Can you imagine what is would be like to have your beautiful young son or daughter come to you with such hatred for their appearance that they are begging you to take them to a plastic surgeon?
I think from time to time we all check out our image in the mirror and make an evaluation of it. Some people (young and old) make such critical evaluations of their appearance that they start to believe that they are unable to contribute to any sort of life because of their appearance. When this becomes debilitating, we usually consider a diagnosis of Body Dysmorphic Disorder.
Formulation and treatment planning in complex cases involving a young person are particularly challenging because of the sheer volume of information available to us. The key question is how to make effective use of it all. My suggestion is that we extend the well-known 4P approach to take into account 4 more critically important areas. In my view, ‘4P + 4’ would enable us to reach much greater clarity on what to target, why and how in order to improve a young person’s situation.
For a long time now, good psychologists have been considering client issues with reference to the 4 Ps: predisposing factors, precipitating factors, perpetuating issues and protective factors. I believe that in complex cases involving young people, the 4Ps need to be developed further to take individual development, established evidence, bio-psycho-social approach and system politics into account.
“Get back into your bed and go to sleep!”
“But I just need a glass of water!”
Complex cases involving young people come in a whirlwind of politics, spent and burnt-out workers and a trail of services that, for whatever reason, have been unable to help. In fact, Taz the Tasmanian Devil, the animated cartoon character, comes to mind. He usually moves around in a whirlwind of chaos, but sometimes steps outside to watch from arm’s length. And that’s exactly what we need to do: step back in order to separate the actual presenting problem from the chaos in a complex case.
Complex cases involving young people can seem chaotic. There’s the trauma of their own experience; the multitude of variables introduced by the families, carers and agencies supporting them; and the confusion that can arise from interagency politics, policies and rules. It can be difficult to know where to start in formulation and treatment planning.I suggest taking a step back, like Taz. In my experience, what follows is the clarity that leads to formulation and treatment that are useful. Here’s what you should consider:
“I’ll do it later.” “I’ll start tomorrow.” “I’m waiting until I’m in the right mood.” “I work better under pressure.” “I’m waiting for the rest of my group to get started.”
We all put things off from time to time or find it hard to make a decision. For the most part, we can usually come up with the goods in time to avoid dire consequences. However, some young people get so stuck in putting things off that it starts to have a big impact on their life.
There are few certain things in life. Sadly, like head lice in schools, there will likely always be difficult people that cross paths with your child from time to time. And just like head lice, it’s wise to check in with your kids from time to time to see whether they are dealing with someone they are finding difficult and to help them with a plan to manage.
Now, when I say check in with your child, you would know by now that I don’t mean putting them through the third degree. Most, but not all children will tell you if things are difficult with someone at school. If you have noticed a change in your child’s mood after school that’s lingering over a number of days, it’s wise to check in with them directly.