To prepare:
Review this week’s Learning Resources and reflect on the insights they provide.
View the media, Disruptive Behaviors. Select one of the four case studies and assess the client.
For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources.
Case study on blaming adolescent :
Write an explanation of your observations of the client in the case study you selected, including behaviors that align to the criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.
Week 9 Main Discussion Post
Counseling Adolescents
The case study I selected to discuss involved the blaming adolescent. The client presented appears as a middle adolescent male. In the scenario, the adolescent has stolen a car that does not belong. To justify why he has taken the car, he placed the blame on the owner of the car because he left the keys in it. He also mentions that his parents need counseling, not him. Unfortunately, he does not take full responsibility for his poor actions. He appears to believe he is innocent, and others are to blame for his actions.
Diagnosis
His behavioral actions may be a result of uncontrolled emotions such as anger. Disruptive, impulse-control and conduct disorders are a group of psychiatric conditions that affect the self-regulation of emotions and behaviors and begin in childhood or adolescence (Amboss, 2018). A differential diagnosis for the presented client would be oppositional defiant disorder. According to the Substance Abuse and Mental Health Services Administration (2016), the oppositional defiant disorder is classified as a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months. It is essential to investigate the possible causes of ODD. Defiant behavior in children can be triggered by family abuse, unstable home environment, or sudden change in family structure.
Therapeutic Approaches
A recommended therapeutic approach would be cognitive behavioral therapy (CBT), which involves the psychotherapist collaborating with the client. Cognitive behavior therapy helps the patient understand that they are not bad, but the behavior may be (Wheeler, 2014). With CBT, clients learn to cope effectively with negative emotions by developing new cognitive and behavioral skills. To change an emotion, one must change how they behave or act.
An additional therapeutic approach I would use would be dialectical behavior therapy, which is a research-based therapy. The client presents with impulse control, poor insight, and defiance. Dialectical behavior therapy focuses on the client’s overall behavior. Clients with difficulty managing the emotional challenges of their lives because they lack the needed behavioral coping skills. With the use of this therapy, the client would openly discuss their feelings, display insight into their decision process while judgment is not portrayed. A strong commitment to change must be displayed. According to Mindfulness Therapy Associates (2019), Research has shown that DBT treatment is most effective when it includes individual therapy, a weekly skills training group, and assistance with skills application by phone with the own therapist between sessions.
Psychotropic Medications
Research shows psychotropic medications are not recommended to treat ODD in children and that no drugs have been specifically approved. ODD should be treated as an emotional and behavior challenge that requires therapy, changes in a person’s environment and support to develop better social skills (Good Therapy, 2019). Since children diagnosed with ODD are often diagnosed with ADHD, stimulant medications can be used as a source of treatment.
Expected Outcomes
With the implementation of therapeutic approaches such as cognitive-behavioral therapy and dialectical behavior therapy, clients will be empowered to make their own decisions. Hopefully, they will have a greater understanding that there are consequences to all chosen choices, and they are held accountable for their actions. Additional mental health conditions, such as ADHD or conduct disorder, need to be examined to determine if associated with ODD. With an understanding and managing feelings of defeasance and opposition, clients maintain happy relationships and tend to excel at work and school.
References
Amboss. (2019). Disruptive, impulse-control, and conduct disorders. Retrieved from
control%2C_and_conduct_disorders
Good Therapy. (2019). Oppositional Defiant Disorder Treatment. Retrieved from
https://www.goodtherapy.org/learn-about-therapy/issues/oppositional-and-defiant-
disorder/treatment
Mindfulness Therapy Associates. (2019). Dialectical Behavior Therapy (DBT). Retrieved from
Substance Abuse and Mental Health Services Administration. (2016). DSM-5 Changes:
Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD):
Substance Abuse and
Mental Health Services Administration (US); Table 18, DSM-IV to DSM-5
Oppositional Defiant Disorder Comparison. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t14/
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 18, DSM-IV to DSM-5 Oppositional Defiant Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t14/
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to
Guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing
Company.
Chapter 17, “Psychotherapy With Children” (pp. 597–624).
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 18, DSM-IV to DSM-5 Oppositional Defiant Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t14/