Case Study II

Google Image: Depressed Teen

THE DEPRESSED TEEN

“She was moody and withdrawn.”

Reverend Lisa Dunn is a pastor of a medium-sized church in the Midwest, in which

the Jordan family has been involved for several years. They became especially active
after the death of their youngest son from leukaemia one year ago. Their sixteen-year-
old daughter, Jean, had become noticeably withdrawn from both family and friends in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 participating in the youth group and her grades dropped at school. She was
moody and had become pessimistic in her outlook toward life. She developed a short
fuse and complained of feeling worthless. Recently, friends reported that they had
seen Jean drinking with a group of older students after school. Jean had been very
close to her younger brother and appeared to have been the most affected by and
least accepting of his death.
It is important to have an accurate picture of Jean’s alcohol use and emotional
state. The rapid and negative changes in her life suggest something serious has
developed. Is she using alcohol in an attempt to cope with unresolved grief related to
the death of her brother? It is not uncommon for alcohol and drug abuse to mask
depression and grief reactions. Depression is one of the most common forms of
emotional problems in young people. Experts estimate that about one in twenty

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 teens is depressed (Reynolds, 1995), while one in four depressed adolescents use
drugs or alcohol to cope with the problem (Fleming & Offord, 1990). The drop in
Jean’s grades may signal decreased concentration and slowed thinking, also common
in depression.
The use of alcohol for self-medication is often the pattern of individuals with
poor coping skills and high addictive potential. How much is Jean in denial about
her alcohol abuse? Does she minimise her alcohol use? How much insight does Jean
have into her problem?

RESPONSE TO VIGNETTE
Jean has many of the signs of a teen who has an alcohol-abuse problem and
depression: she has withdrawn from family and friends and has stopped activities she
had enjoyed at church. She has difficulties at school and has had a significant negative
change in her mood and thinking. Her family reports that Jean has decreased interest
in her physical appearance. She may have developed peer relationships with youth
who are using alcohol.
Reverend Dunn and Jean’s parents decided to talk to Jean about her new
behaviours. The pastor used her active listening skills while assessing Jean’s
emotional state. Reverend Dunn established a safe and caring relationship as she
empathetically responded to Jean at the family home. The teen confessed increasing
use of alcohol. When the pastor reminded Jean of how much her family loved her and
was concerned about her, she broke down and wept. She began to express her deep
grief over the death of her beloved brother. With gentleness and support, Rev. Dunn
encouraged Jean to grieve her loss, understanding that each individual has a unique
way to grieve, and that Jean will need to mourn her brother’s death according to her
inner timetable.
After Rev. Dunn and Jean’s family had their intervention with her, Jean agreed to
see a psychiatrist, Dr. Barbara Miller, who specialises in teenage substance-abuse
problems. The physician advised a medical examination to rule out physical problems
that could have triggered the depression, but no underlying medical issue was found
that would account for the depression. Jean was also assessed for anti-depressant
medications and was given a prescription to help her through the first several
months.
Over the months of therapy, it became clear that Jean had begun to rely on
alcohol and was drinking to self-medicate her depression. Jean was successfully
treated as an outpatient for alcohol abuse and depression.
The psychiatrist also noted that Jean’s family needed to address its poor
communication, which became pronounced after the death of a family member. Jean’s
substance abuse was, in part, a symptom of their pain as a family and their inability to
express their anguish in a way that could bring healing. With several months of

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 therapy, the family was able to develop deeper bonding and a renewed faith as they
worked together through the crisis.

DIAGNOSTIC CRITERIA
Alcohol abuse has as its basic feature a pattern of use characterised by negative,
recurrent, and significant consequences related to repeated use. This diagnosis
requires only one of the following criteria over the course of twelve months (APA,
2000):
1. Recurrent alcohol use results in a failure to fulfil major obligations at home
or work (such as repeated neglect of school responsibilities).
2. Repeated use of alcohol in situations in which such use is known to be
physically hazardous.
3. Recurrent alcohol-related legal problems.
4. Continued use despite having persistent or recurrent social or
interpersonal problems resulting from the effects of the alcohol (such as
arguments with friends or family members about the consequences of
using the substance).

An adolescent is diagnosed with a major depression when there have been two
weeks or more of feeling sad, gloomy, depressed, irritable, or experiencing a loss of
interest, motivation, or enjoyment in usual activities (APA, 2000). Along with a
depressed mood or loss of interest, the person must also have had two or more weeks
of at least four of the following eight symptoms:

 fatigue or loss of energy

 lethargy or increased restlessness (agitation)
 loss of appetite and weight or excessive appetite and weight gain
 difficulty sleeping or sleeping too much
 loss of social or sexual interest
 feelings of worthlessness or excessive guilt
 difficulty concentrating
 feeling that life is not worth living, wanting to die, or feeling suicidal

TREATMENT WITHIN THE FAITH COMMUNITY

Research has shown that stable families lower the risk of alcohol and drug abuse,
so church programs that focus on strengthening the family can be a preventive
strategy (Johnson et al., 1996). A strong youth program that promotes good
communication and social skills is a valuable preventive measure as well. Teen alcohol
and drug abusers tend to have poor assertion skills, high social anxiety, and low self-
worth. Social skills training can enhance coping, self-control, social problem solving,
negotiation skills, and assertiveness, as well as increasing the ability to resist peer
pressure (Haggerty et al., 1989).

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 Encouraging teens and their families to be active in the life of the community of
faith is in itself an important preventive strategy when addressing substance abuse.
Youth who practice their religious faith have more positive social values and caring
behaviours and their families are more stable than those who do not practice their
faith. Surveys have found that adolescent regular church attenders are half as likely
to use alcohol as teens who do not attend church regularly (Gallup and Bezilla, 1992).
These findings add to the extensive research supporting the social benefit of
nurturing, no punitive religious practice in limiting and preventing alcohol and drug
use (Gorsuch, 1995).
Religion can protect children and their parents against depression by acting as a
buffer against stressful events. According to researchers at Columbia University,
children whose mothers are religiously committed are less likely to suffer depression
(Miller et al., 1997). The study found that the daughters of mothers for whom religion
was highly important were 60 percent less likely to have a major depression. A second
study found that frequent church attenders in Texas with high spiritual support had
lower levels of depression than their peers without religious involvement (Wright et
al., 1993).
Although many clergy report that depression is the most common problem that
they are asked to help people overcome, they are often inadequately trained to
identify depression or suicide risk (Weaver, 1995). In a national survey of clergy and
pastoral care specialists, only one in four believed the church was offering helpful
programs for depressed teenagers, and pastors ranked their effectiveness with teen
depression as generally poor (Rowatt, 1989). The study underscores the need for
clergy and other religious leaders to learn to recognise mental health problems in
teenagers competently and to train members of their faith communities to provide
emotional support to youth and their families. Positive social relationships outside
one’s immediate family are a protective factor against developing emotional
problems like depression in at-risk youth (Huntley and Phelps, 1990).

TREATMENT BY MENTAL HEALTH SPECIALISTS

When considering referring a teen to a mental health professional, it is important
to ask what plan of action the specialist will use. A pastor or other religious
professional needs a basic understanding of standard treatment protocols to assess
whether a mental health professional is knowledgeable and experienced in treating
individuals and their families. Here is an example of the sort of treatment
considerations one would make in a treatment plan for an adolescent suffering from
alcohol abuse.
In the beginning, a therapist would encourage Jean to tell her story and empathise
with her viewpoint to foster a therapeutic alliance. The mental health specialist would
ask Jean to discuss her understanding of the negative consequences of alcohol use
and assess her level of insight into her situation and whether she is in denial. It would

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be valuable to provide reassurance that help is available and that change happens
with commitment.
The family would be involved early and often in treatment to lend support and
insight, since treatment without their involvement has little hope of success. In Jean’s
case, the family could be an important part in healing unresolved grief. It would also
be helpful to develop a substance-abuse history of the extended family, since
relatives with abuse issues increase the risk of addiction. A referral to Alcoholics
Anonymous’ teen program (Alateen) can provide Jean with education and continued
encouragement for abstinence. The early stages of abstinence require considerable
support, and the therapist will make clear that occasional relapses are possible and
need to be seen as “human slips,” not “failures” that confirm Jean’s sense of low self-
worth.
A therapist would continue to work with Jean and her family to prevent relapse
and work through temporary relapses if they occur. Sessions would continually
review the reasons for the recovery process; provide support, reassurance,
encouragement, and praise for ongoing work; and explore for insight into the roots
of the addiction. The therapist would encourage Jean to become involved in
extracurricular social, athletic, or artistic activities with positive peer groups and to
expand her interests. It would be important to identify and address family problems
that may be complicating Jean’s alcohol abuse. Family sessions could be used to teach
communication skills and explore underlying family dysfunctions (such as an inability
to express feelings) that may be related to the addictive behaviour.
Regarding depression, a combination of cognitive-behavioural therapy,
medication, and family therapy is the standard treatment. Significant depressive
symptoms in teenagers can be treated with medication. They can be likened to a cast
on a broken arm—a temporary support that promotes healing. Any medication for
minors must be carefully monitored, given the ongoing physical and psychological
development of young people.
In cognitive-behavioural therapy, there is an attempt to change depression-
producing beliefs and attitudes to healthier, more realistic ones. Behaviours that
produce pleasure and fulfilment are also encouraged. Many depressed adolescents
define their life situation in global terms like “nothing is working out” or “I can’t do
anything right.” Depressed youth tend to conclude the worst, dwell on negative
details, and devalue the positive, especially when they have overly critical parents.
Cognitive-behavioural therapy seeks to stop or modify these pessimistic “automatic
thoughts” that people use to define themselves, their environment, and the future.
If these beliefs go unrecognised and unchallenged, such distorted thinking will result
in continued depression. Usually treatment involves self-monitoring of mood and
activities, often in the form of keeping a daily log.

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 CONCLUSION
Jean is fortunate to have a psychologically minded pastor who was prepared to
connect her with a specialised mental health professional who has the training and
experience to help her effectively. Jean also has several factors going for her that point
toward a long- term positive outcome. Importantly, she has the motivation to change
and has responded well to treatment. In addition, she has the valuable support of
her family and church community.

Source: Koenig, H.G. & Weaver, A.J. (2009). Pastoral Care of Alcohol Abusers. Minneapolis,
USA: Fortress Press.

Activity – Group Discussion

Instruction: In groups, discuss the questions below.

1. In your opinion, what could be the main reason Jean was diagnosed with depression?
Use Fishbone Diagram to present your answer.

2. By using SWOT Analysis, present the best solution to avoid teenagers from using drugs
to help them deal with challenges they are facing in life.

Activity – Forum
1. Based on the topics listed below, conduct a forum discussing on the causes, effects,
solutions and personal life experiences. Make sure each group has a different topic.
a. Depression among NDUM students
b. Depression among new mothers
c. Depression among soldiers
d. Depression and drug abuse
e. Depression and suicide
f. Depression and broken family

2. Roles involved are moderator (one person) and panellists (e.g.: psychiatrist,
counsellor, doctor, professor, mother, teenager)

3. You may prepare the script but DO NOT memorise or read the script. It should look as
spontaneous as possible. Moderator has to be prepared to any new questions to be
thrown at the panel during the forum.

4. You are also required to submit an A3-sized poster for the forum before the
presentation. The poster should have the title and the name of the panellists. Be as
creative as possible.

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References

Depressed Teen Image. (2017). Retrieved January 19, 2018, from

http://www.thepediablog.com/2017/06/08/13-of-teen-girls-depressed/

Koenig, H.G. & Weaver, A.J. (2009). Pastoral Care of Alcohol Abusers. Minneapolis, USA: Fortress Press.

Chandran, S. (2015). Leadership Case 2 ‘Find, Fix, Finish & Exploit’ Counter Insurgency Operations.
Leadership in the Military. Kuala Lumpur, Malaysia: UPNM.

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