Spencer is a 15-year old boy from an upper middle class family living in an affluent neighborhood in New York City. Spencer lives at home with his parent. Spencer has a history of depression, anxiety, and substance abuse. His first hospitalization occurred a year ago when he was 14 due to his threats to hurt himself while at school. Spencer has a history of abusing multiple substances, including marijuana and prescription pills. He describes his substance use as a way in which he can “numb” himself from his depression. Spencer has reported having a tumultuous relationship with his father whom he reports is verbally abusive (i.e. telling Spencer that he will never amount to anything). Spencer often avoids his father at home and most of their contact is reported as “screaming matches” Alternatively, Spencer is very close to his mother and has been open with her in voicing his feelings of depression and hopelessness. Spencer is also very open with his mother in reporting to her any times in which he has engaged with substance use, although he does not report any intention or desire to stop using. Spencer’s parents do not agree on how to approach Spencer’s escalating substance use and increased depression. His parents also report that it has become increasingly more challenging to monitor Spencer’s substance abuse when he is interacting with peers who also engage in substance use. Spencer’s father believes in “tough love” and sending Spencer off to military school or some other institution where Spencer will be “properly disciplined. “ Spencer’s father also reports that his wife is “too soft” and is in denial as to the extent to which Spencer is abusing drugs. In particular, Spencer’s father reports that his wife should limit Spencer’s interactions with peers, whom are also suspected to use substances and she should also not “give in” when Spencer refuses to attend school, particularly in cases when he is hung over from excessive drug use. Spencer’s mom in turn does not believe that she is being too soft on her son, but rather she feels helpless in what can be done to stop his drug use, as he is refusing to stop. She also believes that Spencer needs to be treated for his depression, as she attributes his drug use to his feelings of hopelessness. Therefore, she does not agree with her husband that Spencer is simply “acting out” and needs harsh discipline; however she is not certain how she may be able to get her husband to become more empathetic towards their son’s emotional challenges and be more engaged in finding therapeutic treatment that does not require sending Spencer out of the home.

1. What is the organizational structure of this family? Do you notice any examples of triangulation and cross-generational alliances? And how might alliances within the family’s structure contribute to maintaining the problem?

2. What is the hierarchy in the family structure? As therapist, who do you identify may have the most power and control in the family? Who may have the least? Is there an incongruent hierarchy within this family? Briefly describe

3. Briefly describe an alternative structure that you may present to this family ?

4. Describe some structural therapy techniques that you may use with this family in session in order to facilitate reorganization of the family structure. In your description, provide examples of how these techniques may be applied to this particular family’s presenting issue.

5. As a family therapist working with a family in which one or more members may not be motivated for therapy, what are some strategic therapy techniques that you might employ to help this family solve their problems? Briefly give an example of one or two strategic therapy techniques .

Case:

A 6-year-old boy is brought to the clinic where his mother reports that he was bitten by a neighbor’s dog two days earlier. The child’s right hand is lacerated between the thumb and index finger and this area is inflamed but healing. The doctor’s examination reveals small but painless swellings beneath the skin inside the right elbow and arm pit and he explains to the mother that these are active lymph nodes enlarged in response to the infection in the hand.

Questions:

6. What has produced the swelling?

7. Many immune-related cellular activities are often impaired in aged patients. Which lymphoid organ(s) normally develop less functionality and increasing amounts of adipose tissue with age?

8. Immunologists recognize two partially overlapping lines of defense against invaders and/or other abnormal, potentially harmful cells: innate immunity and adaptive immunity. In the case above, which would likely to occur first? What is innate immunity? Explain.

Case:

A 30-year-old woman with a history of infertility is discovered to have a high titer of antisperm antibodies.

Questions:

9. Immunoglobulins of humans fall into five major classes. Which immunoglobulin classes most likely provides acquired “immunity” against spermatozoa in the reproductive tract of this patient? Explain.

10. This immunoglobin class is mainly produced in an initial response to an antigen.

11. This immunoglobulin class can cross the placental barrier and confers passive immunity against certain infections until the newborn’s own adaptive immune system is acquired.

A 6-year-old boy is brought to the clinic where his mother reports that he was bitten by a neighbor’s dog two days earlier. The child’s right hand is lacerated between the thumb and index finger and this area is inflamed but healing. The doctor’s examination reveals small but painless swellings beneath the skin inside the right elbow and arm pit and he explains to the mother that these are active lymph nodes enlarged in response to the infection in the hand.

Questions:

6. What has produced the swelling?

7. Many immune-related cellular activities are often impaired in aged patients. Which lymphoid organ(s) normally develop less functionality and increasing amounts of adipose tissue with age?

8. Immunologists recognize two partially overlapping lines of defense against invaders and/or other abnormal, potentially harmful cells: innate immunity and adaptive immunity. In the case above, which would likely to occur first? What is innate immunity? Explain.

Application to Practice Scenario

A 13-year-old boy presented to the clinic complaining of a sore throat that persisted for 2 days. After those 2 days, he developed fever, nausea, and malaise. A throat culture revealed the presence of Group A beta hemolytic streptococci, and the child was started on antibiotic therapy. The child’s symptoms gradually improved, but approximately 2 weeks later, he returned to the clinic because the fever, nausea, and malaise returned. He became tachypneic and short of breath.

The mother noted that his eyes were puffy, his ankles were swollen, and his urine was dark and cloudy. On examination, the child’s blood pressure was 148/100 mm Hg, his pulse was 122 beats/min, and his respirations were 35/min. Orbital and ankle edema were present. Rales (abnormal breath sounds) were auscultated bilaterally in the chest, but no heart murmurs were found. Slight tenderness to percussion over the flank areas was noted.

A chest X-ray showed evidence of congestion and edema in the lungs.

The patient’s hematocrit was 37% and his WBC was 11,200/mm3. Blood urea nitrogen was 48 mg/dL (normal is less than 20 mg/dL). Urinalysis results showed that the patient’s protein was 2+ (24-hour excretion was 0.8 g), specific gravity was 1.012, and there were moderate amounts of RBCs and WBCs in the urine. Serum albumin was 4.1 g/dL (normal is 3.5–4.5).

1.Which evidence supports the conclusion that this patient has a kidney disease?

2.Which clinical pattern of kidney disease does this patient have? Can you explain the symptoms?

3.Which morphologic changes would you expect in the kidney?

4.What is the prognosis? What are the possible short- and long-term complications of this disease? Is it necessary to hospitalize the patient?

1. For school counselors: A teenage boy has had a sudden drop in grades, totally out of character. When you see him for your first session what would be some of the questions you would ask him in your initial assessment? What might you look for?

2. An elderly man comes in for therapy 4 months after his wife died. He says he is there because his family is making him. How would you differentiate between normal grieving and major depression. What questions would you ask and what do you look for?

3. What is there to learn for the legacy of loss and traumatic experience (such as Jews in holocaust, being a veteran) and how it plays a role in a persons life? What cues do we look for in a persons history to see if they did experience it?

4. How is family intervention and family therapy beneficial and how did family therapy evolve from the intrapsychic psychoanalytic and psychodynamic models?

Susan and Joe were worried. Their little boy, Daniel, had been having an awful lot of bacterial infections and he was barely a year old. It seemed that the antibiotics cleared up one bacterial respiratory infection only to have another follow shortly. The scary thing was that Daniel had just fought off a case of pneumonia caused by Pneumocystis carnii, a fungal infection that was usually found in people with HIV. Waiting for the test results of an HIV test for their little boy was one of the worst waits ever. Thank goodness it came back negative.

However, it seemed that their troubles were just beginning. After this last lung infection, the fungal one, and a negative HIV test, their doctor had ordered a number of other blood tests, including a genetic test that Susan didn’t fully understand. Apparently the doctor was worried about Daniel’s immune system functions. Susan had also met with a genetic counselor who collected a family history of any immune disorders. The details were vague, but Susan’s mother, Helen, knew that one of her three brothers had died young from an unexplained lung infection. Unfortunately, Grandma Ruth had passed away a few years ago, leaving them with numerous unanswered questions.

Susan and Joe had an appointment with their doctor that afternoon to go over the results. When they arrived Dr. Dresdner led them into an office where Ms. Henchey, the genetic counselor, waited. This can’t be good, thought Susan. The doctor began by explaining that they had analyzed Daniel’s blood and found that while he had normal levels of B cells and T cells, his antibody levels were anything but normal. The levels of IgG, IgA, and IgE were very low, almost undetectable, and Daniel had abnormally high levels of IgM and IgD. He went on to explain the nature of these different categories of immunoglobulins.

Ms. Henchey, the genetic counselor, explained that Daniel had a genetic mutation in the gene for the CD40 ligand.

How does a deficiency in CD40 ligand explain Daniel’s immunological deficiency?

repeated measures experiments measure the same set of research participants two or more times while met subjects experiment study participants who unmatched on one or more characteristics which of the following are true for both a repeated measures experiment and a matched subjects experiment when used to compare two treatment conditions check all that apply a matched subjects experiment produced a t statistic with a deal of eight how many subjects participated in this study boy repeated measures experiment comparing two treatment conditions the T statistic has a dl411 how many subjects participating in this

A young boy, age 2 years, pulled a pot of boiling water over his head, arms, and chest, resulting in a mixed burn to the anterior surface of his head and arms, chest, and feet.

Discuss the additional effects associated with burns and the treatments involved, which include shock, pain, electrolyte and fluid imbalances, respiratory complications, infection, metabolic problems, and anemia. (See Effects of Burn Injury.)

Discuss the actions to promote the healing of burns. Specifically address the problems that may be associated with scarring and the effects of growth that this 2-year-old may experience. (See Healing of Burns.)