Case Study
Patient Demographic: Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)
Mental Status Exam: Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg
Presenting Problem: You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.
Other Contexts: You arrive at the client’s house for the session, and he decides to meet with you in the family office and brings some toys with him. He sits on the floor, and you decide to sit on the floor with him and engage in play to continue building rapport. While playing, you begin to ask the client about what frustrates him about his parents, and, through processing, you identify that he desires some independence. You meet with the parents after the session and encourage them to give him some choices throughout his day so that he can have a sense of control. You state that they can be choices that may not be consequential, such as the order of the bedtime routine, so that the routine still happens but he has some control over the order of the process.  During the session, the client requests that his parents bring him a snack, and they decline until the session is over, so the client begins to yell and throw a tantrum

Question: During the session, the client requests that his parents bring him a snack, and they decline until the session is over, so the client begins to yell and throw a tantrum. Based on behavioral therapy, which of the following would be considered the function of this behavior?
(A): Escape
(B): Attention seeking
(C): Sensory
(D): Tangible

Correct Answer: Tangible
Explanation: These terms are often used as part of applied behavior analysis, and, in this situation, the function of behavior is for a tangible item. The client is seeking a snack and was denied one, so his behavior’s function is to push his parents to get frustrated, give in to his behavior, and provide what he wants. The counselor’s response to this would be to encourage more effective and appropriate manners of expressing his wants and needs. The behavior can be rewarded when he appropriately advocates for his wants and needs. It is possible that the request for a snack is to escape the session. However, the behavior was clearly escalated when he was denied the snack, so the behavior was more about being denied the item. The client is not requesting the snack for attention-seeking purposes, demonstrated by his strong reaction to not being able to have one at that moment. Generally, attention-seeking behavior is focused primarily on the attention, rather than the outcome of the request or behavior. In this scenario, the client is already the center of attention in the session. Therefore, the correct answer is (A)
Competency: counseling skills and interventions