Diagnosis & Treatment of dysfunctional Behavior

1. Diagnosis & Treatment of dysfunctional Behavior Dr. Levi Armstrong Amberton University

2. Diagnostic InterviewingLecture 1 of 2 • What is a diagnostic interview? • Usually performed during initial meeting with client • Sometimes takes a few sessions (2 or 3 at most) • Reviews a wide range of the client’s history and symptoms • See next slide • Purpose is to establish a provisional diagnosis so as to delineate a specific plan for treatment • Identifies other conditions in need of a referral to ancillary providers • Should be therapeutic in nature and an effective means for “breaking the ice” during initial sessions with the client • Often erroneously overlooked when practicing counseling • Can be performed with individuals, couples, and families

3. Diagnostic InterviewingLecture 1 of 2 • Review of the Client’s Chief Complaint/Main Areas of Concern • Chief Complaint • Client’s spontaneous list of concerns • WHY SEEK THERAPY NOW? • When did the symptoms begin? • How often do they occur? • What is the severity of the symptoms? • In what context do the symptoms occur? Triggers, etc.? • What, if anything, helps decrease or manage the symptoms? • QUICK TIP: Most, if not all this information, can be gathered with an intake questionnaire to be reviewed by you in the first session.

4. Diagnostic InterviewingLecture 1 of 2 • Background Information You Should Gather • Developmental History • Born and raised where? • Born on time? If not, how many weeks early/late? • Any complications with mother’s pregnancy or delivery? Exposure to any drugs/alcohol/trauma in utero? • Any health complications immediately after birth? • Treatment history of this, if any • Developmental Milestones • Feeding abilities • Motor milestones – sitting up, crawling, walking, running, fine motor dexterity • Speech-Language milestones – early vocalizations, reciprocal vocalizations, first word, first sentences, any speech delays or abnormalities • Early Social Development • Attachment style with parents, siblings, peers • Early Behaviors & Cognitive Abilities • Any inattention/hyperactivity early on? • Impulsivity, defiant behaviors, acting out, explosive anger episodes? • Home Life Growing Up & current relationships with family

5. Diagnostic InterviewLecture 1 of 2 • Background Information You Should Gather • Academic History • Pre-K – College History • When, Where attended • Any grades repeated/failed? • Behaviors during elementary through college • Any special education services (e.g., speech therapy, 504, IEP, etc.) • Any learning disabilities diagnosed? – any specific testing? • Social development through academic history • Any bullying? • Academic strengths & weaknesses • DIAGNOSTIC INTERVIEW REVIEW TO BE CONTINUED NEXT CLASS…

6. BRAIN BREAK! • How Not to Do Therapy…. • https://www.youtube.com/watch?v=4qiQI-zrPvQ

7. Diagnostic InterviewingLecture 2 of 2 • Medical History: • Current Medications, dosages, frequency, side effects, effectiveness, prescribed for what? • Any major illnesses or injuries • History of brain injuries/disease: • Seizures • TBI/Concussions • Exposure to toxic substances • Etc. • Past Surgeries • Current Physicians Following Client • Names, Contact Info • Current medical diagnoses • Past medical diagnoses

8. Diagnostic InterviewingLecture 2 of 2 • Psychiatric History: • Current/past diagnoses • Current/past medications • Inpatient hospitalizations • Previous suicide attempts • Previous counseling experiences • With Whom? For how long? Why did/didn’t they work? • Previous psychological testing • Diagnoses suspected and why? • Exposure to traumatic events/abuse? • Substance Use/Abuse History • Vocational History: • Current/past places of employment • Job titles, reason for leaving, salary earned • Family Medical/Psych History: • Known or suspected diagnoses • LD’s, ADHD, Schizophrenia, Bipolar, Anxiety, Depression, Autism, etc. • Social Functioning: • Current/past marriages • What, if any, problems occurred? • Children • For children, ask about peer relationships at school, etc.

9. Diagnostic InterviewingLecture 2 of 2 • Legal History: • I typically start here… • Previous arrests/charges, outcomes • Any child-custody/divorce proceedings? • Suing or being sued by anyone? • Name(s) of any attorneys • Contact information too! • Applying for disability? Workers Comp? • Review of Subjective Symptoms: • Cognitive • Attention • Memory • Language/Speech abilities • Visuospatial skills • Executive Functions • Planning, prioritizing, organizing, etc • Academic skills • Daily Problem Solving Abilities

10. Diagnostic InterviewingLecture 2 of 2 • Review of Subjective Symptoms: • Physical Symptoms: • Pain or Headaches • Energy Level • Appetite • Sleep • Balance/Coordination • Vision/Hearing • Review of Subjective Symptoms: • Emotional/Behavioral Symptoms: • Mood • Mania or hypomania • Suicidal or Homicidal • Thoughts, Plans, Intents • KNOW HOW TO ASSESS THESE DOMAINS CAREFULLY • Anxiety • Irritability • Lability • Inhibitions • Initiation • Psychosis

11. Developing a Treatment Plan(individual therapy) • Step 1: KNOW YOUR CLIENT • Step 2: KNOW WHO IS PAYING • Step 3: DIFFERENTIAL DIAGNOSIS • 3a Case Conceputalization • Step 4: SELECT LENGTH OF THERAPY • Step 5: SELECT TIMING OF THERAPY • STEP 6: DETERMINE SPECIFIC GOALS • STEP 7: DETERMINE OBJECTIVES • STEP 8: DETERMINE INTERVENTIONS • Step 9: Start Therapy • Step 10: Assess/Evaluate Effectiveness • Step 11: Document Effectiveness • Step 12: Plan for Termination • Time-limited vs. open-ended • Termination issues • Maintenance Plan