Adolescent Counselling: Oppositional Defiant Disorder.
Counseling is a method used to provide psychological care to mentally disturbed or mentally ill patients with the goal of restoring normal functioning of the individual. Mental health problems often pose challenges to the affected individuals by impairing communication, coping skills and judgment leading to behavior change.
Mental disorders are common worldwide, and according to statistics, about one in every five people in the United States suffers from a mental health disorder in a given year (McLeod et al., 2016). The Diagnostics and Statistical Manual (DSM-5) provides a list of mental disorders and gives the criterion for each diagnosis made in the healthcare set up. I was involved in counseling a client diagnosed with an Opposition Defiant Disorder (ODD), and this paper outlines the findings from the counseling session. It describes the pertinent history of the patient, justification of the diagnosis and legal implications of counseling the client.
Description and Pertinent History
Demographics: The client is a 13-year old Male of American origin. He stays with his parents at their home in northern California and goes to school at a nearby facility. The client communicates well in English, and he attends church services regularly at a nearby Catholic church.
Presenting Complains: The client reports that “I was given duty at school by the class teacher to do, but I did not feel like doing it. When I refused, I was called to the head teacher’s office, but instead of him listening to my views he wanted to punish me. I was angry and banged the door as I walked out of the office. When people give me orders, I feel irritated and angry.” The mother reported that the client has been aggressive of late; refusing any orders given by adults and when he makes mistakes he blames them on others. The parent also reports that the client loses his temper easily, shouts at his siblings and is spiteful occasionally.
History of Presenting Illness: The client is calm, talkative and is oriented to time, place and person. The client’s mother reports that it is almost six months now since he started showing disrespect. He has been refusing to do, tasks at home, walks out when being advised and lacks respect for the elders. Sometime back two of the neighbors reported that the client was aggressive and abused other children. When asked about the same, the client blamed the victims saying that they called him names. The client reports that he feels angry when people give him tasks that should be done by others, and he doesn’t like being given orders anymore. Three weeks ago, the client was counseled by teachers at school about his behavior, and he agreed to change. A week later, he was observed by the class teacher shouting at other students, spitting at them and when asked he, denied the accusations. The client has been calm until yesterday when the misconduct was observed at the head teacher’s office.
Past Psychiatric History: The client has a history of substance abuse. The mother reports that when he was staying at her aunt’s place two years ago, he used to abuse cocaine secretly. They realized the abuse earlier, and he was taken for a medical checkup at a nearby psychiatric center. No medications were given to solve the issue because he was not addicted. It was during this time that the client moved back to the family in California and enrolled in the current school. He attended a few psychotherapy sessions to streamline behavior, but they did not last long as he was not abusing cocaine anymore.
Family History: He is the second born in a family of three. Both parents are alive, and he stays with his mother in California while the father works in New York. There is a family history of substance abuse. The client’s father uses alcohol, and it is observed that his grandfather died two years ago due to alcohol intoxication. There is no history of chronic illnesses like diabetes, hypertension or cancer in the family.
Prescribed Medications: The patient is currently on Risperidone 1mg PO OD. Risperidone is a selective blocker of dopamine and serotonin used primarily in the management of psychosis. It is found to be effective in the management of positive and negative signs of schizophrenia. However, the drug is also effective in the management of aggression and irritability (Laureate Education, 2013). It is effective impulse control which reduces aggression. The low dosage of 1mg was used as a starting, but adjustments will be made depending on the patient’s progress.
DSM-5 Diagnosis: Oppositional Defiant Disorder Code F91.3
The diagnostics and the statistical manual gives the criteria for the diagnosis of an oppositional defiant disorder. According to DSM-5, an oppositional defiant disorder is characterized by emotional and behavioral symptoms that last for at least six months (American Psychiatric Association, 2013). The symptoms include: Angry and irritable mood presented by the person often losing temper, often angry and resentful and is frequently touch and easily annoyed by others. Secondly, the individual shows argumentative and defiant behavior manifested by arguing with adults, the person often defies complying with rules and often blames others for his mistakes. The individual also shows signs of vindictiveness such as spitting often. For a full diagnosis to be made, the individual must present with at least four of the symptoms.
Justification: The patient is an adolescent manifesting with signs of an oppositional defiant disorder. It is observed that the patient is aggressive, disobeys commands given by adults, is irritable and blames others for his mistakes. According to the history taken, the client has been showing the symptoms for six months now and irrespective of counseling for behavior change, the symptoms are persistent. The above manifestation leads to a diagnosis of an oppositional defiant disorder.
Legal and Ethical Considerations
Ethical considerations in client counseling are applied to give a guide to the nature of the relationship between the therapist and the patient. The therapists understand that patients have rights that should be adhered to during therapy sessions. The moral principles of reasoning should be used by therapists during client counseling to evaluate the course of action (Wheeler, 2014). Autonomy, beneficence, justice, nonmaleficence, and fidelity should be used to make decisions during difficult situations, especially in mentally ill patients.
The first ethical consideration in counseling the client is confidentiality. Confidentiality is an ethical consideration used in counseling sessions especially CBT that involves keeping the patient’s information between the brackets of the patient and the therapist. The patient has the right to sue the health practitioner f their confidential information is breached. The patient has the right to dictate who should be given information concerning treatment or the diagnosis (Koocher, 2003). In some cases, the therapist uses privileged notes to keep off the hospital record confidential information regarding the patient’s treatment.
Informed consent is the second consideration during counseling sessions. Informed consent defines the relationship between the client and the therapist. It gives the client the opportunity to feel that they are part of the team trying to offer a solution for the problem (Kaplan, 2014). Informed consent covers the diagnosis of the patient, the rationale for the treatment or counseling session offered, the risks involved regarding the therapy and any other options available. When the patient is unable to make decisions on their own as observed in the minors, the parents or significant others should be informed on their behalf.
The health protection and portability act (HIPPA) advocates for good record keeping as part of the standards of practice (Kaplan, 2014). The information of the patient should remain in the healthcare setting all the time for protection. The counselors and the nursing practitioners should remain updated on the legal and ethical issues associated with counseling the clients. The clients need assistance to cope with their diagnosis as well as dealing with psychological concerns that affect their daily living. The counselors should minimize the effects of counseling offered both to the patient and the family, and this is made possible through the guidance of the ethical principles of counseling. The counselor understands that any breach of the legal and ethical considerations might lead to the intervention of the law as stipulated by the patient’s protection act.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Bass, C., van Nevel, J., & Swart, J. (2014). A comparison between dialectical behavior therapy, mode deactivation therapy, cognitive behavioral therapy, and acceptance and commitment therapy in the treatment of adolescents. International Journal of Behavioral Consultation and Therapy, 9(2), 4–8. doi:10.1037/h0100991
Kaplan, D. M. (2014). Ethical implications of a critical legal case for the counseling profession: Ward v. Wilbanks. Journal of Counseling & Development, 92(2), 142-146.
Koocher, G. P. (2003). Ethical issues in psychotherapy with adolescents. Journal of Clinical Psychology, 59(11), 1247–1256. PMID:14566959
Laureate Education (Producer). (2013a). Disruptive behaviors – Part 1 [Multimedia file]. Baltimore, MD: Author.
McLeod, B. D., Jensen-Doss, A., Tully, C. B., Southam-Gerow, M. A., Weisz, J. R., & Kendall, P. C. (2016). The role of setting versus treatment type in alliance within youth therapy. Journal of Consulting and Clinical Psychology, 84(5), 453–464. doi:10.1037/ccp0000081
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
Zilberstein, K. (2014). The use and limitations of attachment theory in child psychotherapy. Psychotherapy, 51(1), 93–103. doi:10.1037/a00309
Counseling is a method used to provide psychological care to mentally disturbed or mentally ill patients with the goal of restoring normal functioning of the individual. Mental health problems often pose challenges to the affected individuals by impairing communication, coping skills and judgment leading to behavior change. Mental disorders are common worldwide, and according to statistics, about one in every five people in the United States suffers from a mental health disorder in a given year (McLeod et al., 2016). The Diagnostics and Statistical Manual (DSM-5) provides a list of mental disorders and gives the criterion for each diagnosis made in the healthcare set up. I was involved in counseling a client diagnosed with an Opposition Defiant Disorder (ODD), and this paper outlines the findings from the counseling session. It describes the pertinent history of the patient, justification of the diagnosis and legal implications of counseling the client.
Description and Pertinent History
Demographics: The client is a 13-year old Male of American origin. He stays with his parents at their home in northern California and goes to school at a nearby facility. The client communicates well in English, and he attends church services regularly at a nearby Catholic church.
Presenting Complains: The client reports that “I was given duty at school by the class teacher to do, but I did not feel like doing it. When I refused, I was called to the head teacher’s office, but instead of him listening to my views he wanted to punish me. I was angry and banged the door as I walked out of the office. When people give me orders, I feel irritated and angry.” The mother reported that the client has been aggressive of late; refusing any orders given by adults and when he makes mistakes he blames them on others. The parent also reports that the client loses his temper easily, shouts at his siblings and is spiteful occasionally.
History of Presenting Illness: The client is calm, talkative and is oriented to time, place and person. The client’s mother reports that it is almost six months now since he started showing disrespect. He has been refusing to do, tasks at home, walks out when being advised and lacks respect for the elders. Sometime back two of the neighbors reported that the client was aggressive and abused other children. When asked about the same, the client blamed the victims saying that they called him names. The client reports that he feels angry when people give him tasks that should be done by others, and he doesn’t like being given orders anymore. Three weeks ago, the client was counseled by teachers at school about his behavior, and he agreed to change. A week later, he was observed by the class teacher shouting at other students, spitting at them and when asked he, denied the accusations. The client has been calm until yesterday when the misconduct was observed at the head teacher’s office.
Past Psychiatric History: The client has a history of substance abuse. The mother reports that when he was staying at her aunt’s place two years ago, he used to abuse cocaine secretly. They realized the abuse earlier, and he was taken for a medical checkup at a nearby psychiatric center. No medications were given to solve the issue because he was not addicted. It was during this time that the client moved back to the family in California and enrolled in the current school. He attended a few psychotherapy sessions to streamline behavior, but they did not last long as he was not abusing cocaine anymore.
Family History: He is the second born in a family of three. Both parents are alive, and he stays with his mother in California while the father works in New York. There is a family history of substance abuse. The client’s father uses alcohol, and it is observed that his grandfather died two years ago due to alcohol intoxication. There is no history of chronic illnesses like diabetes, hypertension or cancer in the family.
Prescribed Medications: The patient is currently on Risperidone 1mg PO OD. Risperidone is a selective blocker of dopamine and serotonin used primarily in the management of psychosis. It is found to be effective in the management of positive and negative signs of schizophrenia. However, the drug is also effective in the management of aggression and irritability (Laureate Education, 2013). It is effective impulse control which reduces aggression. The low dosage of 1mg was used as a starting, but adjustments will be made depending on the patient’s progress.
DSM-5 Diagnosis: Oppositional Defiant Disorder Code F91.3
The diagnostics and the statistical manual gives the criteria for the diagnosis of an oppositional defiant disorder. According to DSM-5, an oppositional defiant disorder is characterized by emotional and behavioral symptoms that last for at least six months (American Psychiatric Association, 2013). The symptoms include: Angry and irritable mood presented by the person often losing temper, often angry and resentful and is frequently touch and easily annoyed by others. Secondly, the individual shows argumentative and defiant behavior manifested by arguing with adults, the person often defies complying with rules and often blames others for his mistakes. The individual also shows signs of vindictiveness such as spitting often. For a full diagnosis to be made, the individual must present with at least four of the symptoms.
Justification: The patient is an adolescent manifesting with signs of an oppositional defiant disorder. It is observed that the patient is aggressive, disobeys commands given by adults, is irritable and blames others for his mistakes. According to the history taken, the client has been showing the symptoms for six months now and irrespective of counseling for behavior change, the symptoms are persistent. The above manifestation leads to a diagnosis of an oppositional defiant disorder.
Legal and Ethical Considerations
Ethical considerations in client counseling are applied to give a guide to the nature of the relationship between the therapist and the patient. The therapists understand that patients have rights that should be adhered to during therapy sessions. The moral principles of reasoning should be used by therapists during client counseling to evaluate the course of action (Wheeler, 2014). Autonomy, beneficence, justice, nonmaleficence, and fidelity should be used to make decisions during difficult situations, especially in mentally ill patients.
The first ethical consideration in counseling the client is confidentiality. Confidentiality is an ethical consideration used in counseling sessions especially CBT that involves keeping the patient’s information between the brackets of the patient and the therapist. The patient has the right to sue the health practitioner f their confidential information is breached. The patient has the right to dictate who should be given information concerning treatment or the diagnosis (Koocher, 2003). In some cases, the therapist uses privileged notes to keep off the hospital record confidential information regarding the patient’s treatment.
Informed consent is the second consideration during counseling sessions. Informed consent defines the relationship between the client and the therapist. It gives the client the opportunity to feel that they are part of the team trying to offer a solution for the problem (Kaplan, 2014). Informed consent covers the diagnosis of the patient, the rationale for the treatment or counseling session offered, the risks involved regarding the therapy and any other options available. When the patient is unable to make decisions on their own as observed in the minors, the parents or significant others should be informed on their behalf.
The health protection and portability act (HIPPA) advocates for good record keeping as part of the standards of practice (Kaplan, 2014). The information of the patient should remain in the healthcare setting all the time for protection. The counselors and the nursing practitioners should remain updated on the legal and ethical issues associated with counseling the clients. The clients need assistance to cope with their diagnosis as well as dealing with psychological concerns that affect their daily living. The counselors should minimize the effects of counseling offered both to the patient and the family, and this is made possible through the guidance of the ethical principles of counseling. The counselor understands that any breach of the legal and ethical considerations might lead to the intervention of the law as stipulated by the patient’s protection act.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Bass, C., van Nevel, J., & Swart, J. (2014). A comparison between dialectical behavior therapy, mode deactivation therapy, cognitive behavioral therapy, and acceptance and commitment therapy in the treatment of adolescents. International Journal of Behavioral Consultation and Therapy, 9(2), 4–8. doi:10.1037/h0100991
Kaplan, D. M. (2014). Ethical implications of a critical legal case for the counseling profession: Ward v. Wilbanks. Journal of Counseling & Development, 92(2), 142-146.
Koocher, G. P. (2003). Ethical issues in psychotherapy with adolescents. Journal of Clinical Psychology, 59(11), 1247–1256. PMID:14566959
Laureate Education (Producer). (2013a). Disruptive behaviors – Part 1 [Multimedia file]. Baltimore, MD: Author.
McLeod, B. D., Jensen-Doss, A., Tully, C. B., Southam-Gerow, M. A., Weisz, J. R., & Kendall, P. C. (2016). The role of setting versus treatment type in alliance within youth therapy. Journal of Consulting and Clinical Psychology, 84(5), 453–464. doi:10.1037/ccp0000081
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
Zilberstein, K. (2014). The use and limitations of attachment theory in child psychotherapy. Psychotherapy, 51(1), 93–103. doi:10.1037/a00309
