Case Study
Patient Demographic: Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)
Mental Status Exam: Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la
Presenting Problem: You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.
Other Contexts:    bile. Family History: The client has two younger brothers who are 6 and 7 years old. The client often engages in physical fights and arguments with his younger siblings and often will break or steal their toys. The client takes advantage of his 6-year-old sibling by conning him out of items and activities by convincing him that a certain trade or decision is better for him, when it is usually better for the client. The client’s parents report that these behaviors occur at school and that the client does not have any friends as far as they are aware. The client’s parents state that the client is adopted and that he was in foster care from when he was 2 until he was 4 years old. The client’s parents state that his basic needs were neglected because his birth mother was heavily using drugs.  It will be important to build rapport with this client to provide effective counseling

Question: It will be important to build rapport with this client to provide effective counseling. Which of the following would most effectively promote therapeutic rapport with this client?
(A): The client is young; therefore, the parents will likely be the ones using interventions so it is more important to have rapport with the parents.
(B): Spend a few sessions trying to play with the client.
(C): Rapport will be built over time, so continue to be consistent and creative with your sessions.
(D): Empathize with the client’s view of why he engages in these behaviors.

Correct Answer: Empathize with the client’s view of why he engages in these behaviors.
Explanation: The client is likely often in trouble with his parents, and teachers and other adults likely side with his parents when he is in trouble. It would be beneficial to your counseling relationship to show the client that you understand why he engages in these behaviors and why he might be frustrated or angry or why he may feel misunderstood. Rapport will be built over time, but coming alongside your client by helping him feel like you are on his side and that you want him to be happy and enjoy himself will be much more beneficial and more proactive. Providing enjoyable activities or playing with your client might increase rapport; however, the client is old enough to engage in cognitive therapeutic work, which might be more beneficial. Although it is important to support the parents, you are the client’s therapist and you need to promote his interests and help him engage in them in a more appropriate manner. Therefore, the correct answer is (B)
Competency: counseling skills and interventions