Clinical Application of Explanatory Theory

SOWK 605

Assignment #1: Clinical Application of Explanatory Theory

Jacquelyn Wise

Jun 16, 2016

University of Southern California

Professor Maureen Macias

Introduction

The purpose of this paper is to clinically analyze a case based on the theoretical concepts of Contemporary Attachment Theory, integration of Attachment Theory and Neurobiology, and Kohutian framework of the Self Psychology paradigm. Theoretical application provides clinicians with a framework by which they may assess and treat a client that is grounded in scientific research and practice.  The author’s intent is to demonstrate a clear, clinical understanding of theoretical application.

Presenting Case

        Brianna is a thirteen year old, hispanic female.  She was referred to case management after asking a teacher to be referred.  Brianna is second born of four siblings.  All children in the home were placed in foster care when Brianna was two because of domestic violence and drug abuse.  She lived with two separate foster families.  She describes her second foster family as “evil”.  Brianna was the only child returned to her birth mother at the age of four.   Brianna and her mother live in abject poverty in the inner city of San Antonio.  Brianna exhibits marked instability in her relationships at home and socially. She often gets in physical fights with her peers at school and has been suspended several times for outbursts against her teachers.   She reports self mutilating behavior.  The scars that she shows appear to be drawn on with a pen.  She reports suicidal thoughts with one attempt.  Brianna is very theatrical. She most always presents with an upbeat affect. This is generally contradictory to information she shares.  When asked probing questions, Brianna provides responses that contain little to no detail.  She is easily influenceable by suggestion.  Brianna reports being diagnosed with bipolar disorder, ADHD, and reports seeing ghost and hearing voices.  She reports that her pediatrician is the person that diagnosed her with bipolar disorder.  When probed about these conditions, she is flippant and inconsistent. She cannot describe the voices nor does have any detail other than she hears them.  Her current documented diagnosis is ADHD and depression.  In school, Brianna has asked to be admitted to the hospital on three, separate occasions sighting suicidal thoughts.  On all three occasions, she was taken from the school in a squad car to the hospital, admitted and released within the week.  Case management is currently working with Brianna to receive additional psychological services.  

Contemporary Attachment Theory

        In the past ten years, attachment theory has evolved from a behavioristic model of the mother child bond to an integrated, psychoneurological development model.  Building on the foundations of Bowlby’s secure base and Ainsworth’s attachment styles, contemporary attachment theory integrates early relationships with neurodevelopment and affect regulation.  “The essential task of the first year of human life is the creation of a secure attachment bond of emotional communication between the infant and the primary caregiver” (Schore & Schore, 2012).  This communication serves to develop self-regulation therefore, poor caregiver attunment leads to poor self-regulation.  Several recent studies, to include work by Schore and Schore, 2012 suggest that neurodevelopment in the child’s right brain is dependent on the the level of attunment and attachment between a primary care giver and child (Schore & Schore, 2012).