Case Study
Patient Demographic: Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th
Presenting Problem: You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.
Other Contexts: The couple acknowledge some improvement with communication, but they continue to feel significant levels of relationship distress. The client has been asking for what she needs, mainly when she is in pain and functionally limited, but she reports that the husband continues to do little to support her. The husband reiterates that he has a demanding job that depletes his energy and that he has little to give when he gets home at night. The husband’s child has been verbally abusive to the client, and her husband minimizes her concern. The client feels “stuck in the middle” when determining her stepson’s schedule and activities. The client states that her husband’s bitter ex-wife makes her new role as stepparent “nearly impossible.” To help with the postdivorce adjustment and lessen conflict, you provide information on local support groups, parent education programs through family court, and additional educational resources.  You provide educational resources outlining your parenting recommendations

Question: You provide educational resources outlining your parenting recommendations. Which of the following would most benefit all involved parties?
(A): Collaborative parenting
(B): Authoritative parenting
(C): Cooperative parenting
(D): Parallel parenting

Correct Answer: Parallel parenting
Explanation: Parallel parenting is effective for divorced parents who have low degrees of cooperation and high degrees of conflict. Parallel parenting allows parents to disengage from one another but remain engaged in their children’s lives. After disengagement, plans are made that determine who is responsible for various parenting domains, such as medical and educational care. Parents form independent relationships with teachers, doctors, and coaches, and communication between the parents is generally conducted via email or through a neutral third party. This approach would benefit the primary client because she would feel less of the burden in raising her husband’s son, in addition to benefiting her husband and her husband’s ex-wife, therefore relieving stress on the entire unit. Cooperative parenting works best with high-cooperation and low-conflict parents. Parents who engage in cooperative parenting effectively communicate with one another and agree on shared responsibilities. Collaborative parenting is used interchangeably with cooperative parenting, making it the preferred approach for couples who communicate effectively and engage in mutual decision making. Parents who use an authoritarian approach emphasize strict obedience and inflict harsh punishments when rules are broken. Using this approach as a form of “tough love” for the husband’s child is ill advised and could be detrimental to the child’s overall well-being. Therefore, the correct answer is (B)
Competency: counseling skills and interventions