Client is a 17 year old African American male that presented for a Comprehensive Assessment to determine eligibility for services. Though biologically male, she has socially transitioned and prefers to be addressed as Charmaine. The client identifies as a female. Her outward appearance was that of a teenage female. Present at the assessment was foster parent. During the assessment, client was argumentative with foster parent and disrespectful; indicating she did not want to come for services. Client reports she has no issues. She is resistant to available resources.

Information gathered was obtained from other records and the foster mom. The client engages in disruptive behaviors and these behaviors have been evident for an extended period of time. Client recently moved to this foster placement. Client’s history is significant for multiple placement changes. She was adopted at approximately the age of four (4) and was placed in DSS custody at age 16. Prior to a request to have the client moved from the former placement, the client cut her genitals (scrotum) with a razor, requiring fifteen (15) stitches to close the wound. The client reports that it was a “shaving accident” and her hand slipped when she was trying to shave her legs.  When asked about consideration for a gender reassignment, client responded she was unsure. Documents indicate she has discussed previously.

It has been reported that the client is overtly defiant with adult authority figures, and often responds with attempts to engage others in verbal arguments. She has shown a pattern of poor emotional regulation. The client has been involved with mental health services for an extended period of time and she has struggled with behaviors and interpersonal interactions. Her problematic interpersonal interactions are often triggered by being unable to obtain her immediate wants, and this poor impulse control often leads to emotional displays of anger and frustration, and they often interfere with her ability to maintain a positive interaction with others.

Client’s history is significant for multiple traumas-abuses and neglects in the biological home, struggles to acclimate and the adoptive home and subsequent discharge to DSS custody. It is reported that client’s biological parents have history for alcohol and drugs, mental illness and general instability.

The client has been provided extensive mental health services ranging from outpatient services to those requiring a secure residential facility. Documents indicate client has made threats of suicidal ideation and threats of homicidal intent (threatened to poison her adopted mother) but she denies.

The client resides currently with a foster parent. Her biological mother was killed by her aunt. Her father was recently released from prison and resides in a halfway house in Ohio.

What was the client’s diagnosis? Gender Dysphoria in Adolescents and Adults, Borderline Personality Disorder, Attention-Deficit/Hyperactivity Disorder, Combined presentation

The client has been involved with DSS at different times in her life, beginning with being removed from her biological family, post-legal adoption services, and recently being returned to foster care. The client has been involved in the legal system due to her stealing a vehicle from a previous residential placement, the illegal use of stolen credit cards, and attempting to drive herself to Ohio. She was involved with DJJ and placed on probation, and per reports she has successfully met the requirements of her probation. Recently, her foster parent reported she made a prank ransom call to her sibling, which garnered police involvement. No charges were filed.

Client reports she has registered to take CNA classes.

Client denies any traumatic events, including the death of her mother. Reports indicate she has suffered abuse and neglect.

Client reports she has a good relationship with her sibling and they communicate often. They live in other states. Documentation indicates that the client often engage in social isolation from peers, and had limited friendships and peer interpersonal interactions

Biological family has history of psychiatric and chemical dependency.

Documentation indicates that the client’s mother may have abused drugs and alcohol during her pregnancy with the client, but there is no definitive proof of such exposure. In addition, it is reported that the client was deaf until the age of four (4) years old, at which time she underwent a surgery that drastically improved her hearing abilities.

Documents indicate client has made threats of homicidal intent (threatened to poison her adopted mother) but she denies.

1.) DSM-5 Diagnosis of a Serious Emotional Disturbance

F64.0 Gender Dysphoria in Adolescents and Adults

F60.3 Personality Disorder

F90.2 Attention-Deficit/Hyperactivity Disorder, Combined presentation

Z62.29 Upbringing Away from Parents

1. What are some issues that Charmaine presents with? What do you think that Charmaine would say are the issues?

2. Write three goals for Charmaine based off the case study. Then write 3 goals that Charmaine would have for herself?

3. Thinking in light of supervision with a problem based story vs a strength based story, what are the client strengths that you see in this case and state why you notice that strength. Is this narrative a problem dominated story or a heroic client story?

4. Where would you need to get more information or training to be competent to work with this client?

5. The case notes that the client is “resistant.” Where do you think that this resistance has originated? What would you do to address it?

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