Problem
Case Study: Peter
Peter is 12-years-old and his parents brought him in due to some serious concerns in regards to his behavior toward others. He is the middle child and has a younger sister and an older brother. Academically, he typically scores high on his assessments; however, he typically fails to do his homework, especially in classes where he shows little interest. He has begun skipping some classes. It appears he has begun smoking cigarettes and his parents are worried about possible drug use.From an early age, his parents described him as angry, hurtful, and spiteful. He would always test boundaries both at home and at school. At age 7, his parents reported his hamster dying of mysterious cause, and when they bought another one a few months later, he died as well due to Peter "playing" with him too rough. As a child, he used to take the wings off of flies and he would keep bugs in containers without air vents or food. His parents reported no longer having any pets in the home due to fear for the pet's safety.Peter frequently calls his younger sister degrading names and neither sibling likes being around him due to his bullying behavior. He especially targets his younger sister due to her frequently crying after he taunts her. His typical response is laughter. His teachers have reported similar behavior during school and after, bullying classmates and/or others in the school. He has been suspended from school multiple times each school year and has seen a few school counselors since 2nd grade. Recently, he was suspended due to stealing the phone of one of his classmates and then beating him up after school when his classmate asked for his phone to be returned. Both parents reported him lying frequently with no tell (no affectual disturbance) and showing no remorse even when caught red handed or when he has caused harm to others (another child or animal).Peter's father is a police officer and tends to be absent from the home frequently (he works evenings and weekends). His father is authoritarian and is pretty strict with discipline. His mother is very anxious around Peter and fears his responses to being disciplined. In the past, Peter has threatened to beat her if she takes away his electronics and he is now physically big enough to intimidate her. In session, Peter's mother breaks down and cries due to feeling completely overwhelmed with parenting her son. She herself has a history of severe depression, including severe postpartum depression after Peter was born. When he was 2 years old, she was psychiatrically hospitalized for a few weeks. Since then, she has been on medication to help control her depression.
Task
1) What questions would you ask to get a better understanding of the child and family system. Include cultural considerations?
2) Discuss both (Conduct Disorder from Oppositional Defiant Disorder) differential diagnoses to consider and why you ruled them out. Consider assessment methods, such as, a clinical interview, client observation and/or the use of screeners or formal assessments. Make sure you are listing all criteria the client meets.
3) What are the environmental and family system factors? Describe the key influences contributing to Peter's case. Why is it important to understand the family system?
4) Identify and briefly describe a minimum of two counseling best practice interventions for Peter's presenting concerns. Consider interventions that may be used in home and school-settings as well. Justify your rationale.