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:    iene. Family History: The client’s parents are married, and he has a younger sister who is 6 years old. The client often deliberately annoys or angers his younger sister and has difficulty following directions from his parents

Question: Which of the following would be a clinically appropriate short-term goal at this point in therapy once rapport is built?
(A): Improve the client’s ability to follow directions from his parents.
(B): Improve social interactions with peers and his sister.
(C): Improve grades and functioning in school.
(D): Improve the client’s awareness of the consequences of his actions.

Correct Answer: Improve the client’s awareness of the consequences of his actions.
Explanation: The client becoming more aware of the consequences of his actions would be an appropriate short-term goal at this point in the therapeutic relationship. This would be appropriate because it is prioritizing creating awareness more than a significant change in behavior and would assist the client in knowing what he is doing and how it affects himself and others. Assisting the client with awareness of his behavior can also help because if the client can find more effective ways of meeting his needs, he may be more motivated to make changes. Grades, functioning in school, social interactions, and ability to take directions are more long-term goals of therapy because they require incremental change and will take time to achieve. Therefore, the correct answer is (C)
Competency: treatment planning