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.  The client states, “My parents suck! They only care about my younger sister

Question: The client states, “My parents suck! They only care about my younger sister.” Which one of the following statements would best be defined as a reflection of feeling by the counselor?
(A): “I can see how you might be frustrated or sad if you feel like they don’t care about you.”
(B): “That sounds like it could feel very lonely or that maybe you feel overlooked.”
(C): “It sounds like you don’t like your parents very much because you feel like they only care about your sister.”
(D): “You seem bothered by their attention at times, but do you wish you had a different kind of attention?”

Correct Answer: “That sounds like it could feel very lonely or that maybe you feel overlooked.”
Explanation: Expressing that the client might feel lonely or overlooked is a reflection of feeling, which is a method of deducing and acknowledging the emotions behind what the client has stated. Sometimes, this technique is beneficial because the client may not be aware of the roots of his feelings. Responding to the client’s statement with a question about how he might be bothered by attention or may want different attention would be the use of clarification. Relating to the client’s feelings by saying that you can understand how he might feel sad or frustrated is an expression of empathy. Identifying that you hear the client saying that he does not like his parents because they prefer his sister is an example of paraphrasing. Therefore, the correct answer is (B)
Competency: counseling skills and interventions