When medications may be necessary it is essential to look at the comorbidity:
19 minutes ago
Lana Deist
Deist Week 9 Angry Adolescent
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The Angry Adolescent
For my case study, I chose the case of the angry adolescent. The client is a young female, and though her age is not mentioned anywhere in the clip, she appears a minor between 12 and 18 years of age. From the minute the session starts, the client is angry, with her yelling at the counselor. Her language and body language made it clear she was not ready for counseling. From the counselor’s recounting of collateral information collected from the mother and probation officer, the client was a popular individual among her peers, which is a positive trait. The client agrees with the counselor’s assessment of being independent; however, this independence has led to breaking the law and being placed on probation. This, coupled with the observed anger, arguing with authority figures, quickly getting annoyed, indicates that the most appropriate diagnosis for this client is oppositional defiant disorder (ODD) by the DSM V (American Psychiatric Association, 2013)
Therapeutic approaches
Pharmacologic agents
Currently, there is no approved medication for oppositional defiant disorder. What is essential to look at is underlying coexisting conditions, such as ADHD, anxiety, and mood disorders, as well as learning and language disorders that could be the source of the behavioral symptoms (American Academy of Child and Adolescent Psychiatry, 2009). When medications may be necessary it is essential to look at the comorbidity: an SSRI for depression/anxiety; a stimulant medication for impulsivity, or in extreme cases, antipsychotic drugs like Abilify and Risperidone have been found useful in managing some of the manifestations of ODD, like defiance, arrogance, and problems with the law.
For this client, I would suggest a medication like Risperidone, which has a stimulant action and can work on her impulsivity, I would start the client on the lowest recommended dosage, 5mg by the mouth once a day, and observe her response (Stahl, 2017). However, therapy is suggested before medication in this case only because I have limited information on this client.
Psychotherapy
Given that there is limited information on this client (comorbid conditions, length of current behaviors, the severity of the crimes committed), psychotherapy is the primary treatment recommended. As seen during the second video, the client was more open to therapy when she was given a choice to participate in the therapeutic process rather than be forced by her family or her probation officer. The therapist uses aspects of acceptance commitment therapy (ACT) to allow the client to be mindful of her emotions and behaviors, which gains the acceptance to commit to further treatment (Bass, van Nevel, & Swart, 2014). With a new therapeutic alliance, I would consider using cognitive behavioral therapy (CBT) with this client. Cognitive-behavioral therapy is a form of psychotherapy that helps an individual to identify irrational thoughts or negative thought processes to enable him or her to identify challenging situations and make appropriate responses that will allow the individual to cruise through the case comfortably.
Cognitive-behavioral therapy rests on how the feelings, the thoughts, actions, and physical sensations correlate, and that irrational ideation (Beck, 2011). For this client, anger is her chief manifestation of an unreasonable idea. This anger has resulted in her breaking the law, and the therapist will help her to learn how to recognize why she is becoming angry. With cognitive behavioral therapy, the therapist will aid in teaching this client the skills and coping techniques on how to identify her triggers, calm down in stressful situations, and handle the situation more appropriately.
Expected outcomes
My expectations for treatment for this client include the need for pharmacology and psychotherapy treatments. I would expect her to need the pharmacologic intervention of Risperidone. With this medication, I hope that the client’s symptoms main symptoms to ease (arrogance, getting angered with ease, defiance of the law, or defying orders or requests by adults). I expect that the client will effectively tolerate this medication with negligible or no side effects (Stahl, 2017).
Concerning psychotherapy, the client will participate in both ACT and CBT. With CBT, I anticipate that the client will learn how to identify negative thought processes and replace them with more constructive thoughts (Beck, 2011). The client will be able to identify situations likely to cause anger and handle them effectively. With these approaches, the goal is for the client to handle her anger without defiance of the law, causing further legal issues, and having a better understanding of her condition.
References
American Academy of Child and Adolescent Psychiatry . (2009). Oppositional Defiant Disorder. The American Academy of Child and Adolescent Psychiatry.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Association. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1176/appi.books.9780890425596
Bass, C., van Nevel, J., & Swart, J. (2014). A comparison between dialectical behavior therapy, mode deactivation therapy, cognitive behavioral therapy, and acceptance and commitment therapy in the treatment of adolescents. International Journal of Behavioral Consultation and Therapy, 9(2), 4-8. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1037/h0100991
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (Second ed.). New York, N.Y.: The Guilford Press.
Stahl, S. M. (2017). Stahl’s Essential Psychopharmacology: Prescribers Guide (4th ed.). New York, NY: Cambridge University Press.
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