Does he yell at his mom and go sulk in his room for an hour or does he become physically violent?
Respond to at least two of your colleagues by offering additional insights or alternative perspectives on their diagnosis or provide alternate next questions and why you selected those. Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation.
Colleagues Response # 1
The YMH Boston Vignette 4 video shows the beginning of a psychiatric interview that demonstrated the interaction between a mental health practitioner and an adolescent male. The psychiatric Interview plays a significant role in the treatment of a client/patient with a mental health disorder. A good interview is indispensable for appropriate diagnosis and to the client-practitioner relationship.
What the practitioner did well?
The practitioner firstly, made the client comfortable and ready to disclose by demonstrating his understanding of the adolescent situation. Secondly, he made the adolescent aware of the confidentiality of their conversation and when he will not abide by this rule. As stated by Simon and Shuman (2004), patients feel free to disclose private information to their clinicians when they assume their personal information will be kept confidential so his approach of informing the patient first of the rules definitely help to make the patient worry less on confidentiality. The mental health professional in this scenario made obvious efforts to gain Shawn’s (the adolescent) confidence by showing empathy and understanding, evidenced by the comments: “that must have been kind of confusing” and “what teenager likes talking to their mom” (YMH Boston, 2013c).
Areas the practitioners can improve
The practitioner did not present himself to the adolescent client, and there is no indication they ever met before. Also, he made a mistake by stating, “your mother may have a reason” when he was trying to figure out the reason for the visit to the office. Subsequently, the client became defensive and withdrawn until he had the opportunity to express his thoughts.
A major concern is the inability for the clinician to maintain a therapeutic environment at all time. For instance, when he mentions that the adolescent’s mother may have a reason, he appears judgmental and willing to side with the teenager’s mother. Another concern I have is the exclusion of the mother in the treatment. This issue was addressed as a recommendation by the American Academy of Child & Adolescent Psychiatry (2012). My other compelling concern at this point would be the safety of his mother, other members of the household, and Shawn himself. The clinician could evaluate this by asking Shawn what “losing his temper” looks like to include actual behaviors, severity of aggression, and how those behaviors make him and his family feel.
My question would be to gather more information about the family. At this point, we do not have information about any possible other family members (s) and the dynamism inside the family. That information is very important in solving the puzzle why the male teenager behaves with anger toward his mother and not to other people.
The patient’s treatment plan begins with a good interview. The clinician should be skilled to gather all the necessary information for the appropriate diagnosis and to tailor a treatment plan accordingly. A missed opportunity to do so may trigger resentment and misunderstanding of the client/patient’s needs.
Colleagues Response # 2
The presenting vignette shows the beginning of an initial clinical interview of a psychiatric provider meeting with Shawn, a 16-year-old adolescent male, for the first time. Initially, Shawn has body language indicative of being withdrawn and he appears uncomfortable with the situation. The provider starts by explaining patient confidentiality rights and exclusions. This is essential with any patient presenting for treatment, but can be particularly important with adolescents. It is not uncommon for adolescents to be concerned about confidentiality and explaining their rights is a good way to start the conversation (Sadock et al., 2014). Additionally, the provider did a good job working to build rapport with the patient by asking general questions in the get-to-know-you sense. The provider also empathized with the patient not always wanting to talk to his mom, while also trying to find out his support system. These are both good strategies for building rapport while also trying to gather important information about the client.
Areas for Improvement
The provider worked in the first part of the interview to build rapport with the patient and Shawn appears to have responded well to his attempts. The client appears to open up more and talks more about what is going on and why his mom wanted him to be evaluated. However, I feel that the provider went a little too far with his empathy for Shawn and appeared to be taking sides at the detriment to the mother-son relationship. To properly learn about the problem that Shawn and his mother are facing, the provider must appreciate both the mother’s and the adolescent’s perspective (Bhide & Chakraborty, 2020). Dismissing the mother’s complaints may build rapport with Shawn, but also undermines any future attempts at improving communication within the family unit. Another area for improvement during the clinical interview would be to ask more “why” questions. Shawn says that he hates school but the provider misses an opportunity here to find out why he hates it so much. Is he being bullied? Is he struggling in a subject that is negatively affecting his self-esteem? There is an opportunity here to gather more key information and the provider does not inquire further, missing the chance at gathering more information about Shawn and his struggles.
I have several concerns about Shawn and would like to ask additional questions that I feel are important in formulating a diagnosis. Based on the initial interview, Shawn explains that he loses his temper with his mom. However, the provider does not ask what it looks like when Shawn loses his temper. Does he yell at his mom and go sulk in his room for an hour or does he become physically violent? Losing your temper can look very different from one person to another and knowing the associated behaviors is important to understand the severity of the problem. As adolescents grow, nearing adulthood, they will naturally work to establish independence from their parents (Pickhardt, 2009). A natural part of the maturation process includes adolescents learning to differentiate themselves from their parents and this often results in them actively challenging parental authority (Pickhardt, 2009). Consequently, moving forward, my questions would be centered around better understanding what their arguments are about and what happens when Shawn loses his temper. This information will help me determine if Shawn is struggling with a significant behavioral problem or if he and his mother need to work on improving their communication as he grows and establishes his independence.