10/31/2023 EnchantaVaughn Approved Behavior: During the conversation with QMHP, it was difficult for client to share his emotions and how he was feeling today. Client didnât care to speak to anyone as he displayed a bad attitude toward his mom, brother, and sister. Client was asked to fix his attitude and prepare for his therapy. Client was not acceptive of feedback from authority and displayed frustration when he didnât receive the attention that he desired. Behavior: During the second portion of the session, client conduct remained unmotivated, sluggish, bored while he displayed low participation in session. Client was observed removing himself as he became preoccupied and involved in his own feelings and thoughts. Client was reprimanded and lectured on his noncompliant behaviors. Client appeared guarded and offensive at this time. Behavior: Client looked lost in his own thoughts and feelings, as he demonstrated a persistent failure to comply to the rules and expectations and respect for QMHP within the session. Client became irritable and inattentive when counselor was verbalizing his behaviors. Client continues to display outbursts when given redirection for his current behaviors and had a hard time accepting the consequences of his actions. Client struggles with listening and following directions while his mother is present and this has been addressed during the session. Intervention: The QMHP facilitated an individual psycho educational exercise which consisted of the client identifying 3 positive ways to deal with anger and frustrations. The QMHP explored the clientâs responses and responded by reminding the client to refrain from self-alarming and negative statements. QMHP reiterated client safety plan by identifying coping skills he can utilize. QMHP engaged the client in conversation. QMHP practiced calming techniques by modeling examples for the client to follow, such as walking away and cooling off. QMHP prompted client to refrain from impulsive, hyperactive, defiant, and aggressive behaviors especially refusing authority instruction. QMHP utilized behavior modification strategies including removing client from the stimulant environment in efforts for him to reduce inappropriate behaviors. QMHP will monitor effects of meditation and coping practices daily and document progress. Intervention: QMHP utilized role playing to demonstrate the calming effects of predicting the thoughts, feelings and actions of self and others prior to the outbreak of a conflict. QMHP prompted client to share anticipated thoughts and feelings and to indicate how this process reduces angry reactions. QMHP directed the client to practice positive âI-statementsâ before every session to reduce unwanted feelings. QMHP modeled resolution skills for client to implement when faced with a stressful situation. QMHP explored client triggers that result in emotional and defiant responses. QMHP observed the clientâs decline in progression and responded accordingly. QMHP reiterated the directives 2 times to ensure the client understood the exercise. QMHP encouraged the client to try to release his emotions so that he doesnât bottle them up and explode all at once. QMHP reminded the client that talking about his feelings is healthy. QMHP reviewed clientâs goals and objectives with client and parent. Response: Client struggled with expressing his feelings in response to the reasons and causes for his negative and impolite behaviors. Client struggled with expressing or identifying stimulus that triggered his angry emotions. Client admitted to counselor that he does sometimes find it difficult to adjust to his treatment. Client continued to express negative statements. Client reduced eye contact with QMHP and showed no interest in following safety plan. Client offered no form of verbal communication and refused to calm down in an appropriate manner. Client rolled his eyes and smacked his lips at QMHP. Mother verbalized that he does not know why client consistently displays these behaviors. Mother understood that he needs to explain to client the consequences for his behavior and how his behavior will no longer be accepted or excused. Mother verbalized that she is trying her best to implement consequences in the home every day. Response: The client participation level was under the required expectation when practicing calming techniques, as evidenced by client flat mood and demeanor. The client looked disordered, indicating that he didnât know the reason for his negative behaviors. Client displayed a disinterest in the therapeutic activities provided by QMHP, due to avoiding discussion and prompts. Client was unable to relax when being instructed by the use of the calming and relaxing techniques. Client was resistant and reluctant in regard to the QMHP positive empathetic acceptance. Client was inattentive and unfocused throughout the session. Client frowned his face up and ignored the exercise. Client failed to identify 3 positive ways to deal with anger and frustration, remaining aggravated. His mother collaborated with counselor in coming up with consequences for certain behaviors displayed in the home. The coping techniques were determined ineffective to modeling appropriate ways to manage stress.