goals and intentions to explain complex psychological phenomena. Rather they can be reduced to behavioral responses to the environment and shaped by the dynamics of a given situation. Operant conditioning as refined by Skinner envisions four types of reinforcement situations: (a) positive reinforcement (R+), which is a reward for increasing desirable behavior, causing it to go up; (b) extinction (EXT ), which is the removal of a previously-given positive reinforcer, causing undesirable behavior to go down; (c) punishment (PUN+), which is the administration of an aversive, causing undesirable behavior to go down; and (d) negative reinforcement (R), which is the removal of previously-administered punishment, causing the desired behavior to go up. Here is an example of how these concepts might be deployed in Kevins situation. Kevins teachers (the school administration) could develop a token economy for him. Under this he would receive a token for engaging in instances of desirable behavior. He then could trade the token for a desirable reward, such as going on the field trip. Engaging in undesirable behavior might result in the removal

of tokens or the imposition of other sanctions, such as requiring further tokens in order to attain the positive reinforcer. Kevin presently has a sense of entitlement to re ward despite his unruly behavior. Implementation of a token economy would emphasize that receipt of reward is contingent, not automatic. I also would suggest a course of counseling for Kevins parents. They simply might not realize how their hierarchy of rewards and punishments has reinforced Kevins behavior. Kevins parents are in what Galinsky refers to as the authority stage (p. 119). By setting examples, engaging in dialog, and even through positive requests (commands) they have the power to influen ce Kevins behavior. Parents issue a myriad number of cues to their children about how to behave and what to expect. Kevin has picked up on these cues. By constantly probing and testing the limits of his world he has evolved a mental model of behavior consequence that is dysfunctional. It is unlikely his behavior is malicious. Rather, he simply has not had a role model that would show him how he is supposed to act. He is not so much disrespectful of his parents authority as ignoring it. His parents in turn most likely do not even realize how they are contributing to this schematic. They may not understand what Kevin is going to or the strategies he has adapted to cope with the world as he sees it. They may not have devoted enough time to interacting with Kevin, or become bored or facile in their interactions with him. They have abdicated their inherent authority, leading to a chaotic outcome. There are many ways in which they can reassert it simply by modifying their parental style from permissive to authoritative. Caring for their son is not simply permitting him to engage in whatever behavior pops into his head. Rather it is setting limits, acting consistently, and communicating with him as to their rationale.

Case Study #5 Late Adulthood Elizabeth, an 80-year-old widow, will soon be released from the hospital's rehabilitation center after suffering a broken hip. She can move about now, but needs to use a cane. Her mobility is only slightly impaired. Despite her age, she appears physically and mentally capable of caring for herself. Before her accident, Elizabeth was active in her church, and had a male friend who drove Elizabeth to different church activities. For the past 12 years since her husband died, she has lived alone in a small apartment. Paying for rent and food takes most of her social security check. She has no savings or other sources of income. During Elizabeth's' hospital stay, her son noted that she occasionally seemed forgetful and showed some confusion about the circumstances of her accident and how long she had been in the hospital. Her forgetfulness and confusions were not persistent, however, and she now seems mentally alert and aware of things around her. Elizabeth's son, who lives in another state, wants her to come live with him and his wife. Elizabeth's daughter-in-law does not work, and they have no children. Discuss this situation in relation to developments in late adulthood. Consider these questions for your paper: First briefly describe 4 different living arrangements that apply to this case. Don't make any recommendations in your answer to this particular question. 2nd, answer according to only part one of the Discussion guidelines: In each case, the first issue you will write about will be an Erikson's stage of psychosocial development. Don't choose previous stages. Find and read about the appropriate Eriksonian stage in you book. Do not spend energy summarizing Erikson's stages in your paper (although you should be able to.) Once you understand the stage, explain why this stage is relevant to the discussion case, other than simply referring to the age of the person. The stage might be important to consider because of the unique circumstances of the case, or because of what the person does that shows he/she is struggling to resolve the crisis of development articulated by Erikson. 3rd, if Elizabeth agrees to live with her son, what problems do you foresee? 4th, What advantages might there be for living with her son? 5th, what recommendation concerning living arrangements would you make in this case? Who should make this decision and why? Lastly, answer according to part two of the Discussion guidelines (i.e., identify a non-Erikson issue): In addition to an Erikson stage of development, use your textbook to identify one other important developmental problem/issue that specifically applies to the case, or is clearly illustrated by the case. Only pick one other issue in addition to an Erikson stage. Be specific! "Psychosocial development" is too broad and general, as would "family relationships" because every case has a psychosocial development issue and a family relationship, so you must be specific while using your own words. Don't re-define the issue (that's already done in the case). You have limited space to convey a large amount of information, so you should

spend your time and energy on relating the text to the case. You don't have to provide recommendations for this issue.