Case Study 4

The subject in this case study was a 16-year-old Korean adolescent who migrated to New Zealand. This case suggests that these 3 therapies could be combined to form a treatment model, which could significantly benefit the client and positively impact behaviour change (Lee, 2011).The case study provides a question for viewers to consider and reflect on.

Case Study 4: Internet game addiction (Korean)

(Adapted from Lee, 2011).

Jin Soo, a 16-year-old Korean adolescent was referred to Child and Adolescent Mental Health Service (CAMHS) by his mother because of his negative attitude, depression, and overuse of the internet. Even though he did not want to emigrate from Korea to a Western country to study, his parents persuaded him to move with his mother and brother. He migrated to New Zealand 4 years ago and had difficulty speaking English. He withdrew from his friends. Jin Soo started playing internet games at the age of seven. Since moving to New Zealand, he spends many more hours playing games because he spends so much time alone.

For Koreans respect between older and younger generations is very important. While Westerners refer to another as “you” regardless of age and status, Koreans use different pronouns to address those who are older which indicate respect. Jin Soo has poor social relationships with his brother and with Korean seniors because he does not use the respectful forms of address. Jin Soo’s mother was concerned about his negative attitude towards his father. For example, when his father visited him from Korea, and suggested doing something together, Jin Soo was negative. 

Jin Soo wanted to reduce the hours of using internet games. He spent 3 to 5 hours on playing games on weekdays and 13 hours on weekends. He said that it was difficult to control, especially on weekends.

THE PROCESS OF INTERVENTION

The counsellor was a European woman. Counselling consisted of five individual sessions that ranged in length from 30 minutes to 1 hour per week. Homework assignments were used to record Jin Soo’s activities and how he spent his time. The counsellor explored the thoughts, emotions, and behaviour that helped him to control his desire to play games. The counsellor and Jin Soo discussed how to manage his time during the week and stickers were used as a reward when he kept his promise.

Behaviour Modification

The first session focused on obtaining a general assessment. The second session focused on the assessment of game addiction and creating a contract for behaviour modification. Jin Soo agreed to try to reduce the time spent on games and to increase the time spent on other healthy activities. His mother promised to give him half the money he needed for a new computer if he reached his goal.

The contract was in written form and signed by Jin Soo, his mother, and a counsellor. Also, Jin Soo was asked to record the time he spent on games and alternative activities on paper.

In the third session, his mother said that he had decreased his game-playing time but showed agitation because of reducing the time spent on games. He spent less than 1 hour per a day on weekdays, but spent over 3 hours per day during the weekend. He had little to occupy himself on weekends. He tried to talk with his mother and watched television dramas instead of playing games. In the fourth session, he reached his goal for only 2 days. He said that he woke up early, did homework, fared well in his exam, and exercised. He skipped two sessions because he slept late in the morning. His mother said that he sat up all night hanging out with his friends. In the fifth session, he did not reach his goal for even 1 day. He spent over 3 hours on games every day, but he tried to spend time on basketball, talking, and bowling with friends. He explained that he did not come the last 2 weeks because he thought it was too much trouble and it was too far to travel to CAMHS. When he was asked whether he wanted to continue with counselling, Jin Soo avoided giving a direct answer. He was given 1 week to think about this. After contacting the counsellor, finally he said that he wanted to give up.

Cognitive-Behavioural Therapy

Jin Soo was encouraged to be conscious that he was spending more time on games, than he intended to and to explain which emotions, thoughts, and behaviours contributed to his overuse of games. He was encouraged to think about which factors were helpful in reducing time spent on games. Jin Soo was asked to record his thoughts, emotions, and behaviours related to games on a form each week. In the second session, discussion focused on the reasons for spending time on games, the disadvantages of playing games, methods to use to decrease time spent on games, and how to improve his overall health. Jin Soo said he played online games because it was fun; he could meet people through online games, and feel satisfaction when he reached the goals of game scores. He wanted to reduce time on computer games because it interfered with his study and was not good for his health. In the third session, a screening tool for measuring his game addiction was given because he did not accept that he was addicted to computer games. He thought that if he wanted to, he could stop. He was encouraged to express emotions, thoughts, and behaviours related to games. He always felt bored at home. When he felt bored, he usually played computer games. He could not drive. His mother and brother were usually away from home until the evening or late at night and he was often alone on weekdays. Loneliness contributed to his game addiction. In the fourth session, he forgot to bring his homework. He expressed feeling burdened by doing his counselling homework. The idea of cognitive-behavioural therapy was good, but it was difficult for him to practice daily. As time went by, he had difficulty accurately writing down his exact hours on different activities. Additionally, he was asked to record weekly (1) his activities and time, (2) his emotions, thoughts, and behaviours related to games. It was difficult for him to keep the records and bring them to the sessions.

The main issue for Jin Soo was managing his boredom. It was suggested that he do something different with his time. After the fifth session, he started to learn golf and he was becoming more interested in golfing. This meant that he reduced the time he spent on games. He and his mother were encouraged to spend time outside the house doing something together such as playing golf.

12-Step Programme

The questions for each session were based on the 12-step programme (On-line game anonymous, 2006). For example, the goal of the first session was “we admitted we were powerless over on-line gaming and that our lives have become unmanageable”. The counsellor offered three questions to approach this goal. “Which part is difficult for you to control?”, “Which part is easy for you to control?” and “Have you despaired about your failure of self-control?” Jin Soo doubted the existence of God because he prayed for something but God did not answer. Therefore he doubted God could help with his problems. He did not feel the need to pray. In the fourth session, what harm he caused to others was discussed. He said that he often lied in online games to sell his items at a high price. He said that he used abusive words because his friend used those words. He said he would try to reduce the abusive words he used. He was encouraged to apologise to the people he harmed through lying and using abusive words. In the fifth session, demerits in his character were discussed. He said that he had difficulty accepting authority figures, often used abusive language, had perfectionism, and played games excessively. He thought that his perfectionism contributed to game addiction because he made a goal for game scores and he wanted to reach the goal. He was encouraged to think about the reasons he had difficulty having relationships with older people. He knew that he should use respectful language and manners when he met Koreans but he said that he did not want to behave differently towards Westerners and Koreans. It felt to him like having a dual personality. His counsellor empathised with the difficulty of living with the expectations of two cultures. He was encouraged to think about other’s perspectives. To have a good relationship with others, his counsellor explained the need to act differently according to different cultural norms.

Result of the intervention

The programme consisted of eight sessions originally. However, the counselling stopped after five sessions. During the counselling, there was some improvement. However, Jin Soo did not do his homework and did not keep his promise to reduce game hours. In the 2-month follow-up, his mother said that he had reduced his game time since he had started golfing with her.