Unit 2 – Discussion 1 & 2? $30.00 Due (Monday) 7/16/2018.

Unit 2 Study 3

Forming a Differential Diagnosis

Counselors of children and adolescents typically receive informal information about their client before the first meeting. Someone has become concerned enough about the young person to suggest counseling. Counselors use this background information to develop questions for themselves that they try to answer in their first interview with a child. The answers lead the counselor through a process called differential diagnosis, whereby various plausible alternatives are ruled out to form an initial diagnosis. The initial diagnosis is the basis for the initial treatment plan. The initial diagnosis and treatment plan may be changed later as more facts come to light, but they are very important because they offer a counselor a place to start. Your task for this assignment is to develop a differential diagnosis.

Choose either the case of Luis, the child, or the case of Crystal, the teen. Decide upon your diagnosis by working through these six specific steps, as described in the DSM-5 Handbook of Differential Diagnosis, linked in Resources (see pages 1–16).

1. Rule out malingering and factitious disorder. (Are the symptoms genuine?)

2. Rule out substance etiology. (Are the symptoms a result of the consumption of drugs or alcohol?)

3. Rule out an etiological medical condition. (Is there a medical condition that explains the symptoms?)

4. Determine the specific primary disorder(s). (What appears to be the most accurate initial diagnosis?)

5. Differentiate Adjustment Disorder from the residual Other Specified or Unspecified Disorders. (Have the symptoms developed into a sufficiently maladaptive response meriting a primary disorder, or are they better described with one of these other diagnoses?)

6. Establish the boundary with “no mental disorder.” (Is a primary diagnosis merited due to “clinically significant” symptoms, or are the concerns better described as “Other Conditions that May Be a Focus of Clinical Attention“? Not all counseling involves treating a mental disorder.)

The Case of Luis

Luis is in the fourth grade. His mother is concerned that he may need counseling because he has not grown out of a fear he has had since he was young that is now interfering with developing peer friendships. Luis is afraid of vomiting in a public place. As you speak with him, you learn that when he was in kindergarten, he once got upset and cried so much that he vomited. His teacher was not particularly sympathetic and his parents could not be reached for a while, so he spent several hours with soiled clothes, feeling very ashamed and embarrassed. Subsequently, he became fearful that he might vomit again, with no reason or warning. His behaviors have become more restricted over the years, and now he will not eat if his family goes out to dinner because he fears the food might make him sick. He eats very little at school—just a few foods that he has decided are safe—and his peers have begun to tease him. If he eats something and starts worrying about vomiting, he soon begins to feel sick and often does vomit. So he has begun avoiding more and more social occasions; he declines invitations to birthday parties and sleepovers because he doesn’t want to refuse to eat (and risk being teased) but he is afraid that he will vomit if he does eat. His mother says she has always had trouble with a sensitive stomach so she is very sympathetic toward Luis’s fears. However, Luis’s pediatrician says he can find no medical problem with Luis.

Note: It is important to follow your protocol in exactly the order it is presented below.

Develop a differential diagnosis for Luis by reviewing the following DSM-5 Handbook for Differential Diagnosis Decision Trees and Tables:

o 2.13 Decision Tree for Anxiety.

o 2.15 Decision Tree for Avoidance Behavior.

o 2.17 Decision Tree for Somatic Complaints or Illness/Appearance Anxiety.

o 2.18 Decision Tree for Appetite Changes or Unusual Eating Behavior.

o 3.5.3 Specific Phobia.

o 3.5.4 Social Anxiety Disorder (social phobia).

o 3.10.1 Avoidant/Restrictive Food Intake Disorder.

The Case of Crystal

Crystal is a 14-year-old girl in the tenth grade. Crystal’s school counselor has contacted you in order to refer her due to concerns about recent changes in her behavior. Last year, when Crystal was in ninth grade, her grandmother had a fatal stroke. Crystal was very attached to her grandmother, as she had lived with her intermittently during childhood. Crystal’s teachers reported that she seemed extraordinarily sad about this loss; she lost interest in her studies and seemed very withdrawn, spending entire class periods with her head on her desk. This year, however, Crystal has been very irritable toward her teachers and has been caught fighting with other girls on several occasions over minor provocations. She has been suspended twice for this behavior. She was recently referred to a community health center, where no physical problems were found. When you talk with Crystal, she confirms all this but also tells you that she witnessed her grandmother’s death, and that her father blames her, saying Crystal “stressed her out.” Crystal says she hates her current family situation because her father plays favorites with her siblings and step-siblings, and admits to occasionally sneaking whiskey from her father’s stash when she feels very upset. She says she finds it difficult to concentrate in school. She feels very guilty about her grandmother, and says she sometimes wishes she could join her “on the other side.”

Develop a differential diagnosis for Crystal by reviewing the following DSM-5 Handbook for Differential Diagnosis Decision Trees and Tables:

o 2.1 Decision Tree for Poor School Performance.

o 2.15 Decision Tree for Behavioral Problems in a Child or Adolescent.

o 2.9 Decision Tree for Irritable Mood.

o 2.9 Decision Tree for Depressed Mood.

o 2.16 Decision Tree for Trauma or Psychosocial Stressors Involved in the Etiology.

o 3.4.1 Depressive Disorders.

o 3.4.4 Disruptive Mood Disorder.

o 3.14.1 Oppositional Defiant Disorder.

o 3.7.1 Trauma- and Stressor-Related Disorder.

o 3.15.1 Substance Use Disorders.

The differential diagnosis for your chosen case will be used in this unit’s discussion.

Resources

· APA Style and Format.

· DSM-5 Handbook of Differential Diagnosis.

Unit 2 Discussion 1

Diagnosing Children and Adolescents

In your Discussion post, use the differential diagnosis you developed for your chosen case in this unit’s third study:

o Note your thoughts for each of the six steps, including your rationale for your initial diagnosis.

o What other diagnoses did you consider, but tentatively rule out?

o List three questions you could pursue in future sessions to be even surer of your diagnosis (by ruling out other potential diagnoses).

Resources

• Discussion      Participation Scoring Guide.
• APA Style      and Format.
• DSM-5      Handbook of Differential Diagnosis.

 Unit 2 Discussion 2

Practice Child Counseling Skills

For this discussion, you are to create a two-page transcript of a hypothetical counseling interaction, including the skills of reflection, paraphrase, and summarization, in order to practice adapting skills and techniques for use with children.

Imagine that you are a counselor creating a transcript from a recent session. When creating your transcript, adhere to the following:

o Choose either a child or an adolescent. You may wish to use the client you created for your background sketch in Unit 1.

o Begin by writing a one- or two-sentence narrative indicating the issue being discussed, such as concerns about schoolwork, sadness about a lost pet, or anger about getting grounded.

o Complete a counseling transcript, using the instructions below.

§ Each comment or question by a counselor must have the skill and counselor purpose or counselor intention clearly identified.

§ Use a range of skills from the list of Universal Counseling Skills, on pages 84–85, in Counseling Children.

Take a few minutes to carefully examine the example of a transcript and transcription instructions below and in the Counseling Transcript Template, linked in Resources. Then, develop your own transcript. Be sure to follow the instructions. Upload your completed transcript to the discussion.

1. Counseling Transcripts should have three columns.

1. The left-most column designates who was speaking—the client or the counselor.

2. The center column depicts what was said.

3. The third column labels the skill that the counselor used and the counselor’s intentions [in brackets].

4. The skill should come from the list of Universal Counseling Skills in Counseling Children, pages 84–85.

5. The intention should apply one of the Purposes listed in the text’s table to the interaction with the client.

2. Each talk turn should be on its own row.

3. You may use the template linked in Resources after deleting the instructions, or create your own form that meets Specifications 1 and 2. Add more rows if necessary.

4. Your transcript should be no more than 2 pages long.

5. Please be sure to cite two sources in this discussion. You may cite them in the third column to indicate what sources you used to identify the universal skills you used.

 

SPEAKER

VERBATIM RESPONSE

UNIVERSAL   SKILL
[purpose and counselor intentions]

 

Counselor:

I’m   glad you could come talk to me. Jess and Harry told me they are worried about   you.

Providing   information [to give Sari the facts about why she was sent to talk to me].

 

Client:

[says   nothing but sits on her hands and looks at her shoes; sighs]

 

Counselor:

(Gently)   Sari, you look like you feel a little sad.

Reflection   of feeling [to show awareness of her emotion and her body language].

 

Client:

(Looking   up) I guess so.

 

Counselor:

How   long have you been feeling sad?

Closed   question [to get more information].

 

Client:

Since   my last report card. I think Mr. Gomez hates me.

 

Counselor:

Oh,   so you’re worried that Mr. Gomez doesn’t like you because he gave you a bad   grade.

Paraphrase   [to give back he message and make sure I got it right].

 

Client:

Yep.   (Wiping away a tear.)

 

Counselor:

Sounds   like this caught you by surprise…and it really hurt.

Empathy   [to let her know I can “read between the lines” and imagine what is   like to be her].

 

Client:

Mmm   Hmm. (Looking up.) Now I’m afraid my grades won’t be good enough so I can go   out for track.

 

Counselor:

Sounds   like you want me to help out with that.

Defining   the problem [I’m guessing what she wants help with].

Resources

· Discussion Participation Scoring Guide.

· Counseling Transcript Template.

· Revisiting Basic Counseling Skills With Children.

Taneka, a 17-year-old African-American female, is a high school junior. She is the oldest of three siblings living with her single-parent mother. Her mother has worked for the past 15 years at a manufacturing plant. Her father has not been a part of Taneka’s life.

As the oldest child, Taneka has held major responsibilities throughout her life to support her working mother, such as caring for her younger siblings: Derrick, now age 14, and Kenya, age 12. These early duties reinforced development of her natural leadership skills. Taneka has been recognized from an early age for being mature, responsible, and dependable. As her siblings have grown, she has been able to have part-time jobs, most recently as a salesperson at a teen fashion store in the local mall. It was here that she first realized she had a knack for dealing with people, and they responded well to her—employers, co-workers, and customers alike. She was recently approached by her supervisor to consider participating in the company’s employee leadership training program.

This has caused Taneka to start thinking about post-secondary education possibilities. Previously she had thought college was out of her reach, due to the limited financial resources of her family and no history of anyone in her family ever attending college. As such, she had not previously given much importance to her grades. Rather than participating in extracurricular school activities, she focused on working. She is on track for graduating with her class next year and has a current grade point average of 2.05.

Taneka is now questioning her previous assumption about college or other post-secondary educational possibilities, but she does not have a clear idea of what she would like to pursue as a career. Choosing a career and a post-secondary program to prepare for it, seeking financial support, and navigating the admissions procedure all remain mysteries to her.

 

 

Using the Taneka case scenario from your Unit 2 assignment, apply two Codes of Ethics from our professional bodies (using the most current codes). One needs to come from NCDA and the other can be of your choice from the suggested list in this unit’s studies. Embellish the case as you need to in order to apply two ethical codes to the case. For example, you can say that the counselor is starting to have romantic feelings towards the client. State which code would apply (ACA, A.5.b), and how you would handle the situation. Make sure you use both codes (NCDA and, for example, ACA).

Response Guidelines

Respond to the main discussion posts of two of your peers. What reactions do you have to the ideas they presented? Include examples from the course readings or your own experience to support your perspective, and raise questions to continue the dialogue. This is a discussion question. I need to post a discuss to the above case study , it needs to contain at least 3 references   I need a response to two peer postings which I have included.

 

First Peer Posting

Case Study of Tanika

Tanika is a 17- year old African American female she is currently and High School junior she is living with her mother and the oldest of three siblings. Tanika helps her mother often around the home since her mother is a single working parent Tanika also has a job and has shown to be responsible and does extremely well working with people she has strong interpersonal skills and is excellent in customer service. Tanika is interested in moving forward with building her career but has some challenges educationally and is unsure what the cause she tends to struggle with testing in which she will need to get into college, Tanika discloses this to her counselor however her counselor does not seem to pay attention to Tanika s concerns Taneka needs direction and resources but have not been informed by her counselor. The counselor should be helping to research and advocate for resources that are available to Tanika that she can use to be successful in all aspects of her life.

NCDA Code of Ethics

The code of ethics helps to Define professional behavior in the case of Tanika evaluation and assessment is important (E.2.B) NCDA, which is the appropriate use of evaluation and assessment career professionals are responsible for the appropriate application Kama scoring, interpretation, and the use of assessment instruments relevant to the needs of the client, where they score and interpret such assessments themselves or use technology or other services.

ACA Code of Ethics

(A.7.B) ACA Advocacy when appropriate counselors Advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients.

As the counselor, I should have knowledge f the correct assessments to provide to Tanika to identify what areas she needs support. If I do not have the appropriate knowledge, then I must obtain consent and branch out third party for testing and assessment as well as advocate for resources to ensure that Tanica is getting the appropriate support that she needs to be successful.

References

American Counseling Association (ACA) Code of Ethics Retrieved from: https://www.counseling.org/search-results?q=aca+disibilities

 

National Career Development Association (NCDA) Code of Ethics (2015)

 

 

Second Peer Posting

The counselor must make sure that she has informed consent with the client.  According to the NCDA, 2015 (National Career Development Association), section A.2. informed consent in the professional relationship, the client has the right to enter or remain in a professional relationship.  To make informed choices, clients need adequate information about the working relationship and the career professional (NCDA, 2015).    The counselor must make sure that she adheres to the standard A. 2. B. which states that the counselors must have information needed for the client. Taneka a 36-year-old African American woman has come to the counseling because she has some concerns regarding career choices and she must make some serious decisions.  Taneka is interested in attending college but is afraid she cannot afford to attend school.  She is also afraid that she will not find a good fit for her career.  The counselor has an interest survey readily available for Taneka to find out what she is interested in doing.  The intake interview provided many insights into Taneka’s personhood and where she wants to go throughout our journey together.   During the intake interview Taneka shared her goal for our sessions, her schooling plans, her timeline, her major, and much more.  Some of Taneka’s goals for our sessions were: learning more about herself, finding direction, and beginning to look for a career.  Identifying this in Taneka helped me guide her throughout our sessions in that we needed to crystallize, clarify, specify, and implement some career aspirations.

Taneka expressed her anxiety when it came to deciding on what she wanted to do.  The career counselor can help Taneka explore career options, can inform her of the labor market, and can assess her skills, interests, and work related values. The counselor can also help her sharpen her job search skills, and can help her learn how to move up the corporate ladder.   I helped her be intentional, assess her interests and opinions, clarify her goals, encourage her to persists despite obstacles (ie anxiety), and formulate plans for action.  Lastly, I gave Taneka a folder of all the handouts and information we went over.  This collection as well as our sessions, I believe, achieved the goals Taneka set at our first session: to know more about herself, to find direction, and to begin looking for a career. According to the American School Counseling Association (2004), it is the responsibility of the school counselor to help a child develop effective coping skills, identify personal strengths

and assets, and recognize and express feelings, as well as to provide a foundation for the child’s personal and social growth as he or she progresses through school into adulthood.  In the Ethical Standards, confidentiality is emphasized as a crucial part of the counseling process (Dahir et al., 2005). Confidentiality assures the student that the school counselor will keep all that is said during their counseling sessions private, except under certain circumstances which are conveyed to the student at the beginning of the counseling process.

 

References

American School Counselor Association (2004). ASCA National Standards for Students.   Alexandria, VA: Author.

Dahir, C., Hardy, D., Ford, D., & Morrissey, D. (2005). The New York State Model for   Comprehensive K-12School Counseling Programs. Leicester, NY: New York State   School Counselor Association.

 

National Career Development Association. (2015). 2015 NCDA code of ethics. Retrieved from http://associationdatabase.com/aws/NCDA/asset_manager/get_file/3395