7/3/2023 EnchantaVaughn Approved Behavior: Upon arrival, client was reported needing assistance right away. Client displays impulsive and hyperactive behaviors while engaging in individual therapy. Client struggles with handling her emotions, displaying multiple outbursts when given redirection and has a hard time accepting demands from QMHP. Client struggles with listening and following directions even with mother present. Client was reprimanded by her mother on the appropriate ways to carry herself in front QMHP. Client is often observed talking back to authority and showing frequent anger reactions, in which she exhibited oppositional defiance. Client was non-compliant for most of the session. It was difficult for client to remain in her seat while talking to the QMHP. Client appeared very moody today for no reason, as seen pouting and complaining more often than normal. Behavior: Client did not take constructive criticism well and proceeded to walk away from session without permission. Client was demanded to apologize and have a seat and wait for her counselor to review instructions. Client transitioned into the activity with manic behaviors but participated. However, client attitude did not change, as she proceeded to answer QMHP questions with short and quick responses. Client is encouraged to stop acting stubborn and be more mature. Behavior: Client gets frustrated quickly when faced with challenges. Client displays excessive movement throughout the session, as observed. As the client utilizes stress management techniques she has experienced a decrease in impulsive and hyperactive behaviors. Client did not seem interested in working towards her treatment plan or achieving her objectives today. Intervention: QMHP helped client problem solve when she began displaying negativity towards herself and others. QMHP intervened to prevent the negative behaviors from escalating. QMHP observed the client’s progression and responded accordingly. QMHP encouraged the client to try to release her emotions so that she doesn’t bottle them up and explode all at once. QMHP reminded the client that talking about her feelings is healthy. QMHP reviewed client’s goals and objectives with parent. QMHP prompted the client to think about how her negative actions can affect others. QMHP communicated with mom that client need to learn how to calm down on her own. QMHP will continue to assist client with managing anger and frustration by reviewing and role-playing effective coping skills. QMHP will collaborate with mom regarding behaviors and performance in the home. Intervention: QMHP developed a plan to help client with the challenging areas. QMHP will work with client to identify parts of her body that hold tension and anger. QMHP physically redirected client to an alternative activity. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP explored non-verbal activities that can still benefit client without causing her to shut down. Intervention: QMHP utilized worksheet exercises to have client make appropriate decisions when faced with verbal confrontations in the home and community settings. QMHP reiterated the directives twice to ensure the client understands the exercise. QMHP will review actions and consequences, as it pertains to home rules. QMHP provided positive feedback when client engaged in the more appropriate behavior. Response: The client participation level was low when practicing calming techniques, as evidenced by client flat mood and demeanor. The client looked confused, indicating that she didn’t know the reason for her negative behaviors. Client displayed a disinterest in the therapeutic activities, 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 informed QMHP of her behaviors after QMHP confronted her again about her behaviors. Client understood the rules to the home but could not give QMHP an answer as to how come she could not follow the house rules every day. Response: Mother verbalized that she would come up with defined rules for the home and agreed that the rules are probably what are needed in the home. Mother collaborated with counselor in coming up with consequences for certain behaviors displayed in the home. Mother verbalized that she did notice that client is very insecure and needed more support at home and planned to help her. Client did not respond as information was shared on anxiety and stress. Response: Client later displayed quiet behaviors as she shrugged her shoulders and did not want to answer anymore questions. Client continued to make poor choices in session as it pertains to verbal skills and communication. Client was reluctant and hesitant to share her thoughts on her mental disorder and was extremely quiet during this time.