Mishka is a 16-year-old female, who attends your school. A year ago, Mishka lost both her parents to a murder-suicide (committed by her father) which was hard for her to accept. Mishka was present during the ordeal as she hid behind the sofa as her parents argues. At first, Mishka would tell family members and friends that she would still see her parents and they were not dead. After reality struck, she bargained with God, asking him to return her mother. She promised that she would be the best child if he did. Months later, she is sent to you (the school’s guidance counselor) because she has changed from a happy child to one that constantly disrupts the class. There has also been a major decline in her grades. Additionally, Mishka has been accused of exposing some classmates to pornographic materials and drugs. The teacher and students notice that she has been cutting herself (which you see when she entered your office) and is hypervigilant and hyperaroused. In discussion with Mishka, she shouts at you and states that no matter what, you cannot help her. She explains that the only thing that dulls the pain and relieves her of the constant flashbacks is the alcohol and heroine that she gets from a local dealer. The alcohol, she notes, also helps with her insomina. She expresses that once she reaches home to her sexually abusive uncle and verbally abusive aunt, she is going to lock herself in her room and slash her wrist. Mishka also shares that she has secretly stashed a bottle of pills she stole from her grandmother last week, which she plans to consume. She had previously attempted suicide three months ago using a similar method. Mishka shares that she hates her mother and is angry at her for leaving her, especially to abusive family members. She tells you there is no meaning to this worthless life without her parents and there is no love and support for her.
As the counselor,
1. What are the instances of loss and grief in this case?
2. Using the knowledge you have garnered about the developmental and structural crisis, explain (using examples) how Mishka’s case can be seen as both.
3. Share five common reactions to trauma during the period of adolescence.
4. Identify at least five suicide warning signs in the case above
5. List the ten risk factors to look for when completing a suicide risk assessment.
6. Discuss three strategies you would use as it relates to the prevention and intervention of suicide?
7. Describe how you would challenge Mishka’s hate and anger towards her mother
8. Explain (using examples) the grief process that Mishka is experiencing using one of the grief and bereavement models.
9. Identify and explain three emotions that may be felt when a sudden loss is experienced; as well as three activities or strategies a counselor can use to help the client express their emotions during the grieving process.
10. Identify and briefly describe one theory that can be used to explain Mishka’s loss.
11. Identify five (5) techniques or strategies that you would use in your therapeutic intervention as it relates to Mishka's case. Please ensure to state why each was chosen or how it would be beneficial to the client.
12. With the aid of examples, differentiate between Stress, Acute Stress Disorder and PTSD.
13. Considering your knowledge of Acute Stress Disorder and PTSD, which would you diagnose the client as experiencing and why?
1. Mishka loses her parents , which is hard for her to accept. It is sign of denial. She also says seeing them and believes that they are not dead. After accepting the death, she begins yearning for her mother's return and pleads to God.
2. Mishika has not developed a sense of self and is dependent on drugs. This is a developmental crisis. The extended family members have not changed their behaviour towards Mishika as per the developmental needs of her. Instead they are abusing her. This is structural crisis.
3. In teenagers, the common reactions to trauma are - getting irritated easily, getting angry, disturbed sleep, feelings of guilt and anxiety.
4. Suicide warnings are drastic change in behaviour from happy person to a person constantly disrupting the class, self-harm, feeling helpless of the situation, previous attempts to suicide, contemplating suicide and considering life worthless to live.
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