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:    iene. Family History: The client’s parents are married, and he has a younger sister who is 6 years old. The client often deliberately annoys or angers his younger sister and has difficulty following directions from his parents.  After you finish talking with the client’s parents, you decide to go to the living room where the client is

Question: After you finish talking with the client’s parents, you decide to go to the living room where the client is. What would assist you in building rapport with this client?
(A): Engage the client in talking about the video game he is playing or play the game with him.
(B): Encourage the client to return to the home office where the session was taking place.
(C): Initiate a conversation about sports with the client to find a common interest.
(D): Continue the intake session in the living room with the client because he seems more comfortable here.

Correct Answer: Engage the client in talking about the video game he is playing or play the game with him.
Explanation: The client is resistant to the therapeutic process or is uninterested. The client may respond well to you showing interest in the game that he is playing because it is his preferred activity and topic. Although it may not feel therapeutic or clinical to talk about video games, this meets the client’s developmental needs to talk about or engage in preferred activities or play. Sports may create further conversation, but it cannot be assumed that the client enjoys sports, nor is establishing common interests a priority in the therapeutic relationship. Encouraging the client to return to the office or to continue the session in the living room may not be fruitful because the client is clearly uninterested in therapy at this moment. Therefore, the correct answer is (B)
Competency: counseling skills and interventions