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

Question: Based on the client’s developmental level, why is it important that his parents are engaged in his treatment?
(A): The client does not want to participate in counseling, so his parents will be the ones participating in treatment.
(B): The presenting problem is centered around the client’s difficulty with following directions from his parents and teachers.
(C): The client is not developmentally able to deal with strong emotions, so his parents will need to support him.
(D): The client is not self-aware enough to know when he needs to cope with strong emotions.

Correct Answer: The client is not self-aware enough to know when he needs to cope with strong emotions.
Explanation: Developmentally, the client does not have the self-awareness to know when he needs to cope with strong emotions and thoughts; therefore, it will be important for his parents to prompt him to cope when he is experiencing these triggers. The client is able to deal with strong emotions at this age, but he may not always know when he needs to, so his parents’ support will be very important. The presenting problem does involve a defiance in following directions from his parents, but this is not related to his developmental level. The client is currently resistant to therapy, but he has improved his engagement from the last session; therefore, it is possible that he will be able to fully participate at some point. Therefore, the correct answer is (A)
Competency: treatment planning