Case Study
Patient Demographic: Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1)
Mental Status Exam: Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par
Presenting Problem: You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.
Other Contexts: You meet with the client 2 weeks after the initial intake because she refused to come for the session scheduled the past week. Because of the cancellation, you decide to change the focus of your session to meet the client’s needs for comfort and security over the foster parents’ need for guidance and skills. The client engages a little more in interacting with you, and you praise her for her involvement. At one point in the session, the client hits you and goes and sits down to continue playing. At the end of the session, you provide the foster parents with ways that they can increase attachment and positive interactions with your client. You empathize with the foster parents regarding their desire to help the client feel loved and cared for

Question: All of the following can be beneficial in improving attachment between the foster parents and the client EXCEPT:
(A): Encourage the foster parents to bring the client to visit her birth parents to show that they affirm the client’s past experiences and biological family.
(B): Encourage the parents to provide family activities focused on family cohesion.
(C): Engage in one-on-one play daily with the client.
(D): Provide physical affection and verbal reinforcement daily to the client.

Correct Answer: Encourage the foster parents to bring the client to visit her birth parents to show that they affirm the client’s past experiences and biological family.
Explanation: Encouragement to visit the client’s birth parents should be a highly planned out event, should be coordinated with the foster care case manager, and should follow court recommendations. This kind of visit has the potential to cause harm to the client and also to the client’s relationship with her caregivers. One-on-one play, physical affection, verbal reinforcement, and family cohesion activities can all foster a more appropriate attachment between the client and the foster parents. Therefore, the correct answer is (D)
Competency: counseling skills and interventions