ical, psychological, and social factors related to one another? How do these factors contribute to the individual’s presenting problem? What is the relationship between these factors and a plan for treatment? Case Study: Shawna Experiences Enures
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How are the biological, psychological, and social factors related to one another? How do these factors contribute to the individual’s presenting problem? What is the relationship between these factors and a plan for treatment?
Case Study: Shawna Experiences Enuresis (Individual Child Therapy)
Shawna is an 11-year-old Caucasian girl who lives with her parents, older sister (15), and two cats. She is presently in sixth grade in a public school, where she is performing very well academically. Shawna's family lives in a wealthy suburban area where achievement and success are strong community values. There are no significant current stressors in the home or past traumas identified.
Presenting Problem: Shawna has been troubled by almost nightly enuresis, or bedwetting, ever since she was “out of diapers.” Both Shawna and her parents are deeply embarrassed by this problem, which has remained a deep family secret and prevented Shawna from the normal range of overnights and sleep-away activities with her peers. Assessment of the enuresis does not reveal any consistent stressors or emotional antecedents to the almost nightly occurrences. However, the consequences of the wetting involve Shawna's mother or older sister changing her bedclothes and informing her father: “another wet night.”
Key Biopsychosocial Factors:
- Biological: The clinician needs to rule out a medical basis for enuresis (e.g., bladder disease or abnormality). Some children sleep so deeply as to not heed the physiological sensation of a full bladder.
- Psychological: The clinician needs to rule out an emotional basis for enuresis (e.g., anxiety, trauma, stress). For example, shame and isolation as well as a lack of developmentally appropriate independence and autonomy may play a role.
- Social: Community values on success intimidate this family from sharing problems with friends and extended family and increase sense of shame and isolation.
Treatment Goals and Plans: Treatment will focus on resolving the enuresis, working through the shame and secrecy, and increasing Shawna's sense of competence and social access.
The treatment plan involves the following components.
- A medical examination is required to rule out any physical basis for the enuresis.
- In the absence of a medical problem, a behavioral program using a special device that buzzes at the first drop ofmoisture in bed will be employed. This technique requires that Shawna take responsibility for attaching the device to her bed each night, and as soon as the alarm is activated, she is to get out of bed and go to the bathroom to urinate. (Eventually, children become conditioned to the association between a full bladder and the buzzer and learn to awaken on their own.) Shawna is to record each morning whether the buzzer woke her, whether she woke herself, and other relevant details. She is also to handle her own linens, with family members involved only at her direct request.
- Individual sessions will discuss the progress of this behavioral program while exploring her feelings of shame, success, isolation, and so on.
- Intermittent family sessions will ensure that the family is allowing Shawna more autonomy and afford an opportunity to discuss embarrassment and the pressure to “always look good” in their community. As Shawna's enuresis resolves, her newfound pride and independence can be integrated through discussion and ventures into overnights, and therapy sessions eventually tapered.
This example illustrates the use of individual and family modalities in a combined behavioral and humanistic approach to understand, support, and increase self-efficacy around a specific problem. Medical consultation in addition to an understanding of the meaning of the problem in the larger sociocultural context further adds to the treatment efficacy.
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What might happen regarding Shawna's situation if we only treat the symptom of bedwetting rather than the underlying cause?
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