1/17/2023 EnchantaVaughn Approved Behavior: Client exhibits a poor attitude when transitioning from social/academic setting to therapeutic setting. Client displayed hostile and disruptive manners. Client did not start his work in the session right away. Client was encouraged to lose the attitude and get his work done before he's penalized for his actions. Client have struggled to ignore distractions and finds himself off task and interrupting others who are trying to learn. Client is learning to respect authority figures by listening to directions the first time they are given. After reviewing ISP, client shows difficulty in following home rules often choosing to act out on purpose. Mom have reported several times that client refuses to listen to her. Client displays outbursts when confronted about negative behaviors. Client was reported to have required 3-4 prompts prior to being sent to his room to cool down. Behavior: Client was confronted about his current and displeasing behaviors which affects everyone around him. Client would not own up to anything and continued to act like he wasn’t the problem blaming others for his mistakes, including his mom and siblings. When client realized he was only making matters worst he decided to finally open up about what happened. Client was honest and upfront admitting his wrongdoing. Client was acceptive of redirection from his counselor. During this time, client was unable to identify many significant positive hopeful things in his life that could help him make better choices and was provided with examples of these. Reinforcement was provided to client during the psycho educational activity. Client promised to be more respectful and comply to rules during the remainder of the session. Intervention: QMHP will meet with client daily to discuss progress and expectations that are working and not working in the home. QMHP utilized active listening skills as client spoke of his current mood. QMHP assisted client to behave in more positive ways by addressing the conflict he was facing with his family this week. QMHP will teach client necessary coping skills to decrease impulses. QMHP will brainstorm strategies with client and encourage self-monitoring. QMHP will educate client on behavior modification to help client identify what behavior he needs to decrease and avoid daily. QMHP will provide mediation and relaxation techniques, as well as, simple praises and encouragement to continue his treatment. Intervention: QMHP will teach client necessary coping skills to decrease impulses. QMHP will brainstorm strategies with client and encourage self-monitoring. QMHP will collaborate with mother regarding behaviors and performance once client is able to get back on task. QMHP reiterated to client the benefits of following the rules and of the privileges he can receive when he does so. QMHP assisted client with identifying privileges that he would like but does not receive due to his negative behaviors; in efforts to stimulate his thinking about cause and effect of his behavior choices QMHP will help client develop healthy self-esteem by reducing level of anxiety and emotional reactions related to home and other independent functioning. Response: Client understood the expectations that were established in the home and in the community, and how to conduct himself in each setting. Client utilized coping skills and impulses started decreasing. Client showed good understanding of what it means to be respectful, encouraging, mindful, and fair to others. Client utilized meditation and relaxation techniques at this time to get back on track. Client was seen decreasing anger and frustration. Client also reported a decrease in symptoms following the relaxation techniques. Client was observed strategizing a plan to better himself by writing down his thoughts and feelings in his journal. Client was taught to deep breathe until he is ready to process his feelings. Response: The interventions were unsuccessful, as client was unable to relax when being instructed by the use of the calming techniques throughout the session. Client did not extend a welcoming rapport back to QMHP. Client failed to communicate his feelings. Client refused to reflect on his poor behaviors, displaying an unemotional and flat facial expression on his face. Client continued to display a lack of concern and remorse for the thoughts, feelings, and needs of others. Client struggled with identifying stimulus that triggered his defiant and disrespectful feelings and moods, despite the assistance of the QMHP. Client informed counselor of his behaviors and attitude and how he was working on doing better at home.