Comprehensive treatment Plan

Item

Description

Appropriate DSM-5 Diagnosis

1. Disruptive, Impulse-Control, and Conduct Disorder

2. Intermittent Explosive Disorder (IED)

3. Oppositional Defiant Disorder (ODD)

Nathan’s behavioral patterns are an indicator of Disruptive Impulse-Control and Conduct disorder. Further, his impulsive, aggressive tendencies when interacting with his peers suggest that he may also have IED and ODD.

Intermittent Explosive Disorder, or IED, shows itself as unexpected outbursts that are way too intense compared to what set them off. Nathan loses his cool quickly when another kid tries to disturb him, which matches what happens in IED. But if he keeps up this kind of pushback attitude a lot, then maybe Oppositional Defiant Disorder (ODD) could be what the problem is. Right now, it looks like IED is what's going on since his aggressive snaps and trouble with keeping his impulses in check are all over the place (First et al., 2022).

Appropriate long-term goals.

A. Managing Aggressive Impulses

B. Enhancing Social Skills

C. Promoting Emotional Regulation

Nathan needs to learn to manage his angry outbursts and find some good ways to deal with anger. He should also work on his people skills to make and keep suitable friendships. He must learn how to keep his emotions in check and use them in a positive way.

Appropriate short-term goals for each identified long-term goal.

Goal 1: Managing Aggressive Impulses

A. Short-term Goal 1: recognize early signs of anger or frustration.

B. Short-term Goal 2: replacing physical responses with verbal communication

Goal 2: Enhancing Social Skills

A. Short-term Goal 1: Take part in group activities.

B. Short-term Goal 2: Increase tolerance for other children.

Goal 3: Promoting Emotional Regulation

A. Short-term Goal 1: Attend weekly therapy sessions.

B. Short-term Goal 2: Create a "feelings chart."

To manage aggressive impulses, the client should identify early signs of frustration or anger and implement self-soothing strategies (e.g., deep breaths, counting to ten) before his anger escalates. He will also engage in at least one role-play scenario each week with a counselor, practicing replacing his physical response with verbal communication (i.e., instead of becoming physical during conflicts (Gill et al., 2024).

To enhance his social skills, Nathan will engage in small group sessions with the assistance of a counselor, practicing taking turns, sharing, and listening. He will also practice tolerating his peers when interacting with them, beginning with five minutes during structured play or social settings and increasing this duration over time (Sarmiento & Lau, 2020).

Nathan will attend play therapy sessions once a week during which he identifies and names his emotions so that he can express them adaptively. He will also implement a "feelings chart" to keep track of his emotions throughout the day and discuss them with his parents or therapist for further emotional growth.

Current and potential legal issues may impact the client's counseling treatment.

1. Confidentiality of the IEP

2. Right to a Safe Educational Environment

3. Mandated Reporting Requirements

The Individualized Education Plan (IEP) contains sensitive information regarding Nathan's mental health needs. This information is confidential and is considered protected. Institutions must be cautious and not reveal personal information to others (First et al., 2022). The school is not doing a great job of providing the required safe environment for its students. But if Nathan is violent, then the school has to weigh his right to education against the rights of every other student who might be injured in one of his attacks. Suppose Nathan displays behaviors that may mean he will harm himself or someone else. In that case, school personnel may be required to report those concerns to local authorities or seek additional assistance because of mandatory reporting laws (Sarmiento & Lau, 2020).

Current or potential ethical issues may impact the client's treatment in counseling.

1. Balancing Nathan’s Needs with Classroom Safety

2. Respecting Cultural Sensitivity.

3. Avoiding Labeling or Stigmatization.

Nathan's right to an education needs to be weighed against the need to protect other kids and adults from harm. The school will want to ensure they are not punitive while providing a safe learning environment. Advisors and educators should consider cultural contexts when interacting with families or implementing discipline practices. Calling Nathan "aggressive" or "impulsive" opens him up to stigmatization in and out of school (Collins et al., 2020). Professionals should carefully weigh their words when discussing Nathan’s behavior with peers and staff to avoid using negative labels.

Journal articles.

Colins, O. F., Van Damme, L., Hendriks, A.

M., & Georgiou, G. (2020). The DSM-5 with

limited prosocial emotions specifier for conduct disorder: A systematic literature review. Journal of Psychopathology and Behavioral Assessment, 42, 248-258.

First, M. B., Yousif, L. H., Clarke, D. E., Wang, P. S., Gogtay, N., & Appelbaum, P. S. (2022). DSM‐5‐TR: Overview of what’s new and what’s changed. World Psychiatry, 21(2), 218.

Gill, C. S., Dailey, S. F., Karl, S. L., & Minton, C. A. B. (2024). DSM-5-TR Learning

Companion for Counselors. John Wiley & Sons.

Sarmiento, C., & Lau, C. (2020). Diagnostic and statistical manual of mental disorders: DSM‐5.

The Wiley Encyclopedia of Personality and Individual Differences: Personality Processes and Individual Differences, 125-129.

Item

Description

DSM-5 Diagnosis

A. Major Depressive Disorder (MDD)

B. Co-occurring Substance Use Disorder.

Considering Alex's behaviors, symptoms, and reported nature of substances used, a possible indicative DSM-5 diagnosis could be Major Depressive Disorder (MDD) with Possible Co-occurring Substance Use Disorder. Common symptoms of Major Depressive Disorder include a persistent low mood, loss of interest in hobbies, withdrawal from social activities, and irritability. His substance use may be a form of self-medication or a maladaptive strategy for coping, which is often the case with adolescents suffering from depression. Furthermore, if his behavioral problems have caused substantial difficulties in his social or academic life, Conduct Disorder (CD) may also be diagnosed (First et al., 2022). Considering his symptoms and age, Major Depressive Disorder with Substance Use is the most fitting diagnosis at the moment.

Long-term goals.

1. Enhancing Emotional Regulation and Coping Skills.

2. Improving Academic and Social Engagement.

3. Reducing and Managing Substance Use.

Alex will learn and apply skills to manage and express his emotions so he can be aware of, make sense of, and deal with his feelings constructively. Due to the increase in school involvement and positive peer relationships, Alex will decrease his negative behaviors, such as truancy from school and encounters with law authorities. Alex will replace alcohol with new coping mechanisms while addressing the underlying issues without the use of substances.

Short-term goals for each identified long-term goal.

Goal 1: Enhancing Emotional Regulation and Coping Skills.

A. Short-term Goal 1: Identify and discuss his emotions.

B. Short-term Goal 2: Participate in Cognitive Behavioral Therapy (CBT).

Goal 2: Improving Academic and Social Engagement.

A. Short-term Goal 1: Attend at least 80% of his classes for the next month.

B. Short-term Goal 2: Participate in extracurricular activities.

Goal 3: Reducing and Managing Substance Use

A. Short-term Goal 1: Attend weekly meetings with a counselor.

B. Short-term Goal 2: Reduce substance use over the next one month.

Every week, Alex will track and discuss his feelings with a therapist, discovering early signals that depressive thinking is beginning, as well as how that shapes his actions. Alex will be doing CBT exercises (like journaling) to learn how to identify and counter negative thought patterns.

For the next month, Alex will attend at least 80% of his classes, concentrate on getting back into a routine and show some interest in academic life again. To help Alex establish healthy peer relationships and strengthen his sense of belonging, he will engage in one school or extracurricular activity of interest (Gill et al., 2024).

Alex must see a substance use counselor each week to discuss the reasons for his drinking and marijuana usage and what he can do instead of using these substances (Gill et al., 2024). Alex will make a plan to decrease his substance use this month and then eventually abstain from substances (using a self-monitoring log).

Current and potential legal issues

A. Confidentiality and Parental Consent.

B. School Disciplinary Policies.

C. Mandated Reporting

Being a minor, his parents still have the right to know about his treatment. Alex may face disciplinary action at school due to his truancy and possible substance use, affecting educational opportunities. Any punishment, however, warranted, would have to be carefully structured along legal lines so that Alex's rights as a minor with mental health problems are not violated. Mandatory reporting may be required if Alex's substance use or any actions indicate a risk of self-harm. His statements and behaviors must be tracked closely by therapists and school counselors in the most legal capacity that ensures his safety (Sarmiento & Lau, 2020).

Current or potential ethical issues may impact the client's counseling treatment.

1. Respecting Confidentiality with Substance Use.

2. Cultural Sensitivity.

3. Avoiding Stigmatization.

Due to his age and the fact that substance use is a sensitive matter, the ethic of care requires a degree of openness with the parents as well as caution when dealing with Alex's affairs. Strengthening trust between him and others will ensure that he can communicate freely without being scolded; thus, while disclosing information to his parents, this has to be done, bearing in mind that it's best for Alex (Sarmiento & Lau, 2020). It is important to understand what kind of family Alex comes from and what they value so as to not worsen his relationship with his parents or deepen his existing enmity. Culture raises the possibility that the ideas for treatment will be palatable to Alex and his family. Ethical treatment means no referent or stereotyping of Alex for the behaviors since there is a social bias on mental health and substance usage (Colins et al., 2020). Those who worked with him, namely clinicians and educators, should avoid criticism of him and focus on things that he can develop and improve.

Journal articles.

Colins, O. F., Van Damme, L., Hendriks, A. M., & Georgiou, G. (2020). The DSM-5 with

limited prosocial emotions specifier for conduct disorder: A systematic literature review. Journal of Psychopathology and Behavioral Assessment, 42, 248-258.

First, M. B., Yousif, L. H., Clarke, D. E., Wang, P. S., Gogtay, N., & Appelbaum, P. S. (2022).

DSM‐5‐TR: Overview of what’s new and what’s changed. World Psychiatry, 21(2), 218.

Gill, C. S., Dailey, S. F., Karl, S. L., & Minton, C. A. B. (2024). DSM-5-TR Learning

Companion for Counselors. John Wiley & Sons.

Sarmiento, C., & Lau, C. (2020). Diagnostic and statistical manual of mental disorders: DSM‐5.

The Wiley Encyclopedia of Personality and Individual Differences: Personality Processes and Individual Differences, 125-129.