Case Study
Patient Demographic: Client Age: 4 Sex: Female Gender: Female Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not applicable Counseling Setting: Private Practice Clinic Type of Counseling: Family Therapy Presenting Problem: Foster Care; Disengaged Child; Behavioral Problems Diagnosis: Provisional Diagnosis of Reactive Attachment Disorder (F94.1)
Mental Status Exam: Mental Status Exam: The client is disengaged, and when the foster parents prompt her to answer questions, she ignores them and continues playing. The client appears oriented to person, place, time, and situation because she answered questions about these topics. The client appeared more responsive to your questions than her foster par
Presenting Problem: You are a private practice counselor specializing in working with children with developmental disorders. The 4-year-old female client is referred to you by her PCP and arrives with her foster parents, who join her in the first session. The client has been with her foster parents for the last 13 months after being removed from the care of her biological parents due to their incarceration for drug trafficking and attempted armed robbery. The foster parents are worried because the client exhibits minimal positive mood, irritability without an obvious trigger, and behaviors that appear to be clearly connected to attachment with caregivers. She experienced emotional and physical neglect from the birth parents and changes in primary caregivers. The foster parents also report that the client does not seek comfort when something happens that upsets her. The client did not engage very much in the intake session and was instead playing with the toys provided by the counselor. During the session, the client becomes upset with her foster parents when they prompt her to answer some questions. She hits the foster father, runs out to the lobby, and sits down with the toys. You leave the office and meet her in the lobby.
Other Contexts: ents. Family History: The client entered foster care 1 year ago when her parents were arrested on charges of drug trafficking and armed robbery. The client has been with the same foster parents for the past year. The client experienced emotional and physical neglect by her birth parents and was separated from her 5-year-old brother and 2-year-old sister when she entered foster care. He appears to have had trouble with attachment to the foster parents per the foster parents’ report

Question: All of the following are appropriate treatment objectives for reactive attachment disorder EXCEPT:
(A): Assist the foster parents with demonstrating expectations, feedback, and structure to demonstrate that they are in control.
(B): Assist the foster parents with reframing the client’s problem behaviors as opportunities to support and love their foster child.
(C): Instruct the client on cognitive reframing on anxiety about being with the foster parents.
(D): Develop trust and comfort with the client.

Correct Answer: Instruct the client on cognitive reframing on anxiety about being with the foster parents.
Explanation: The client is too young to have a cognitive focus in therapy because she will have trouble processing thoughts and feelings about her situation. Developing trust and comfort with the client is important because she is unengaged in therapy and may need help feeling comfortable with adults in order to engage in therapy. The foster parents would benefit from learning to reframe problem behaviors as opportunities to build their relationship with their foster child. They would also benefit from providing expectations, feedback, and structure on a consistent basis, which shows the client that her caregivers are in control and have her best interests in mind, which might help her manage strong emotions. Therefore, the correct answer is (D)
Competency: counseling skills and interventions