1

case study #1: the depressed teen

She was moody and withdrawn.

Reverend Lisa Dunn is pastor of a medium-sized church in the Midwest, in which the Jordan family has been involved for several years. ey became especially active aer the death of their youn est son from leu!emia one year a o. eir si"teen-year-old dau hter, Jean, had become noticeably withdrawn from both family and friends in the past several months and had become less interested in her appearance. Jean stopped participatin in the youth roup and her rades dropped at school. She was moody and had become pessimistic in her outloo! toward life. She developed a short fuse and complained of feelin worthless. Recently, friends reported that they had seen Jean drin!in with a roup of older students aer school. Jean had been very close to her youn er brother and appeared to have been the most aected by and least acceptin of his death. #t is important to have an accurate picture of Jeans alcohol use and emotional state. e rapid and ne ative chan es in her life su est somethin serious has developed. #s she usin alcohol in an attempt to cope with unresolved rief related to the death of her brother$ #t is not uncommon for alcohol and dru abuse to mas! depression and rief reactions. Depression is one of the most com- mon forms of emotional problems in youn people. %"perts esti- mate that about one in twenty teens is depressed &Reynolds, '(()*, while one in four depressed adolescents use dru s or alcohol to cope with the problem &+lemin and ,ord, '((-*. e drop in Jeans rades may si nal decreased concentration and slowed thin!in , also common in depression. e use of alcohol for self-medication is oen the pattern of individuals with poor copin s!ills and hi h addictive potential. .ow much is Jean in denial about her alcohol abuse$ Does she minimize her alcohol use$ .ow much insi ht does Jean have into her problem$

Jean has many of the si ns of a teen who has an alcohol-abuse prob- lem and depression/ she has withdrawn from family and friends and has stopped activities she had en0oyed at church. She has dif- culties at school and has had a si nicant ne ative chan e in her mood and thin!in . .er family reports that Jean has decreased interest in her physical appearance. She may have developed peer relationships with youth who are usin alcohol. Reverend Dunn and Jeans parents decided to tal! to Jean about her new behaviors. e pastor used her active listenin s!ills while assessin Jeans emotional state. Reverend Dunn established a safe and carin relationship as she empathetically responded to Jean at the family home. e teen confessed increasin use of alcohol. 1hen the pastor reminded Jean of how much her family loved her and was concerned about her, she bro!e down and wept. She be an to e"press her deep rief over the death of her beloved brother. 1ith entleness and support, Rev. Dunn encoura ed Jean to rieve her loss, understandin that each individual has a uni2ue way to rieve, and that Jean will need to mourn her brothers death accordin to her inner timetable. 3er Rev. Dunn and Jeans family had their intervention with her, Jean a reed to see a psychiatrist, Dr. 4arbara Miller, who specializes in teena e substance-abuse problems. e physician advised a medical e"amination to rule out physical problems that could have tri ered the depression, but no underlyin medical issue was found that would account for the depression. Jean was also assessed for anti-depressant medications and was iven a pre- scription to help her throu h the rst several months. ,ver the months of therapy, it became clear that Jean had be un to rely on alcohol and was drin!in to self-medicate her depression. Jean was successfully treated as an outpatient for alco- hol abuse and depression. e psychiatrist also noted that Jeans family needed to address its poor communication, which became pronounced aer the death of a family member. Jeans substance abuse was, in part, a symptom of their pain as a family and their inability to e"press their an uish in a way that could brin healin . 1ith several months of therapy, the family was able to develop deeper bondin and a renewed faith as they wor!ed to ether throu h the crisis.

case study #1: the depressed teen diaGnostic criteria Alcohol abuse has as its basic feature a pattern of use characterized by ne ative, recurrent, and si nicant conse2uences related to repeated use. is dia nosis re2uires only one of the followin criteria over the course of twelve months &353, 6---*/

'.

Recurrent alcohol use results in a failure to fulll ma0or obli- ations at home or wor! &such as repeated ne lect of school responsibilities*. 6. Repeated use of alcohol in situations in which such use is !nown to be physically hazardous. 7. Recurrent alcohol-related le al problems. 8. 9ontinued use despite havin persistent or recurrent social or interpersonal problems resultin from the eects of the alcohol &such as ar uments with friends or family members about the conse2uences of usin the substance*. 3n adolescent is dia nosed with a major depression when there have been two wee!s or more of feelin sad, loomy, depressed, irri- table, or e"periencin a loss of interest, motivation, or en0oyment in usual activities &353, 6---*. 3lon with a depressed mood or loss of interest, the person must also have had two or more wee!s of at least four of the followin ei ht symptoms/ : : : : : : : : fati ue or lethar y loss of appetiteand difculty much loss of feelin s uilt difculty feelin that to die, suicidal loss of ener y or increased restlessness &a itation* appetiteand wei ht or e"cessive wei ht ain sleepin or sleepin too social or se"ual interest of worthlessness or e"cessive concentratin life is not or feelin worth livin , wantin

treatMent Within the faith coMMunity

Research has shown that stable families lower the ris! of alcohol and dru abuse, so church pro rams that focus on stren thenin

pastoral care the family can be a preventive strate y &Johnson et al., '((;*. 3 stron youth pro ram that promotes ood communication and social s!ills is a valuable preventive measure as well. <een alcohol and dru abusers tend to have poor assertion s!ills, hi h social an"iety, and low self-worth. Social s!ills trainin can enhance copin , self-control, social problem solvin , ne otiation s!ills, and assertiveness, as well as increasin the ability to resist peer pres- sure &.a erty et al., '(=(*. %ncoura in teens and their families to be active in the life of the community of faith is in itself an important preventive strate y when addressin substance abuse. >outh who practice their reliious faith have more positive social values and carin behaviors and their families are more stable than those who do not prac- tice their faith. Surveys have found that adolescent re ular church attenders are half as li!ely to use alcohol as teens who do not attend church re ularly &?allup and 4ezilla, '((6*. ese ndin s add to the e"tensive research supportin the social benet of nurturin , nonpunitive reli ious practice in limitin and preventin alcohol and dru use &?orsuch, '(()*. Reli ion can protect children and their parents a ainst depression by actin as a buer a ainst stressful events. 3ccordin to researchers at 9olumbia @niversity, children whose mothers are reli iously committed are less li!ely to suer depression &Miller et al., '((A*. e study found that the dau hters of mothers for whom reli ion was hi hly important were ;- percent less li!ely to have a ma0or depression. 3 second study found that fre2uent church attenders in <e"as with hi h spiritual support had lower levels of depression than their peers without reli ious involvement &1ri ht et al., '((7*. 3lthou h many cler y report that depression is the most common problem that they are as!ed to help people overcome, they are oen inade2uately trained to identify depression or suicide ris! &1eaver, '(()*. #n a national survey of cler y and pastoral care specialists, only one in four believed the church was oer - in helpful pro rams for depressed teena ers, and pastors ran!ed their eectiveness with teen depression as enerally poor &Rowatt, '(=(*. e study underscores the need for cler y and other reliious leaders to learn to reco nize mental health problems in teen- a ers competently and to train members of their faith communities

case study #1: the depressed teen

to provide emotional support to youth and their families. 5ositive social relationships outside ones immediate family are a protective factor a ainst developin emotional problems li!e depression in at-ris! youth &.untley and 5helps, '((-*. treatMent by Mental health specialists 1hen considerin referrin a teen to a mental health professional, it is important to as! what plan of action the specialist will use. 3 pastor or other reli ious professional needs a basic understandin of standard treatment protocols to assess whether a mental health professional is !nowled eable and e"perienced in treatin individ- uals and their families. .ere is an e"ample of the sort of treatment considerations one would ma!e in a treatment plan for an adoles- cent suerin from alcohol abuse. #n the be innin , a therapist would encoura e Jean to tell her story and empathize with her viewpoint to foster a therapeutic alliance. e mental health specialist would as! Jean to discuss her understandin of the ne ative conse2uences of alcohol use and assess her level of insi ht into her situation and whether she is in denial. #t would be valuable to provide reassurance that help is available and that chan e happens with commitment. e family would be involved early and oen in treatment to lend support and insi ht, since treatment without their involve- ment has little hope of success. #n Jeans case, the family could be an important part in healin unresolved rief. #t would also be helpful to develop a substance-abuse history of the e"tended family, since relatives with abuse issues increase the ris! of addiction. 3 refer- ral to 3lcoholics 3nonymous teen pro ram &3lateen* can provide Jean with education and continued encoura ement for abstinence. e early sta es of abstinence re2uire considerable support, and the therapist will ma!e clear that occasional relapses are possible and need to be seen as human slips, not failures that conrm Jeans sense of low self-worth. 3 therapist would continue to wor! with Jean and her fam- ily to prevent relapse and wor! throu h temporary relapses if they occur. Sessions would continually review the reasons for the recovery processB provide support, reassurance, encoura ement, and praise for on oin wor!B and e"plore for insi ht into the roots

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pastoral care

of the addiction. e therapist would encoura e Jean to become involved in e"tracurricular social, athletic, or artistic activities with positive peer roups and to e"pand her interests. #t would be important to identify and address family problems that may be complicatin Jeans alcohol abuse. +amily sessions could be used to teach communication s!ills and e"plore underlyin family dysfunctions &such as an inability to e"press feelin s* that may be related to the addictive behavior. Re ardin depression, a combination of co nitive-behavioral therapy, medication, and family therapy is the standard treatment. Si nicant depressive symptoms in teena ers can be treated with medication. ey can be li!ened to a cast on a bro!en arma temporary support that promotes healin . 3ny medication for minors must be carefully monitored, iven the on oin physical and psycholo ical development of youn people. #n co nitive-behavioral therapy, there is an attempt to chan e depression-producin beliefs and attitudes to healthier, more realistic ones. 4ehaviors that produce pleasure and fulllment are also encoura ed. Many depressed adolescents dene their life situation in lobal terms li!e nothin is wor!in out or # cant do any- thin ri ht. Depressed youth tend to conclude the worst, dwell on ne ative details, and devalue the positive, especially when they have overly critical parents. 9o nitive-behavioral therapy see!s to stop or modify these pessimistic automatic thou hts that people use to dene themselves, their environment, and the future. #f these beliefs o unreco nized and unchallen ed, such distorted thin!in will result in continued depression. @sually treatment involves self-monitorin of mood and activities, oen in the form of !eepin a daily lo . conclusion Jean is fortunate to have a psycholo ically minded pastor who was prepared to connect her with a specialized mental health profes- sional who has the trainin and e"perience to help her eectively. Jean also has several factors oin for her that point toward a lon - term positive outcome. #mportantly, she has the motivation to chan e and has responded well to treatment. #n addition, she has the valuable support of her family and church community.

11 case study #1: the depressed teen helpful booKs MacLachlan, Malcolm, and 9aroline Smyth. 6--8. Binge Drinking and Youth Culture. Dublin, @C/ Liey 5ress. 5reston, John. 6--8. You Can Beat Depression: A Guide to Prevention and ecover!. San Luis ,bispo/ #mpact 5ublishers. Ro ers, 5eter D., and Lea ?oldstein. 6--6. Drugs and Your "id: #o$ to %ell &' Your Child #as a Drug(Alcohol Problem and )hat to Do About &t. ,a!land/ Dew .arbin er. Rowatt, ?. 1ade. '(=(. Pastoral Care $ith Adolescents in Crisis. Louisville/ 1estminster John Cno". Schaefer, Dic!. '((=. Choices * Conse+uences: )hat to Do )hen a %eenager ,ses Alcohol(Drugs. 9enter 9ity, Minn./ .azelden +oundation. Stone, .oward. 6--=. Crisis Counseling. 7d ed. 9reative 5astoral 9are and 9ounselin . Minneapolis/ +ortress 5ress. . 6--A. De'eating Depression: eal #elp 'or You and ose )ho -ove You. Minneapolis/ 3u sbur . 1eaver, 3ndrew J., John D. 5reston, and Lei h 1. Jerome. '(((. Counseling %roubled %eens and eir .amilies: A #andbook 'or Pastors and Youth )orkers . Dashville/ 3bin don.