Case Study
Patient Demographic: Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3)
Mental Status Exam: Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea
Presenting Problem: You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.
Other Contexts: The client’s formal assessment, along with informal observations, warrants a psychiatric evaluation to assess for ADHD, and the PGM has agreed to this. The client has done well in therapy and has met her short-term counseling goals. She has processed grief and loss concerning separation from her parents and shows improvement with emotional regulation. The use of brief strategic family therapy (BSFT) has helped address patterns of interaction between the client and her PGM, and the client is having fewer tantrums. The PGM reports that the client continues to talk back, and she is not completing her chores. You plan to conduct a series of home visits to assist the PGM with parent management skills but receive word from your agency’s office indicating the client has lost insurance coverage

Question: Brief Strategic Family Therapy (BSFT) uses which of the following?
(A): Enactments and sculpting
(B): Reframing and restructuring
(C): Linking and pacing
(D): Chaining and modeling

Correct Answer: Reframing and restructuring
Explanation: Brief strategic family therapy (BSFT) uses reframing and restructuring after joining with the family and diagnosing the problem. BSFT is an evidence-based practice for ODD grounded in the here-and-now, emphasizes process over content, and includes techniques such as reframing and restructuring. Reframing, a form of restructuring, is used to help clients view situations, feelings, and relationships in a more positive light. Counselors use restructuring by instructing families to interact during the therapy session. This allows counselors to assess family dynamics (eg, boundaries and alliances) and restructure family systems by providing alternative ways for members to behave and communicate. Linking is a group leadership skill used to help members relate to one another’s challenges, solutions, and other shared experiences. Pacing occurs when counselors attend to the emotional intensity of a session. Brief strategic family therapists use enactments, while human validation process model family therapists use sculpting. Counselors use enactments by having family members talk to one another rather than the counselor. Enactments help illustrate relationship patterns and identify patterns and roles requiring modification. Sculpting is a non-verbal technique where the counselor physically arranges family members to help them envision aspects of emotional closeness or distance. Chaining, which refers to reinforcing the totality of a sequence of behaviors, is a behavioral therapy technique. Finally, modeling, which is necessary for imitation, is a component of social learning theory. Therefore, the correct answer is (B)
Competency: counseling skills and interventions