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Counseling Adolescents

Anger is a basic and common emotion. It begins with a triggering event that is appraised in a manner that turns general arousal into anger. The private anger experience consists of thoughts and fantasies, often of revenge, and physiological reactions. The public expression most often consists of verbal responses such as yelling, insulting, and profane exclamations (Wheeler 2014). A good anger management program consists of preparation, teaching strategies for change and acceptance, and preparing for relapse

Summary of the Case study

The selected case is of an angry adolescent girl from the Disruptive Behavior Media part 2 (Laureate Education, 2013a).  The client in the video appears to be angry and agitated and terms her therapist as a “horrible” counselor and a stupid person. The girl also says she hates being in the therapy sessions or talking to the counselor. She says that being there was worthlessness and says that she will not speak with the counselor because she knew nothing about her. 

Diagnosis

The clinical manifestations of the adolescent confirm the diagnosis of the oppositional defiant disorder (ODD).  Anger and irritability are the primary symptoms of ODD and comorbid with other forms of psychopathology. According to the statistical diagnostic manual (DSM-5), the criteria for diagnosing ODD include behavioral and emotional symptoms at least months, including angry and irritable mood featured by often and quickly losing temper, easily annoyed by others, and resentful (American Psychiatric Association, 2013). Also, an adolescent may present and argumentative and defiant behavior such as often arguing with adults or people in authority, and deliberately annoying or upsetting people. The girl in this file meets the criteria for ODD such is one of the common disruptive behavior disorders. 

Therapeutic approaches

The most common cognitive-behavioral approach to anger management is cognitive behavior therapy (CBT). The technique targets deficits in emotion regulation and social problem-solving skills that are associated with aggressive behavior. The label “cognitive-behavioral” refers to interventions conducted with the child and emphasizes the learning principles and the use of structured strategies to produce changes in thinking, feeling, and behavior (Booker et al., 2019). Common cognitive-behavioral techniques include identifying the antecedents and consequences of aggressive behavior, learning strategies for recognizing and regulating anger expression, problem-solving and cognitive restructuring techniques, and modeling and rehearsing socially appropriate behaviors that can replace angry and aggressive reactions.

In addition to therapy, a clinician may recommend medication to treat adolescent’s oppositional defiant disorder. There currently are no drugs explicitly prescribed for ODD. Still, specific symptoms of the disease, when found in conjunction with another condition, can respond very well to medication in conjunction with psychotherapy. Drugs that may be prescribed to treat ODD symptoms include: Stimulants for attention-deficit hyperactivity disorder (ADHD) such as methylphenidate (Ritalin) and dextroamphetamine (Dexedrine) and antidepressants for depression or anxiety such as escitalopram (Lexapro) fluoxetine (Prozac) (Booker et al., 2019)

Expected Outcome

The expected outcome of Psychopharmacological treatment was to reduce the anger and irritability symptoms of the adolescent and improve her therapeutic relationship with the counselor. CBT places more emphasis on the importance of the client-counselor relationship. It primarily uses open-ended Socratic questioning to help clients reflect upon and discover the inaccuracies of their thinking. The approach value homework assignments, including reading assignments, have clients engage in behaviors designed to test the validity of cognitions, and frequently draw upon a wide range of behavioral techniques. There is also strong evidence in the literature to suggest that ODD and ADHD overlap; many medications that are used to treat ADHD may also be efficacious in the treatment of ODD (Tzang et al., 2016)

                                                  References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Booker, J. A., Capriola-Hall, N. N., Greene, R. W., & Ollendick, T. H. (2019). The parent–child relationship and posttreatment child outcomes across two treatments for oppositional defiant disorder. Journal of Clinical Child & Adolescent Psychology, 1-15.

Laureate Education (Producer).(2013a). Disruptive behaviors – Part 1 [Multimedia file]. Baltimore, MD: Author. 

Tzang, R. F., Chang, Y. C., Tsai, G. E., & Lane, H. Y. (2016). Sarcosine treatment for oppositional defiant disorder symptoms of attention deficit hyperactivity disorder children. Journal of Psychopharmacology, 30(10), 976-982

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.