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Case Presentation: W C-E. Counseling Intern: Kathy Parker 2/28/13 1.

Client/Student: W is a 15 year-old Caucasian male who attends Ingraham High School in the 10th grade. W lives part of the week with his mother and the other part with his step-dad. His birth father (diagnosed with A.I.D.S.) for has lived in California for some time and just recently died. W appears to be from a middle economic class. His main interests are computer games and comedy shows.

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Date session occurred: 2/26/13: session number: on going ; length of session: 39.06 min. S.O.A.P. (Subjective, Objective, Assessment, Plan) Notes:

Subjective: Ws presenting issue is he is struggling to pass his classes and often does not turn in his work. My supervising counselor referred W to me at the beginning of the year. W will set goals for his grades and does not meet them. There is a disconnect between the grades W wants and what it takes to get those grades. He was asked if he wanted to stay in Spanish, as he failed it first quarter, he said yes. He was upset that he might have to be removed from the class is he failed again, however he has done no work this quarter. When I ask W how is doing in a class he will say fine. When I look at this grade he will have D or Es. William got better grades last year and when asked what was different last year he says, he had more friends in his classes. When asked on a rating scale of 1-5 how he would feel if he got all As he picked a 3. When asked how he would feel if he got Ds and Es, he picked a 3. Objective: W is fairly well groomed and usually had flat affect. He does not often make eye contact, and sometimes turns away quickly as if he had too much input and needs a break. He speaks very quietly in one-word answers. In this session he closed his eyes quite a bit at the beginning. He will smile every so often and usually because we are talking about something from his childhood. At times he seems very child-like. When leaving, W will often seems disoriented and not know what to do. I will give him directions that he can go and he will walk into the hall and still seem disoriented. W has very good attendance. His mother states that he has only 2 or 3 friends at school. When asked on a rating scale of 1-5 how he would feel if he got all As he picked a 3. When asked how he would feel if he got Ds and Es, he picked a 3. He refused to do an assignment that asked him to memorize all the students names in the class (in class, oral assignments are a challenge). Assessment: Ws presenting problem seems to encompass the following: (1) Biological: There are no documented biological issues. However, an Autism Spectrum evaluation may be helpful. W had strep throat last winter and after that his grade never were the same. I would like to ask his mom if he is having any symptoms indicating PANDAS (Pediatric Autoimmune Neuropsychological Disorder Associated with Strep) (2) Psychological: Nothing has been formally diagnosed as the mother does not have insurance, but W appears to be depressed at times based on his affect and lack of interested in most things. There may be some other issues going on caused by early trauma as his mother stated that he began to

regress in his potty training in Kindergarten. She also mentioned he is afraid to talk to people most of the time. He appears to be struggling with his birth dads death, as he was crying when we talked about it in session. (3) Sociological: William lived with his father and mother initially, then she re-married his stepfather, which she has since divorced. Ws stepfather takes an active role in Ws life currently. Ws mother does not have insurance so has not evaluated W for autism. Last year, W refused to go to a mental health counselor. He attended an alternative school for elementary and middle school that did not use grades. Plan: W is having trouble focusing in class and following through on turning in his homework. The plan is to help W continue to set goals and evaluate what is working. We have been setting goals for a while and he is gradually meeting less and less goals, so I will start to focus more on Ws emotional state, especially how he is feeling about his dads death. I will ask W scaling questions each time he comes in and leave out the neutral option. It seems important for W to find a purpose and motivation, both of which are lacking. He also seems to want friends but doesnt have many, so working on social skills may also be beneficial. 4. 5. What multicultural factors influence the client-counselor relationship? No issues have surfaced at this point. Gender may be an issue, as I cant fully relate to W on that level. What counseling theories are you using in this session and what evidence do you have to support this? I am mainly using solution focused brief therapy. I asked W what has worked before the help him turn in his homework on time. He replied he just does it. I wonder if there is a need for control also, so I will also use some narrative therapy to help W tell a new story in which he views himself and his world in a more positive way. List three things that you did well in the session with the client. 1. Patience with clients lack of talking/ expression 2. Kept the focus on the client 3. Provided a comfortable environment for student List three things that you can improve on in your session with the client. 1. Move focus off of grades to social/emotional issues 2. Looking at the computer too much while talking to the student. 3. Often say so. 7. ACA Advocacy Competencies: Client/Student Level: What are you doing to empower the client in the session? Working with the student to develop self-control and externalize what is affecting him emotionally. I am also providing a place for him to belong and work on social skills and learn to trust people.


School/Community Level: What systemic barriers impede the clients ability to achieve her/his academic, career, and personal/social goals? Social interactions are difficult for W. Helping teachers understand Ws learning style would help him be more accepted in class. Alternative ways to show what he knows would be helpful, instead of oral presentations.

How would involving school and community members help the client with her/his presenting concern? Consulting with other professionals in the field has been helpful, such as a speech therapist and a mental health counselor. I learn techniques and strategies from them that incorporate the mind and body connections. Public Arena Level: How would the clients life change for the better by being involved at the political level? A greater awareness of what these students experience may alleviate the belief that they are just shy or uncomfortable socially. More research on students that enjoy computer games but lack social skills would be helpful to learn ways to connect them to others, so they feel like they belong in ways that are comfortable to them. How do you take the clients issue and bring it to the public eye? Educating teachers on the differently learning styles and offer resources on different ways to reach students who lack social skills. Discuss with teachers how to use a game club to also teach social skills. This issue could also be brought to the public eye by publishing an article on current research about social skills and lack of connection with academics.