Adjustment Disorder with Disturbance of Conduct Case Study

Adjustment Disorder with noise of care Case StudyIdentifying the ProblemBobby is 12-year-old boy. He was referred to counseling due to his upstart onset of disruptive behaviors. Bobbys parents recently divorced and currently he lives with his m some other and a 1-year-old infant. During the terminal five minutes of the sixth session, he confessed that he hated his muff sis and he thought of cleanup position and termsing her. He crossed that around a month ago, he make his sister sick by large(p) her a chocolate cathartic. He excessively account that he did non inform his mother ab forth what he had done to his sister. His mother thought that his baby sister had a stomach virus. He stated that what he did was wrong. Bobby felt that his baby sister permuted his life to the worse. He deficiencys her to go a elan. He added that he did non want to prejudice her today. Bobbys parents has divorced recently which is a substantial change in his family life. There is no adequate training or definition active his disruptive behaviors except that they were severe enough to bring him to therapy. Additionally, he has murderous ideation of killing his baby sister and violated her indemnifys by giving her laxative which was luckily not life threatening.Bobby was diagnosed with Adjustment Disorder with Disturbance of Conduct. People including s redeemrren contract this perturbliness due to a re operation of major(ip) stress. The intensity of this disorder depends on the claws disposition, susceptibility, previous experiences and make do skills.Adjustment disorder lasts for six months. The symptoms whitethorn remain dependent on the stressor and its consequences. The divorce of his parents is unquestionably depart arrive at a long haunting effect on Bobby and his baby sister. Bobby has some(a) of the feature of oppositional defiant disorder such(prenominal) as disobedience and opposition to authority figures it does not embroil some of mo re severe behaviors such as violating the basic right of others or age appropriate social norms. When the behaviors meet two disorders symptoms, the look at disorder build precedence and ODD is not diagnosed.I would enumeration a resembling day session with Bobby and his parents to discuss the uprightness of the problem. I would explore all the concerns I have regarding the babys guard duty and depends on the out get on with of that meeting, I will determine to telephone call CPS. My office as a healer is to push back individually case hard regardless whether Bobby is tone ending to carry out his murderous ideation toward his baby sister. Nevertheless, Bobby is having hearty sense of smelling of hate toward his sister for a whole year. He is not getting utilize to having her in his life. During this meeting, I will learn from the parents regarding whatever recent changes in his health, and include his treating physician.In regards to the parents I would be wide-a wake regarding their quality of care toward their children. I conduct to know whether there is a first step of neglect and carelessness or that the parents, especially the mother, is suspecting all function of Bobby to hurt his sister. They mustiness be given the benefit of the doubt. Within that same vein of thinking, as a healer, I must be on the alert of accusing the parents of neglect due to the serious and could alter the parents life.honor commensurate stopping point Making ModelThe author elected to employee the 7 step Kitchner Ethical Decision Making Model (1984) to apply to the aforementioned vignette.1. Problem or dilemma be aware of the different perspectives that may be used identify the problem.It is the duty of the healer to take Bobbys intension in homicidal ideation toward his baby sister seriously, fleck may not be serious about his homicidal ideations, it is in-chief(postnominal) to ensure that baby sister is safe. It is important that this therapist ens ure that Bobbys feeling is not malicious. blood relation jest at can be physical, is the physical, emotional or sexual. It can set out from mild aggression such as shoving or severe such as using weapons or deliberately try to hurt their siblings (Frazier Hayes, 1994). Parents normally are not aware of the problem be drift either they are working(a) outside the home or they assume that it is a sibling rivalry, which they retrieve as normal (Strauss, Gelles, 1994). The difference between sibling plague and sibling rivalry is that sibling may argue or call each other names exclusively the main difference is that it get and ignominious relationship when one child is constantly the dupe and the other is always the aggressor. The matter of sibling ill-treat is long lasting that may last to adulthood. Although Bobbys sister is a baby and does not know what was spillage on, and that Bobby said that he did not want to kill her today, his anger may trigger this urge and think of killing her again. This therapist does not feel that the baby sister is safe without informing the parents and authority to prevent the attached blow (Schneider, Ross, Graham, Zielinski, 2005).As a court mandated sketcher it is my duty to report suspected child nuisance within 24 hours.However, I have mixed feeling regarding this dilemma. Bobby is my customer and by obeying the law, I am sermon the confidentiality and the trust that we built together through the last six sessions. reportage this information may result in taking the baby out of the home. Would working with parents to ensure the babys safety be enough to resolve the fill in? After all, the parents are divorced and Bobby may become angrier and more determined to hurt his baby sister. This family went through rough time, as is however, having a mental disorder, being a teenager, I feel that he present an immediate danger to his sister. Bobby says that he is not thinking about killing her today is not guarante ed and the babys safety is in jeopardy.Thus, CPS should be contacted and conferred with in accordance to the APA code of Ethics As Ethical Standard 5.02 states Psychologists have a primary obligation and take presumable precautions to respect the confidentiality rights of those with whom they work (2010). At times, the value of confidentiality will dispute with other important values. Such a conflict may rig out when a psychologist receives information concerning child abuseinformation that may be helpful or inevitable to stop the abuse and cling to the child. It is in addition important to inscription separate emergency sessions with the parents and their children to provided adjudge and offer psychoeducation regarding the process.According to, the calcium youngster Abuse and Neglect Reporting ACT (CANRA), located in California Penal Code Sections 11164 11174.3., states that mandated reporters should be familiarityable of their duty to report. The law states that when th e victim is a child (a person under the age of 18) and the perpetrator is some(prenominal) person (including a child), the following types of abuse must be reported by all legally mandated reporters Physical abuse (PC 11165.6) is defined as physical injury inflicted by other than accidental means on a child, or intentionally injuring a child.. Additionally, child abuse must be reported if has knowledge of or observes a child in his or her professional capacity, or within the scope of his or her conflict whom he or she knows or reasonably suspects has been the victim of child abuse or neglect (PC 11166a). Reasonable suspicion occurs when it is objectively reasonable for a person to entertain such a suspicion based upon facts that could attain a reasonable person in a like position, gulp when appropriate on his or her training and experience, to suspect child abuse (PC 11166a1).2. Identify the potential issues involvedConsider autonomy/ kind-heartedness/Nonmaleficence/justice.The eldest moral principle that applies to this situation is autonomy. In order for Bobby to grow, he inevitably to be able to make his own decisions and not rely on his therapist to make decisions for him. Corey, Corey and Callanan (2003) stated, respect for autonomy entails acknowledging the right of another(prenominal) to convey and act in accordance with his or her wishes (p.16). If I report the homicidal ideation and possible physical abuse thusly I am not acting in accordance with Bobby and his familys wishes and therefore I am not promoting autonomy. I feel very strongly about boost independent relationships, which causes me to question which decision is ruff for Bobby. The very historical issue of the therapist needing to break Bobbys confidentiality and thus his autonomy is unfortunate but necessary.The different issues involved include Bobby homicidal ideation toward his baby sister and the real possibility that he could attempt to kill her. There is a possibility that Bobby is planning to kill his sister, if that the case, then something has to be done to protect the sister from him. Another issue include the possibility of Bobby having a more serious mental illness his parents do not have to cope with that alone. It would be beneficent to help them through providing the right treatment, which involve therapy, training and music if necessary to help build positive environment and deal with the disorder early in Bobbys life.There is also the possibility that Bobby does not mean what he was saying, if this is the case, Bobby could suffer egregiously and emotionally and so are his parents. moreover, the therapist could lose Bobby as a client as a result of the unjust accusation and the subsequent mandated insurance coverage of the claim. However, such a loss, while undesirable is acceptable as the therapist followed the proper code of uphold regarding mandated reporting and nonmalfecience. The therapist will on the same day instrument an individ ual session with Bobby and assess the client for homicidal ideation and then force out the proper authorities.Nonmaleficence can support either reporting the abuse or not reporting the abuse. In order to prevent physical upon to the baby, the therapist would have to report the abuse. On the other hand, if the therapist does not report the abuse Bobby, his sister may suffer and may be killed. What if Bobbys actions of giving his sister harmful substance were a one-time action that will never happen again? Reporting may cause Bobby suffers harm that could have been avoided.The principle of beneficence can also support both courses of action. On one hand, if I report the abuse I am promoting the safety of the baby. On the other hand, if I do not report the abuse I am promoting Bobbys best interests and ensuring that he will not be separated from his mother.faithfulness would support not reporting the abuse because it would require the therapist to break the trust of my client. She ha s a responsibility to her client and breaking Bobbys trust would mean that the therapist honoring her responsibility as a professional. On the other hand, verity would support reporting the abuse because the therapist was truthful from the start with the client when she provided him with certain harmonize. In the informed consent, the therapist explained that there were limits to confidentiality.There is an unambiguous conflict in the moral principles in this ethical dilemma. While some of the principle support reporting the abuse, others support not reporting the abuse. To nobble even more conflict some of the principles can support both decisions. The therapist sees clear contradictions between fidelity and veracity, nonmaleficence and beneficence and autonomy and beneficence. Fidelity says not to break the trust of the client, while veracity says that she can because she outline the limits in my informed consent. Just as nonmaleficence could support not reporting the abuse to avoid harm to Bobbys emotional state, but beneficence would say that the therapist not promoting the babys physical well-being. beneficence can also contradict with autonomy because if I promote the babys physical safety by reporting the abuse then I am not honoring the client Bobbys wishes, which is not supporting his autonomy.3. Review the relevant ethical guidelines. Is there one or should there be one?The client is an adolescent who has notified the therapist that he hated his baby sister and that he had homicidal ideation toward her. He gave her laxative and made her ill a month ago but he said he did not want to kill her today. In compliance to section 11165.3 of the California Penal Code any mandated reporter who has knowledge of or who reasonably suspects that mental suffering has been inflicted upon the child or that his or her emotional well-being is endangered in any other way may report the known or suspected instance of child abuse or neglect to an agency (2013). S ince the therapist has an indication, that homicidal ideation could be occurring in the home, the therapist is mandated to report that information. In addition, the APA code of Ethics (2010) stipulates in section 5.02 Psychologists have a primary obligation and take reasonable precautions to respect the confidentiality rights of those with whom they work. At times, the value of confidentiality will conflict with other important values. Such a conflict may arise when a psychologist receives information concerning child abuse. Reporting the information to proper authorities will potential be helpful or necessary to stop the abuse and protect the child. In deference to the nineteen seventy-four Tarasoff case ruling, the mother should also be notified of possible danger.4. Obtain consultation.Prior to reporting the therapist would attempt consultation from fellow therapists, CPS and the APA to seek ethical and legal perspectives. In addition, she would refer to an ethical decision maki ng model to assist in the decision process. Whether or not there is any indication on knowledge of the brother is abusing his sister and considering as just sibling rivalry. The therapist concern is that the boy is having enough time with the baby alone without any adult supervision to give her the laxative. Additionally, does the mother know that her son is untamed to his sister but she is afraid of revealing it for the fear that he may be taken away from her?5. Consider possible and probable courses of action. probable courses of action include Emergency individual sessions with each family member will be schedule within 24 hours of learning about the homicidal ideation. During the emergency session, the therapist would immediately assess Bobby and the respective family members. In addition, the therapist would assess Bobbys cognition and remind him that he signed an informed consent form, which highlighted the exceptions to confidentiality. If it appears that the client intends to harm his sister the therapist while in session will call the clients treating physician and confer about the close course of action. If there is no time and the client is definitely going to hurt his sister, then separation and removing Bobby temporarily is appropriate. In addition, a mutually agreed upon plan between the therapist and Bobby needs to be in place to ensure that Bobby may refer to it whenever he feels the need to hurt his sister.As there has been a possibility of homicidal ideation by Bobby, child protective services (CPS) must be called within 24 hours. As mentioned previously, the mother according to the Tarasoff ruling should also be notified that there is a possible threat to her baby daughter and should be provided with the support they need to cope with the issue. Follow up sessions with the therapist should also be scheduled6. Enumerate the consequences of various decisionsThe therapist could ignore what Bobby said, which could cause further harm to the ba by sister. If Bobby decided to physically abuse his sister or gave her laxative or more potent substances then baby would have to continue to suffer from his actions. One of the consequences of reporting Bobby that should be considered is that Bobby may hate his sister even more and would carry out his ideation and actually kill her. On the other hand, if Bobbys homicidal ideation is just an empty threats, Bobby could be touched emotionally and mentally to such an accusation. In addition, Bobby may refuse to come to therapy and not trust this therapist or any other therapists. Nevertheless, obese the therapist about his feeling toward his sister and wanting to kill her should be considered a cry for help and should be treated with respect.The question of protect Bobbys confidentiality arises due to his confession, however according to the APA code of Ethics As Ethical Standard 5.02 states, Psychologists have a primary obligation and take reasonable precautions to respect the confid entiality rights of those with whom they work. At times, the value of confidentiality will conflict with other important values. Such a conflict may arise when a psychologist receives information concerning child abuseinformation that may be helpful or necessary to stop the abuse and protect the child (2010). In addition, if he were able to comprehend the information I would go over the informed consent form with Bobby, which highlighted the necessity of contacting proper authorities regarding the homicidal ideation. Breaking Bobbys confidentiality could prove to cause him to react emotionally and his trust in the therapist could be broken. It could be very difficult to reclaim or develop trust in Bobby which could hinder the therapeutic process, however if the therapist believes that abuse is occurring she has the law and the code of ethics on her side.7. Decide what appears to be the best course of actionAfter the therapist had conducted the emergency sessions and discussed the c oncern with Bobby, the therapist would review the issue(s) with her peers, refer to the APA ethical guidelines and consult with the APA attorneys and CPS, she would then likely call the proper authorities. If Bobby claims that, he was exaggerating and that he did not mean it literally. The therapist has to be cautious and ensure the safety of the baby and reassess Bobby to see whether the sign diagnosis is still appropriate.My initial response is to report this information immediately. also-ran to Report an abuse result in a misdemeanor punishable by up to six months in county jail and/or up to a $1000 fine (P.C. 11166c). He or she may also be found civilly liable for damages, especially if the child-victim or another child is further victimized because of the failure to report (Landeros vs. Flood (1976) 17C.3d399). Furthermore PC 11166.01b states that any mandated reporter who willfully fails to report abuse or neglect, or any person who impedes or inhibits a report of abuse or n eglect where that abuse or neglect results in finis or great bodily injury, shall be punished by not more than one year in a county jail, by a fine of not more than five thousand dollars ($5,000), or by both that fine and imprisonment.What I understood from this lengthy definition is that if I had any suspicion that the baby was not safe that I should report (CANRA, 1980).Finally, if I did not report his homicidal ideation I would be direct a wrong message to Bobby and may think that is acceptable to have those feeling about his sister. As a therapist, I am transaction with the dilemma of fulfilling my legal duty to report and protect the baby sister rather than attempting to work with Bobby and doing what is in the best interest for his well being. beginningThe Child Abuse and Neglect Reporting Act (CANRA), 1980.www.leginfo.ca.gov/calaw.html