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: The client appears to be more comfortable with you as he greets you at the door and starts talking with you about his favorite TV show as you walk back to the office. The client talks about how his parents give different consequences to him than his younger sister and that they also give her more attention than they give him. You empathize with the client about this because it must be frustrating being treated differently. You assist the client with processing further, and he identifies feeling like he is “bad.” But because he gets attention, he continues to push back against their authority. During this session, the client curses at his parents and they punish him by removing access to video games for the next week.  You are using the rational emotive behavior therapy ABC model with the client during this session. You want to challenge the client’s belief that “my parents don’t like me” following their punishment of him

Question: You are using the rational emotive behavior therapy ABC model with the client during this session. You want to challenge the client’s belief that “my parents don’t like me” following their punishment of him. All of the following statements would be a disputation of that belief EXCEPT:
(A): “My parents do like me, and that is why they’re punishing me.”
(B): “My parents don’t want me to be mean, so they made me take time to calm down.”
(C): “My parents don’t like me right now, so they made me take time to calm down.”
(D): “My parents don’t like what I’m doing, so they punished me.”

Correct Answer: “My parents don’t like me right now, so they made me take time to calm down.”
Explanation: The purpose of disrupting beliefs is to challenge thoughts that are harmful or unhelpful. The answer that states “my parents don’t like me right now, so they made me take time to calm down” is still unhelpful because it validates that the client is not liked by his parents. The other options promote the idea that the parents care about him and want him to do and feel better. Therefore, the correct answer is (D)
Competency: counseling skills and interventions