Often times, in the role of a helper, we are bombarded with a lot of information. With the information you have gathered, consider what is your priority and what limitations might you have in the role of a school counselor when answering the ethical limitations. With all of this information, what do you think the next steps and questions might be if Josiah, his mother, and step-father are coming to see you as his school counselor at the local high school?
Josiah is a 16-year-old boy who first encountered mental health treatment after he admitted to his parents that he had thoughts of hurting himself.
He has been caught smoking cigarettes in his room at home by his stepfather and in the verbal altercation that followed Josiah told his mother and stepfather that he “didn’t care anymore and wanted to die.”
Josiah’s stepfather became very angry and threw him out of the house for being disrespectful and untrustworthy.
Josiah’s mother then became enraged at her husband and told her husband that if he kicked out Josiah, she was going, too.
Josiah admitted to feeling depressed for several months prior to this episode.
Josiah’s family consists of his mother, stepfather, 18-year-old older sister, and 11-year-old sister.
Josiah’s biological parents divorced when he was two years old and his mother remarried when he was six.
His mother reports that his biological father was abusive toward her, but not the children.
She left him after an incident where he struck her while she was holding Josiah when he was an infant, and she felt Josiah’s safety was being seriously threatened.
Josiah has had little contact with his biological father since the divorce, but contacted him recently because he wanted to leave his current family and live with him in another state.
To Josiah’s disappointment, his biological father’s response was noncommittal.
Josiah’s mother reports symptoms of posttraumatic stress disorder (PTSD) from the abuse she suffered from Josiah’s biological father as well as from a sexual assault in her adolescent years.
She also experiences chronic headaches and fatigue, which sometimes limit her involvement with her children.
Josiah’s older sister has bipolar disorder and although she has been stable for the last two years, she has had a difficult time for several years and is unable to attend a regular school.
Josiah feels his older sister is not held to the same standard as he is because of her psychiatric illness, and he feels this is unfair.
Josiah feels that the expectations for success are all the more potent for him due to his sister’s illness.
Josiah has had a distanced relationship with his stepfather. Josiah’s stepfather is a retired police officer who highly values order and discipline.
He does not agree with Josiah’s long dyed, hairstyle or passion for acting. He forced Josiah to cut his hair and change his style of clothes after he was caught smoking.
Josiah admits that sometimes he fears him when his temper ignited.
The stepfather is generally suspicious of mental health providers and views psychiatric symptoms as an excuse or a weakness.
This causes marital problems in relation to the mother’s PTSD symptoms as well as Josiah’s depressive symptoms.
Josiah wants to be an actor and says that he does not see the point of studying or going to school.
Although he did well academically in the 9th and 10th grade, his grades declined significantly recently to the point that he is ineligible to participate in extracurricular activities like the drama club.
He admits to having difficulty fitting in and is associating with the kids who skipped class and took drugs.
Josiah’s depressive symptoms include sad mood, decreased motivation, decreased energy, decreased concentration, and sleep difficulty.
After recently breaking up with his girlfriend, he cut himself superficially on his forearm with a razor and had fleeting thoughts of suicide.
What are your initial thoughts and what are follow up questions that you would ask to clarify the diagnostic picture?
What are ethical considerations that are relevant to the case and might impact the situation identified?
What are the observable markers, as defined by the DSM-5, that are found in the presented information?
Include at least 2 scholarly references