Counselling Adolescents with Disruptive Behavior

Client Assessment 

The client is characterized by a persistent pattern of impulsivity and hyperactivity (inattention), which can be said to be inappropriate compared with their peers. This pattern is evident both at home and school and is reciprocated across multiple settings with little change. Notably, the patient is identified with behavioral symptoms of being vindictive, easily irritable, and argumentative; which are usually displayed in their defiant behavior. Both parents and teachers report this pattern of behavior and agree on its long-term persistent, with the parent reporting the behavior to been persistent since childhood (3-4years). Notably, the client displays a progressive and constant evolution of these symptoms from adulthood into adolescence, which is characterized by mood lability, aggressiveness, and irritability; with an obvious deficit in temporal processing, planning and a delayed aversion (American Psychiatric Association, 2013).  

Therapeutic Approaches 

That first therapeutic approach is a behavioral intervention, specifically multi-systemic therapy. Multi-systemic therapy is an approach that involves working with the client’s peer group, both at home and at school. Cognitive-behavioral therapy is another approach that can be used, with neurofeedback training used to improve inattention and hyperactivity-impulsivity. Parental training in the form of Pathways Triple P and The Incredible Years can be used to promote positive parent-child relationships and overly reduce behavior problems, while at the same time increasing opportunities for active involvement, positive behavior reinforcement, and teaching skills which are crucial for social development strategy (Zilberstein, 2014). Atomoxetine in combination with behavioral therapy can be used to treat anxiety, with a second-generation agent (superior to lithium) and a stimulant used for mood stabilization (Mcleod et al., 2016) 

Expected Outcomes 

The adolescent’s ability to engage and conform to the set therapeutic guidelines is a positive indicator that the therapeutic approach is working. On the short term, if the adolescent is able to show reduced irritability, is non-argumentative, and of a gay mood, then there is a positive outcome of the therapeutic approach (Bass, Nevel, & Swart, 2014). On the long term, if the adolescent can interact with their peers normally, control their moods, and relay positive behavior patterns over a 6 month period, the approach can be deemed a success (Wheeler, 2014).  

References 

Bass, C., Nevel, J. V., & 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 

American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental disorders (5th Ed) . Washington DC. 

Koocher, G. P. (2003). Ethical issues in psychotherapy with adolescents.  Journal of Clinical Psychology ,  59 (11), 1247–1256. doi: 10.1002/jclp.10215 

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. (2014).  Psychotherapy for the advanced practice psychiatric nurse a how-to guide for evidence-based practice . New York, NY: Springer Publishing Company, LLC. 

Zilberstein, K. (2014). The use and limitations of attachment theory in child psychotherapy.  Psychotherapy ,  51 (1), 93–103. doi: 10.1037/a0030930