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.  The client expresses frustration that his parents make him do homework when he gets home from school

Question: The client expresses frustration that his parents make him do homework when he gets home from school. Which of the following would be a supportive and empathetic response to the client?
(A): “When you listen to your parents, things seem to work out better for you.”
(B): “What if you asked your parents for a break before you start your homework, in order to take a break from schoolwork?”
(C): “I can see how it might be frustrating to have to start homework right after school.”
(D): “Maybe it would be good to get the homework over with so you can play.”

Correct Answer: “What if you asked your parents for a break before you start your homework, in order to take a break from schoolwork?”
Explanation: It would be supportive to encourage the client to request what he needs, which is a break from schoolwork before starting his homework. It is also empathetic because it identifies and appreciates his unspoken desire for a break and makes the client feel understood and that his desires are valid. The statement identifying that it is frustrating to start schoolwork displays some empathy but does not provide an option for next steps to take and therefore is not the best response in this scenario. Telling the client to get his homework over with or encouraging him to listen to his parents does not provide empathy (because it reinforces the parents’ request over his desire), nor does it assist the client with identifying actions that he can take to improve his situation. Therefore, the correct answer is (D)
Competency: counseling skills and interventions