2/17/2023 EnchantaVaughn Approved 1. Behavior: When QMHP arrived, client was observed standing outside starring at the ground. Client did not look up when greeted by his counselor. Dad stated client got in trouble and had a hard time getting back on track. Client reframed from talking at this time. Client displayed a negative attitude with flat facial expressions when communicating his feelings to QMHP about why he got in trouble. Client was not in the mood to talk about his feelings, as evidenced by his dialogue with QMHP. Client displayed disrespectful behaviors toward his dad, as evidenced by him yelling when he attempted to interact with him to make him speak up. Client lacked respect for both dad and QMHP, as evidenced by client's aggressive behaviors when confronted about his attitude. Client shared that he was not in a good mood. Client reframed from engaging in conversation and tried to cover his face and ears, so he wouldn’t have to listen. Client refused to pay attention in session, as observed. Client behaves poorly in the home setting, as observed. Client reacts negatively to feedback and fails to conduct himself in appropriate manner. Client required 2-3 prompts to acknowledge or carryout a prompt. Client was defiant of QMHPs prompts 4-5 times. Client blamed his dad for his negative behaviors and appeared unapologetic for participating in disruptive actions. Client withdrew during the session as he became quiet and began to display impatient, intolerant behaviors. 2. Behavior: Client continued to have a hard time controlling his temper and calming down. Client continued to exhibit poor conduct and reminded that closing off will only hurt him in the end. Client was reassured that everyone is here to help but he has to be open to receiving help. Client expressed that he is overwhelmed with everything right now and just needs a moment to himself. Client was silent for about 15-minutes then decided to communicate his feelings. Client stated that he missed going places and having a normal life and wished he could go back to school and see all of his friends. Client explained his frustrations and why he has been more stressed than normal lately. Client wants to be able to balance everything and still be a kid. Client is afraid to disappoint his grandmother who expects him to be on top of his school work and therapy. Client expresses he also misses his mom some days and little brother and sister and couldn’t wait to spend time with them for Thanksgiving break. Client opened up about a lot of the insecurities he was starting to experience and why he has been closed off and distant some days. Dad communicated client can take his break after all of his therapy assignments are complete. Client was hopeful and remained very productive and compliant until the end of session. 1. Intervention: QMHP utilized cognitive skills to give the client a chance to openly and honestly discuss his feelings about his current state. QMHP utilized active listening skills and was empathetic with the client as he vented the overwhelming events that had occurred, resulting in him taking his frustration out on his father. QMHP addressed the client’s thinking errors. QMHP reiterated the importance of positive thinking and exercising his coping skills. QMHP highlighted the faulty and unnecessary behavior that the client was engaging in. QMHP informed him that his actions were disrespectful and encouraged him to resist becoming angry and making irrational decisions. QMHP will assist with reducing anger-provoking situations through self-talk and role play scenarios in order to prevent escalation and dealing with anger assertively. QMHP will continue to assist client with managing anger and frustration by reviewing and role-playing effective coping skills. QMHP coached client to acknowledge and list his strengths, resilience, and the positive outcomes that often occur when he makes informed decisions opposed to impulsive ones. QMHP verbally identified the client's impulsiveness to the client and encouraged the client to use self-control and decrease hyperactive behaviors in the home setting that have been reported by his dad on a weekly basis. 2. Intervention: Instruction, modeling and role-playing techniques were used to help client’s general communication skills. QMHP taught client effective problem-solving skills (i.e. identifying the problem, brainstorm alternate solutions, select an option, implement a course of action, and evaluate). QMHP informed client that when he is agitated to refrain from taking it out on people and communicate how he is feeling to others, so they know exactly how he is feeling. QMHP listened to father verbalize how client became agitated when he didn’t get what he wanted. QMHP encouraged father to allow client to express himself in an age appropriate manner and to redirect when needed. QMHP modeled pro-social behaviors for client to strengthen his understanding of them. QMHP engaged the client in a role reversal exercise and required the client to think about his goals for the future. QMHP commended client on utilizing coping strategies to increase his understanding of feelings and emotions. QMHP intervened to prevent the negative behaviors from escalating. QMHP physically redirected client to an alternative activity. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP provided positive feedback when client engaged in the more appropriate behavior. QMHP will collaborate with father regarding behaviors and performance in the home over the weekend. 1. Response: During majority of the session, client was fidgety and required one on one attention. Client was provided with redirection for displaying emotional distress to minor irritants. Father stated that he will continue to work on his approach and delivery with client as much as he possibly can, but he is no longer dealing with his attitude. Client had a difficult time processing his feelings and admitting he was wrong. It was difficult for client to relax and remain stable when being instructed by the calming techniques during the session. Client was reluctant and hesitant to the interventions provided. Client did not offer any forms of social or friendly rapport back to the QMHP, remaining unemotional displaying an unresponsive and nonchalant attitude throughout the session. Client showed lack of concern and empathy in response to positive cognitions. Client did not express verbal communication after positive reinforcement was provided. Client implemented his plan for restoring relationships, and this was reviewed. Client engaged in self-reflection, discussing good and bad parts of his day. Client acknowledged that he tends to engage in disruptive behavior when he begins to become frustrated. The client was very open and honest during his self-expression activity. Client demonstrated excellent understanding of being able to resolve personal conflicts within the home and community. Response: This has been the first occasion in which client has displayed this level of behaviors in the presence of counselor. Client was talking back and yelling loudly at father and counselor. Client said it’s boring and he is having challenges with certain activities and needs help. Client recognizes areas he needs to work on. Client was highly oppositional during second half of session and displayed argumentative and frustrating behavior. Client practiced some of the examples of alternate behaviors (e.g. putting his head down, coloring or draw, think about happy moments, and repeat positive “I-statements” 5-10 times). Client stated that he would try to listen more so that he is able to understand what he needed to do in order to achieve his goals and objectives on a consistent basis. Client agreed to go to bed on time each night, review, practice, and study material for upcoming tests weekly, wake up for school on time, and work harder. Client demonstrated good calming skills by deep breathing and having good voice volume. Client displayed management of individualized behaviors once he calmed down. Client was seen decreasing anger and frustration. Client was aggravated as counselor tried to deescalate the situation that was occurring. Client reiterated that he wished he had his own space to explore more things he like to do while being home with his dad. Client stated that his ability to exhibit positive behaviors within the home is almost non-existence.