Discussion Post 1-Samantha

Diagnosis
I would give Samantha the diagnosis of Severe Oppositional Defiant Disorder (313.81).
Samantha meets diagnostic criterion A since she has demonstrated the following 4 symptoms for
at least 6 months: (1) often loses temper with adults and peers, (2) often argues with adult
caretakers and teachers, (3) often deliberately annoys others like her peers and sister, and (4)
blames others for her misbehavior such as saying that her brother is the one bothering her sister
when it was actually her. Samantha meets criterion B since her behavior is associated with
distress in her and others’ immediate social context. She also meets criterion C because she does
not meet criteria for disruptive mood dysregulation disorder, and her symptoms are not exclusive
to a psychotic, depressive, substance use, or bipolar disorder. Samantha qualifies for the “severe”
specifier because some of her symptoms are present in 3 or more settings (school, home, church).

Ruled out Diagnoses

Rule out Intermittent Explosive Disorder. IED is similar to ODD in that both diagnoses
include verbal aggression behaviors in their criteria which includes frequent temper tantrums and
verbal arguments. Additionally, both IED and ODD’s diagnostic criteria include that the
behaviors negatively impact one’s interpersonal/social functioning. Two ways that these
diagnoses are different is that ODD is met by 4 symptoms occurring for at least 6 months
whereas IED is met by verbally aggressive behavior within a 3-month period or
damaging/assaulting outbursts within a 12-month period. Additionally, IED can include
physically aggressive behaviors, while ODD does not.
Rule out Conduct Disorder. CD and ODD are similar in that they can both show bullying,
threatening, or intimidating behaviors, as well as the deliberate destruction of others’ property.
However, they are dissimilar in that a CD diagnosis is made by at least 3 symptoms being
present within a 12-month period, while ODD must have at least 4 symptoms present during a 6-
month period. Additionally, CD can involve aggressive behaviors towards people and animals,
as well as deceitfulness or theft, while ODD does not.

Stage of Change
I believe Samantha is in the preparation stage of stage. Samantha has an awareness that a
problem exists as indicated by her stating that she knows she needs to “work on her issues”. I
believe she is in the preparation stage because she recognizes that she must prove that she can
change her behaviors before going back home. This shows that she is intent on taking action,
which is the definition of this stage.

Treatment Plan
Because Samantha is in the preparation stage of change, I think it would be appropriate to
begin working on behavior modification techniques with her. One goal that I would propose for
Samantha’s treatment plan would be to learn coping skills to help her regulate her emotions. A
task to go along with this would be to practice with Samantha the act of taking deep breaths and
counting slowly to 10 when she feels angry, upset, or any form of emotional dysregulation.
 Discussion Post 2-Bryan
Diagnosis
Based on the information given, it seems that Bryan most closely meets the
diagnosis criteria for Moderate Conduct Disorder with unspecified onset 312.89 (F91.9),
although I would need more clarification on specific behaviors he has shown within the
past 6-12 months. Based on his behaviors since the age of 18, he would meet diagnostic
criteria since he has shown a repetitive and persistent pattern of behavior in which the
basic rights of others or major age-appropriate societal norms or rules are violated.
Concrete examples include truancy and vandalism which align with the “moderate”
specifier. It is suspected that the behaviors which led him to stay in juvenile detention
would fall under this diagnosis as well. He meets criterion B because his behaviors
significantly impair his social and academic functioning. He meeting criterion C because
he does not meet criteria for antisocial personality disorder. Because there is not enough
information about the age of onset of his first symptoms, “unspecified onset” would be
used. More information is needed to determine if Bryan would meet the “with limited
prosocial emotions” specifiers. Although Bryan has a history with substances and suicide
attempts, there is not enough information to give a diagnosis/diagnoses regarding these
behaviors.

Personal Challenges
Personally, my biggest challenge of working with Bryan would be his volatile
aggression. I anticipate that I would feel very uncomfortable and possibly scared for my
safety during Bryan’s outbursts of verbal aggression. I would feel pressured to write a
note for him to ease his aggression, but am aware that this would be unethical.

Cultural Components
Suspected cultural components include Bryan identity as a white male who has
spent much time incarcerated. It is apparent that Bryan is familiar with expressing his
emotions through anger, as this has likely been the only “acceptable” emotion to show in
the environments he has been in.

Ethical Codes
1. “A.7.b. Confidentiality and Advocacy: Counselors obtain client consent prior to
engaging in advocacy efforts on behalf of an identifiable client to improve the provision
of services and to work toward removal of systemic barriers or obstacles that inhibit
client access, growth, and development.”
2. “B.1.c. Respect for Confidentiality: Counselors protect the confidential information of
prospective and current clients. Counselors disclose information only with appropriate
consent or with sound legal or ethical justification.”