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.
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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.
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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.
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.
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.
Legal and Ethical Considerations
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Informed consent is the second consideration during counseling sessions. Informed consent defines the relationship between the client and the therapist.
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
