Social Work Direct Practice II:

Direct Practice with Individuals, Families, and Groups

Columbia University School of Social Work T7102

Acknowledgements:

In introducing the following work, I would like to begin by acknowledging the traditional, ancestral, and unceded territory on which we learn, work, and resource from at Columbia University School of Social Work is land of the Lenape and Wappinger indigenous peoples. Let us commit ourselves to the struggle against the forces that have dispossessed the Lenape, Wappinger, and other indigenous people of their lands.

I would also like to acknowledge professor Kelsey Reeder and their facilitation of SOCW T7102. If this is all Professor Reeder reads, it has been a great joy to learn from them in the process of developing a client assessment workbook. With Prof. Reeder's lecturers, recommended readings, and guidance, this workbook project took form. Moreover, all my peers in class who contributed to discussions and building ideas that related to the present topic. With these acknowledgements, I present the following work of my own.

Client Assessment Workbook: Executive Summary

This Client Assessment Workbook consists of a series of exercises designed to provide a thorough assessment of the client, K, completed by the present social worker, Ethan H. Freedman. This workbook critically examines K's presenting problems, overall functioning, treatment goals, use of self, and considerations of Power, Race, Oppression, and Privilege (PROP) to develop a comprehensive understanding of his case.

K is a 14-year-old Black and Hispanic male from the Bronx, New York, who identifies as Muslim. He is currently in 7th grade after being held back a year. K demonstrates strong intellectual abilities, particularly in math and STEM subjects, and excels in structured, goal-oriented environments such as competitive sports. However, he struggles with impulsivity, emotional regulation, oppositional tendencies, and rigid thinking, leading to frequent conflicts with authority figures and disciplinary action in school. His past disciplinary history includes bringing a knife to school and later a toy knife, behaviors stemming from his competitive and justice-oriented mindset.

This assessment is framed within the Person-in-Environment (PIE) perspective, integrating structural competency (Metzl & Hansen, 2014) and anti-oppressive social work principles (Finn, 2021). K's behaviors are evaluated within broader systemic factors, recognizing that Black and Hispanic boys are disproportionately disciplined and misdiagnosed in school settings (Hardy, 2016). The assessment incorporates mental status examinations, collateral interviews, and DSM-5 diagnostic considerations to ensure a holistic evaluation.

The goal of this assessment is to develop a strength-based, culturally responsive, and trauma-informed intervention plan that prioritizes emotional regulation, impulse control, academic engagement, and healthy peer relationships while advocating for equitable support systems that foster K's long-term success.

Assignment 1: A Complete Mental Status Exam (MSE) of Agent 'K'

From Lukas (1993), the orienting notions that a Mental Status Exam (MSE) is  the process of “noting the observable in some systematic way” helps abstract through language how assessments can be utilized differently depending on the “clinical settings” (pg. 13). While some might opt into assessing mental status in a static setting at one point in time, the MSE has the capacity to be an ongoing and continuous process of measurement for practitioners. Encouraging social workers and clinicians not to make assumptions, a Mental Status Exam enables engagement that is like “embarking on a mutual effort to understand” the client and “documenting what is noteworthy” (Lukas, 1993, pg. 15).

Although Lukas (1993) outlines the important pieces of a mental status exam that are present in this workbook, Snowden (2003) reminds that racial disparities are pervasive in the process of administering exams. There are systemic issues that expand beyond economic forces when dealing with mental health examination as “bias is a little studied, but viable explanation for these disparities” (2003). The agents and powers controlling the outcomes of the mental status examinations are the professionals who are tasked with documenting, observing, organizing, and overseeing the synthesis and consolidation of information they consider to be relevant in the formulating an understanding of the client. While theories for why these biases implicitly guide assessment processes can focus on the individual clinician administering examination, “stigmas are not primarily produced in individual encounters but are enacted” through “structural cases” persuading for a “shift… from an exclusive focus on the individual encounter to include the organization of institutions and policies” that surround the agent in focus.

With this in mind, the following Mental Status Exam of K takes into account the clinical setting of social work, the practitioner administering assessment, as well as the understanding that evaluation is a continuous process of mutual engagement and effort to understand the agent in focus that takes into account the structural powers that are relevant to an agents individual self, microsystem, and macrosystem.

I. General description

K (he/him) is a 14-year-old boy standing slightly above five feet tall who identifies as a Muslim, Black or African American, and Hispanic Male from the Bronx, New York. With medium length hair that continues to grow, brown eyes, and a lanky or skinny appearance that partners with an agile athletic build, K’s daily appearance can range from intensely maintained to nonchalant or unkempt. While K is sometimes present with a groomed appearance that correlates with positive hygiene practices, there are many circumstances within a week where the scholar’s clothes, hair, and general appearance resembles a lack of attention or care from the agent and surrounding system of support. The scholar has often forgotten his uniform and or reused clothes worn in the week, but maintains good oral hygiene – something K personally notes.  While his posture is often slouched and his energy intensely directed forward, the scholar is able to maintain eye contact through engagement and has no visible signs of malnutrition or physical distress. The scholar also has no visible tattoos , scars, or other distinguishing marks.

Overall, the client is cooperative despite initially showing up guarded in individual counseling sessions. He responds to questions with brief answers and occasional hesitations, but will also divulge into discussing topics of his interest. His posture is directed towards what is in front of him, and can range from slouched to a tall attempt at masculine performance when around his peers. He is rapid with his movements, sly with other behaviors - especially in the classroom and around peers - and engages with others in an intense fast paced manner. While he slows down to annunciate or tonally make clear some sentiments, his facial expressions remain intensely focused on conveying his understanding with little variation in effect. K occasionally fidgets with himself or items around him, such as tapping fingers, singing, or dancing. There are no obvious tics, tremors, or abnormal involuntary movements, though the scholar’s repertoire of language can be similar to a sailor’s at times. Though the scholar was held back a year in school, his character and sense of self is steady with no signs of psychomotor agitation or slowing.

K maintains a tonal range of disengaged and calm to intense and angry, while capable of maintaining eye contact depending on if he is in good graces with which he engages. There is no overt hostility or defensiveness, though he is resistant to answer questions in an extensive manner and often opts into brief answers. When asked clarifying questions, he responds with slight tonal changes that reflect a more sensitive effort in conveying his point and remains engaged. He has a history of suspicion with questioning, though K is able to be vulnerable depending on his situated affect.

II. Mood and affect

K describes his mood as “focused” and “precise” and states that he thinks he is “on top” of his tasks and goals. He feels “confident” in himself and how he shows up at school, and has been feeling this way since he dedicated his energy towards correcting circumstances for school suspension earlier in the 2024-2025 school year. Despite progressing, the client has cited himself as intensely “competitive” and is often “on edge” and “upset” after losing anything competition based. The scholar is frequently worried and focused on his school and athletic performance, often overwhelmed by his large goals for achievements in both categories. He often states that it is “hard to relax” or “focus” in a classroom setting because of these cycling moods alongside course curricula not engaging him enough because it is easy. While he acknowledges intermittent feelings of sadness, he is rarely unmotivated, and tries to stay “logical” and “positive.” Despite these effective goals, “little things” have the capacity to set the scholar astray and can lead to him snapping at peers and adults for no reason. He denies experiencing euphoric moods or drastic mood swings, but is often emotionally fatigued by the end of a session or day.

The client's effect observed within school contexts is constricted, with limited range and intensity of emotional expression. While his energy is more often intensely directed at what is in front of him, this can lead to distractions from the primary task of focus. Accelerating through assignments and conversations is a principle emotional parameter for K as he remains tense in his posture, fidgets frequently (though fidgeting can be conflated for athletic movements), but does not show noticeable shifts in facial expression. His effect is more often consistent than inconsistent, regardless of the topic discussed, but can range in scale or intensity of exhibiting behaviors for the scholar’s emotional state.

Overall, the client's affect is inappropriate to the context of school because of how his domain of emotions operates alongside a system of peer scholars and adult educators. He struggles to discuss emotionally charged events, smiles and laughs through uncomfortable or contextually inappropriate moments for a school setting, and the intense manner at which he shows up for his community can quickly undo his “positive” and “logical” mindset leading to a negative and reactive framework.

III. Speech

K’s speech patterns are consistently at a faster rate and moderately loud volume, with clear articulation and appropriate intonation, stresses, pauses, and rhythm. His communication is coherent and goal-directed, though he occasionally pauses before answers, suggesting mild hesitation–or more likely distraction alongside questioning. There is no evidence of pressured speech, latency, or poverty of speech, though the range of intensity for the scholar’s speech can lead to scalpel mumbles in annunciation. With regards to pressured speech, the client speaks rapidly, almost continuously, and moderately interrupts the clinician. He refrains from interrupting the clinician and provides a range of thorough to short one-word responses. While K can take his time in responding, he doesn’t require repeated prompting despite taking several seconds to formulate answers to questions. He is hardly ever monotonous in his tone and speaks with intense emotion and efforts to convey his emotional state or circumstances.

IV. Perceptual disturbances

While K has never cited experiencing hallucinations or delusions, his understanding of reality is intact for an adolescent and he does not report abnormalities in how he perceives sensory information from his environment. K has never reported hearing voices, seeing things that are not there, or feeling as though others are watching him.

However, he describes mild sensory sensitivities, stating that he often doesn’t notice things around him when he is focused on something. His selective hearing coincides with visual misinterpretations where he chooses to see what he wants to see, rather than using the contextual information in front of him to infer what the reality of the situation could have been. An example of this behavior might be where K insists he saw a peer do something inappropriate when in reality nothing suspicious happened. This can be attributed to being easily distracted and selective with what he pays attention to when K is deeply focused on a task in the context of school.

Moreover, the client has an intense absorption in preferred activities, explaining, “when i’m playing video games, soccer, or working on something I like, everything else just disappears, and I don’t even notice what’s happening around me” – unless my peers are bothering me or being “chaotic.” K also acknowledges that transitioning away from these tasks can be frustrating (especially when competition is relevant) and often leads to irritability and defiant responses when interrupted.

The scholar also reports feeling overwhelmed in loud or chaotic environments, stating he can get “irritated” or “frustrated” when too much noise is present. He describes feeling “misunderstood” when adults interpret his frustration as disrespect as he is “not trying to be rude, just honest and following his truth.” Behaviorally, the client demonstrates oppositional tendencies, particularly in response to authority figures or perceived criticism. He becomes argumentative when given directions he views as unfair, unnecessary, or worthy of challenging. His opposition can appear more reactive than calculated, often emerging in situations where he feels controlled or misunderstood.

K’s overall perceptual experiences appear within normal limits, with some signs of sensory overload, hyperfocus, hyperactivity, and impulsivity that may contribute to oppositional behaviors rather than a primary perceptual disturbance. His resistance to authority and difficulty with transitioning between tasks seem to be more related to frustration intolerance and impulsive emotional regulation rather than deliberate defiance.

V. Thought

The scholar organizes and expresses his thoughts in a range of passionate, logical and coherent to disorganized and preoccupied. While K has a logical and coherent thought process rooted in personal goals that assists in his capacity to appropriately respond to questions and enables him to stay on topic without excessive tangents or circumstantial speech, his disorganized thought processes resemble Attention Deficit / Hyperactivity Disorder as K is somewhat tangential and distractible. He frequently shifts topics, thought finishes his points per topic addressed, and can redirect himself–only after his thoughts are fully fleshed out. He is especially able to return to the topic when prompted, but struggles with maintaining focus in conversation when he is taking on the role of the listener. Along with this, K has a rather circumstantial thought process that is rooted in overly explaining himself to others. While K provides excessive details before answering the questions, his ability to return to the point is not lost despite overly elaborate answers rooted in logical affect. In tangent with these efforts of forming thoughts exemplified by K, the scholar often exhibits a rapid and pressured speech, jumping from one topic to another with a little more than tenuous of a connection. His thought process requires attentiveness to follow due to the rapid pace of speech and thought development, but his notions are formative to each other.

The content of K’s thoughts, or about what K thinks, ranges from normal to preoccupied, obsessive, and anxious or paranoid. While there are no delusions, suicidal/homicidal ideation, or severe neurosis, his thoughts strongly revolve around being based in reality and applicable to the present context. That being said, he is incredibly preoccupied with thoughts of competition in sports and school, repeatedly directing conversations towards this topic. An example of this might be using his grades in classes to justify his opinion based perspectives, but mainly encompasses efforts to redirect conversations towards his interests. This type of thinking is the very thought content that can be obsessive for K. The first part of his day might be spent worrying about his performance in physical education games like soccer or dodgeball, while the second half of the day is a response to how these events unfolded. If he loses a sports game, his day is often “ruined” or he is “unable to let it go”–drastically affecting his directed efforts towards school. The paranoia or anxiety of K is rooted in slightly delusional thinking as he often feels his peers and teachers are secretly working against him attempting to make him fail or mess up on purpose. However, this is often something that is displayed reciprocally as K will attempt to create circumstances where others are messing up or struggling to succeed–something stemming from competitive or defiant behavior. He is resistant to discussing alternative explanations for this belief. An example of this behavior might be when K brought a knife to school for protection, was suspended for this behavior when he threatened another student with it, and proceeded to bring a plastic toy knife to school post suspension in efforts to display the same power that would be rendered with a real knife.

VI. Sensorium and cognition

Alertness, Level of Consciousness, Orientation, Memory, Concentration, and Attention:

Although K displays normal alertness and fully conscious cognition with appropriate responses to verbal and environmental stimuli without any signs of confusion, he has a mildly distracted cognitive framework that leads him to lose focus during clinical and school settings, but generally responds appropriately depending on the agent redirecting him.

His awareness of time, place, person, and situation is relatively normal as he can correctly identify the date, location, and reason for the interview process. He is also able to compartmentalize his tasks for the upcoming weeks of school and or months of the year. In other words, with spring time coming, the scholar is mentally and physically preparing for attending a summer camp that he loves, but can compartmentalize all the work that is required to get to the point where he can attend and enjoy this time. This process of preemptively preparing or anticipating is in line with mild anxiety or ADHD related distractibility as the client struggles to stay in the present and often desires to prepare for the future (ie. applying to high school, joining a club soccer team, and attending summer camp). Moreover,

The scholar’s ability to recall past and recent events in memory is normal as K demonstrates intact short and long term memory. While he accurately recalls or repeats the questions being asked of him in the answers he responds with, he is also able to return to the premise of the conversation despite the time length between themes. That being said, K can still struggle with immediate recall, needing repetition of instructions or questions depending on if he is distracted by confounding variables in the environment, but accurately remembers details from early in conversations and can verbally recall or paraphrase encompassing ideas. Like with many children, K will recall memories in a skewed sense that may attempt to justify the dissonance generated from his own behaviors or attitudes–especially when they are contextually being compared to another student (ie. Discipline related contexts where other parties beyond K are involved.

K’s capacity to concentrate or give his attention to the task at hand while maintaining attention over a certain amount of time ranges from normal to severely impaired. While K can remain focused through the individual counseling sessions, he is easily distracted by his own thoughts, peers, and personal motives. He is great at tasks with multiple steps, though will rush through completion no matter the level of difficulty or number of tasks. An example of this might be when the scholar is handed assignments, he is the first to complete them with great competency levels, but the rate of his work leads to mistakes. These mistakes compound the scholar’s ability to focus beyond initial completion of tasks during processes of revision, accountability, or secondary steps.

Capacity to Read and Write:

The overall ability for K to comprehend written language and produce language based responses is normal compared to scholars at his grade level in his school, though mildly impaired for scholars at his age level. This is in line with the scholar having to repeat a year of elementary school due to disruptive behavior that drastically impaired his learning for the year. At this moment in time, distractions and irritability were high and the scholar had a difficult time organizing thoughts and directing his energy.

Visuospatial Ability:

K’s ability to perceive spatial relationships and navigate his surroundings exceeds beyond normal, but can range in his understanding of what is appropriate. While K can accurately mirror behaviors by peers, teachers, or adults without difficulty, he hesitates when mirroring actions, behaviors, or attitudes that do not align with his. Moreover, K’s awareness of space is not always reflected in the ways he utilizes the space. An example of this is when K is in individual counseling sessions, he opts to play with a soccer ball or basketball. This leads to him using the space to practice his skills, but he may lean into practicing a little too hard for the space's capacity. This may look like kicking a ball against the wall, sporadically running around the room with the ball, or challenging other students to skill based competition in the counseling space. In other words, K may use a space that is designed for soft interactions in a harder or more intense manner.

Abstract Thinking:

K demonstrates a mixed capacity for abstract thinking, showing both strengths in conceptual reasoning and limitations when navigating complex ideas. He is capable of engaging in hypothetical thinking, particularly in domains that align with his personal interests, such as sports, competition, and strategic planning. When discussing future aspirations, personal goals, or hypothetical scenarios related to athletics and academic achievement, K exhibits a logical thought process, often articulating steps needed to reach a desired outcome. This suggests an ability to engage in goal-directed abstract reasoning when the subject matter is personally relevant.

However, K’s abstract thinking is often rigid and tied to concrete experiences, particularly when processing interpersonal dynamics, authority figures, or rule based interactions. The scholar frequently interprets metaphors, idioms, and non-literal language as literal or concrete, though wields figurative rhetoric all the time. If abstract concepts are not related to his interests, he tends to redirect the conversation, through figurative language or not, towards his own tangible experiences. He can engage with theoretical and philosophical discussions in the classroom, though prefers his reality to be logical. K often simplifies complex situations into dichotomous thoughts, such as viewing interactions with his teachers as fair or unfair, competitive or non competitive–rather than consider nuanced perspectives or alternative explanations.

Additionally, K exhibits a preoccupation with justice and fairness, but struggles with abstract moral reasoning. His perspective on right and wrong is largely dictated by personal experiences and immediate contextual factors rather than broader ethicalities. K’s compulsion to personalize hypothetical moral dilemmas rather than reasoning from a detached perspective suggests that he has the capacity for abstract thought, though his application of it remains developmentally appropriate as it is constrained by personal biases and limited cognitive bandwidth.

Overall, K’s abstract thinking is intact, but somewhat underdeveloped in areas requiring him to bend to others, nuance in the conversation, and engagement with theoretical or metaphorical constructs. While he excels in strategic reasoning when it pertains to his personal interests of competition or goal achievement, he demonstrates difficulty in applying the same level of abstractions to emotional processing, interpersonal relationships, and complex social situations. His abstract thought capabilities remain experiential and goal oriented.

Fund of information and Intelligence

K’s intelligence appears intact and developmentally appropriate, with strengths in practical reasoning, strategic thinking, and problem solving goal oriented contexts. He demonstrates intellectual curiosity in areas of personal interest and excels in individual tasks that require quick thinking, adaptability, and strategic decision making. His intelligence is largely self-driven, shaped by observational learning, personal experiences, and trial-and-error problem-solving, rather than strict reliance on instructions.

K gathers a large portion of his information from a combination of direct experiences, peer and family interactions, and digital media. He often relies on personal logic and subjective interpretations, sometimes resisting alternative perspectives that make his own beliefs uncomfortable. His familial, social, and peer environment strongly influences his knowledge base, particularly when navigating authority dynamics, competition, and social hierarchies. He absorbs information from social media, video games, and real-world experiences, integrating lessons from these sources into his world view. An example of this comes from the scholar’s admiration for his brother who is in the military, and his understanding of the military that comes from video games.

Academically, K demonstrates competence in structured learning environments but lacks sustained focus on non-preferred topics. His knowledge retention is strong when he is engaged, but weaker in areas he deems unimportant because they are not stimulating to him. Although he is capable of logical reasoning and abstract thinking, his rigid thought patterns and competitive roots interfere with his ability to incorporate new or conflicting information.

Overall, K’s intelligence and information is rooted in experience, social observation, and competition–with a strong cognitive ability in areas of interest, but a selective approach to information processing. His tendency to prioritize self derived conclusions over external sources may impact his ability to adapt to new perspectives and refine his understanding of complex concepts.

VII. Impulse control

K demonstrates inconsistent impulse control, with better regulation in structured settings and significant challenges in unstructured or emotionally charged situations. When engaged in personally relevant activities, he can pause before responding and delay gratification, especially if there is an external reward at stake (no matter the time til the external reward can be achieved). However, the scholar’s rapid speech, topic shifting, and occasional interruptions suggest mild difficulties with impulsivity, especially in conversation. This has been exemplified through lack of restraint for rudely talking back to any adult whom he is frustrated, and especially any peer.

In social and competitive settings, K’s impulse control markedly decreases. He is highly reactive to perceived unfairness or loss, leading to verbal outbursts, oppositional behavior, and difficulty transitioning from preferred tasks. His defiant stance toward authority and argumentative personality indicate low frustration tolerance and difficulty suppressing immediate emotional reactions.

Behaviorally, K engages in fidgeting, self-stimulation tasks, and risk taking behaviors that suggest difficulty with self-regulation when under stress at the very least. Considering school environments are not the most relaxed, disciplinary incidents have occurred when the scholars' behaviors, stressors, and impulses combine. An example of this is when K brought a knife to school and later a toy knife post-suspension, highlighting poor foresight and emotional impulsivity rather than deliberate defiance.

Overall, K’s impulse control is mild to moderately impaired, with stronger self-regulation in structured, interest based contexts and heightened reactivity in emotionally challenging situations. His challenges appear rooted in emotional regulation, frustration tolerance, and executive functioning abilities–rather than purely oppositional behavior.

VIII. Judgment and insight

The scholar demonstrates variable judgement, with better decision making skills in structured environments and significant difficulties in emotionally charged or unstructured situations. When engaged in tasks that align with his interests, such as academics and sports, he weighs options logically and sets goal-directed plans, indicating an ability to anticipate outcomes when motivated. However, frustration easily seeps in in moments of perceived unfairness and competition that can lead to K’s judgement declining in a noticeable way. The knife incident reflects impulsivity, difficulty with foresight, and preoccupation with power dynamics that indicate a struggle with assessing risk. His questionable behaviors are justified with personal logic, minimizing potential consequences. An example of this might be a moment where the scholar said he “thought Hitler was a great leader.” He followed with not condoning what Hitler did, but also specified that he was not denying aligning with the fascist values. The scholar also discussed another circumstance of wanting to buy his girlfriend a present for valentines day, though he felt stressed for cash. This led him to ask his friends and bully other folks to give him money. Logically, others had money that he knew he could pressure people into giving him.

K’s insight into his own behaviors and emotions is limited but developing. He is aware of his strengths, goals, and recognizes his competitiveness, frustration, intolerance, and difficulties with authority and adults. K struggles to fully acknowledge the overall impact of his actions on others and tends to externalize blame by attributing conflicts to those around him rather than his own behaviors, though rigid thinking patterns and resistance to alternative possibilities suggest a difficulty with adapting his perspective and reflecting.

Overall, K has partial insight into his behaviors and immature judgement, particularly in emotionally charged or high-stake situations–something the scholar creates for himself a lot in his own environment. While K demonstrates logical reasoning in goal-directed areas, his difficulty with impulse control, frustration tolerance, and self-awareness contributes to poor decision making and limited reflection on the consequences of his actions.

IX. Reliability

The reliability of reporting information from K is inconsistent, with accurate recall of concrete facts, but variable credibility in emotionally or socially complex situations. His memory of past events is intact, and he can accurately recount recent experiences, assignments, and upcoming responsibilities.

However, K’s reliability is compromised in emotionally charged or discipline related contexts. He tends to minimize personal responsibility, externalize blame, and reinterpret past events in ways that justify his actions. His competitive nature and desire to maintain control can lead to exaggerations, selective recall, or biased interpretations of social interactions, especially when discussing conflicts with peers or authority figures. K is also resistant to accepting alternative viewpoints, which may further impact the accuracy of his self-reports.

Overall, K is very capable of providing reliable factual information, although his subjective reports–particularly regarding interpersonal conflicts and rule-breaking behaviors–should be interpreted with caution as they are often influenced by defensiveness, competitiveness, and limited self-awareness.

Assignment 2: Symptom Picture

Overview of Symptom Presentation

K presents with a complex symptom profile that includes impulsivity, emotional dysregulation, oppositional tendencies, rigid thinking patterns, and difficulties with executive functioning. His competitive natures, reactivity to perceived unfairness, and difficulty transitioning from taks contributes to his social and behavioral struggles in school and interpersonal relationships. His mood is primarily focused and determined, but he exhibits irritability, frustration intolerance, and mild anxiety, particularly in response to losing competition or experiencing perceived injustices.

Primary Symptoms:

1. Impulsivity and Emotional Reactivity
1. K exhibits mild to moderate impairments in impulse control, especially in emotionally charged or competitive situations.
2. He reacts quickly and defensively when frustrated, often engaging in verbal outburst, arguments, and resistance to authority.
3. His history of bringing a weapon to school demonstrates poor foresight, difficulty assessing risk, and reactive decision making.
2. Cognitive Abilities and Preoccupation with Competition
1. K demonstrates strong strategic reasoning and goal-directed thinking when motivated, but rigid thought patterns interfere with his capacity to consider alternative explanations or accept feedback
2. He is preoccupied with competition and fixates on performance in sports and academics. Losing a game or something resulting in a perceived unfair outcome can lead to prolonged frustration, decreased classroom engagement, and increased social environment disruption
3. Mood and Affect Regulation Difficulties
1. K describes himself as focused and confident, but his emotional state is highly reactive and influenced by external events
2. He is aware of his irritability, difficulty relaxing, and occasional feelings of sadness, though his affect is often constricted with limited emotional expression in structured settings and intensity in social situations.
4. Oppositional and Defiant Behaviors
1. K struggles with authority and rules, frequently challenging directions and resisting control when he perceives unfairness.
2. The scholar rationalizes inappropriate behaviors and externalizes blame, often attributing conflicts to others rather than recognizing his role in them.
3. He is reactive rather than precise in his oppositional behavior, suggesting frustration intolerance rather than deliberate defiance.
5. Executive Functioning and Attention Difficulties
1. K has difficulty sustaining attention in non-preferred activities, displaying distractivity, topic shifting, and fidgeting.
2. He completes tasks rapidly but carelessly, leading to errors and struggles with revisions or following through on his work.
3. K exhibits selective attention, hyperfocusing on personally engaging tasks but struggling with transitions
6. Mild Sensory Sensitivity and Perceptual Biases
1. K experiences mild sensory sensitivities, becoming overwhelmed in chaotic environments and displaying frustration when overstimulated–but lacking awareness of when he is adding to these environments.
2. He has selective perception, sometimes misinterpreting peer interactions or assuming negative intentions from others.
3. Though not experiencing hallucinations or delusion, he demonstrates slight paranoia in social contexts, believing that others are working against him

Diagnostic Considerations:

K’s symptomology suggests possible underlying conditions that include

1. ADHD (Attention-Deficit/Hyperactivity Disorder (Combined Type):
1. Impulsivity, distractibility, difficulty with sustained attention, hyperfocus, and executive functioning challenges.
2. ODD (Oppositional Defiant Disorder):
1. Reactivity to authority, argumentativeness, externalization of blame, and defiant behaviors.
3. Anxiety or mood-related concerns:
1. Frustration intolerance, rigid thinking, competitive fixation, and mild sensory sensitivities

The impact of Functioning on K:

1. School: strong academic potential but distracted, reactive, and inconsistent performance due to competitive preoccupations, frustrations, and difficulty with revision tasks.
2. Social: intense peer engagement but frequent conflicts due to competitiveness, defensiveness, and difficulty accepting loss or criticism.
3. Home: likely tension around authority and control dynamics, with strong attachment to personal interests and external motivators.

Symptom Picture Conclusion

K’s symptom picture is complex, marked by impulsivity, emotional dysregulation, executive functioning difficulties, and oppositional behaviors. While he demonstrates strong cognitive abilities in goal-directed areas, his rigid thinking, competitive fixation, and emotional reactivity contribute to social, academic, and behavioral challenges. A structured, goal-oriented approach with emotional regulation strategies and cognitive flexibility training will be critical in addressing these concerns.

Assignment 3: Medical and Health Issues for Agent ‘K’

K is physically healthy with no chronic illnesses, medical conditions, or history of hospitalizations. He has an athletic build despite a thin stature, engages in regular physical activity, and shows no signs of malnutrition or neurological concerns at the moment. His hygiene and self care routines fluctuate, with consistent oral hygiene but inconsistent grooming and clothing choices that suggest executive functioning difficulties, environmental stressors, or lack of structure in his life.

K reports emotional fatigue by the end of the day, likely due to intense focus, frustration, and difficulty transitioning between tasks. While no sleep disorder is diagnosed, sleep hygiene and fatigue levels may warrant further assessment. He also experiences mild sensory sensitivities, particularly in loud or chaotic environments that lead to irritability and selective attention.

K’s risk taking behaviors, particularly in competitive sports and impulsive peer interactions, increase the potential for physical injuries but is in line with the scholar’s age. His past disciplinary incidents highlight poor risk assessment rather than self-harm tendencies. Overall, while K has no major medical concerns, his fatigue, sensory processing challenges, and inconsistent self-care routines may contribute to emotional and behavioral difficulties.

Key Considerations for K’s Health

1. Sleep patterns, fatigue, and emotional regulation.
2. Sensory sensitivities and their impact on behavior.
3. Hygiene inconsistencies and potential environmental or confounding factors
4. Structured routines to support self care and emotional regulation.

Assignment 4: Collateral Contacts:

To gain a comprehensive understanding of K’s functioning across all different environments, collateral information was gathered over the course of six months from his history and math teacher, homeroom advisor, school social worker, school principal, disciplinary dean, and family members (mother and sister). These contacts provide insight into his academic performance, social interactions, behavioral patterns, and family dynamics. Overall, these contacts confirm K’s strengths and challenges, reinforcing the need for interventions focused on emotional regulation, impulse control, and structured behavioral support.

1. History Teacher:
1. K’s history teacher describes him as intelligent and capable, but highly distractible and “doing too much all the time.” The teacher notes K excels when interested, but disengages himself and others when unchallenged. The teacher also reports K’s competitive nature often influences classroom participation, making him argumentative when he feels challenged or perceives an unfair grading process.This teacher also supports K in his athletics, guiding him through practices for success and drills that help him get better on his skills. The history teacher has cited himself as a mentor of K with positive capacity to enable changes in K’s behavior.
2. Math Teacher:
1. K’s math teacher observes K as a strong problem solver with inconsistent effort and notes that K completes his work quickly, carelessly, and impulsively leading to errors. K is also cited as more likely to disrupt class when frustrated and often engages in tangential behaviors like talking to peers, joking around, or disrupting the class learning environment.
3. Homeroom Advisor:
1. The homeroom teacher describes K as a passionate, loyal, driven, and over-the-top scholar who is charismatic and engaged but emotionally reactive. Although K struggles with transitions and following structured directions, K is well-liked by peers but prone to conflicts when he feels slighted, disrespected, or like he lost control over his peers. K can manipulate others to assist him because of his strong leadership skills and logical approaches.
4. School Social Work Supervisor
1. Speaking to the head of Social Work at K’s school (My supervisor as Social Work Intern) assisted with all the biopsychosocial information that was unpacked in previous years of individual and group counseling. My supervisor expresses concern about K’s difficulty with emotional regulation and authority figures, noting K has trouble with accepting constructive criticism and often externalizes blame. The lead social worker suggests that frustration, intolerance and impulsivity contribute to disciplinary issues as well as the general environment of agent K compounds these problems.
5. School Principal
1. The school principal has mentored K since he was in kindergarten and acknowledges the academic and leadership strengths and potential, but describes K as a frequent source of classroom maladaptive behavior. The principal notes that disciplinary incidents are typically reactive rather than premeditated and expresses concern about K’s defensiveness towards authority and difficulty with accountability.
6. Disciplinary Dean
1. With a history of impulsive decision making and high stress situations that lead to reactive situations, the disciplinary dean references past interactions with K that include bringing a weapon to school, bullying other kids into providing or giving away their items, spewing profanity to teachers, fighting other students, and overall argumentative behavior with staff. The dean notes that K responds better to structured, goal driven interventions rather than punitive measures, and will often opt into strength training as a disciplinary function for K’s behavior. An example of this is push-ups for every curse word he uses.
7. Family Contacts
1. Mother:
1. K’s mother describes him as strong willed, highly independent, and determined, noting that K has always been competitive and struggled with losing. The mother expresses frustration with K’s oppositional behavior at home, especially regarding authority and responsibilities. Moreover, K’s mother is frustrated with his misogynistic and chauvinistic behaviors, but acknowledges his intelligence and ambition. Although she worries about his impulsivity and emotional reactivity, K responds to her authority, reinforcements, and punishments.
2. Sister:
1. K’s older sister describes K as funny, energetic, and loyal despite quickly getting hot tempered. She also notes light misogyny, though has communicated that K has witnessed domestic violence in the home. Through his sister, it is understood that K has seen items being thrown between his mother and her boyfriend. The sister notes K can be stubborn and resistant to advice, but admires their older brother in the military and often seeks to emulate his authority and discipline despite no formative experiences to build a foundation.

Assignment 5: Sex, Drug, and Alcohol History

Overall, while K does not currently engage in high-risk sexual or substance related behaviors, his strong need for control, competitiveness, and impulsivity suggest the importance of early intervention and guidance in decision making and relational dynamics.

Sexual History:

K does not report engaging in sexual activity, though expresses interests in romantic relationships and peer dynamics around dating. The scholar has a girlfriend and displays traditional masculine performance in social settings, often seeking validation through competition and dominance among peers. While he engages in flirtatious and confident behaviors, he has not disclosed any sexual experiences or concerns related to sexual health.

K’s understanding of relationships appears to be influenced by social media, peer interactions, and familial role models. Both his mother and sisters have persuaded K to share when he feels inclined to experiment so that they can ensure his safety, rather than exploring behind their backs. K’s view on gender dynamics and relationships may benefit from guidance in emotional intelligence, consent, and healthy communication as his competitive nature and need for control could impact relational dynamics.

Drug and Alcohol History:

While K denies any personal use of drugs, alcohol, or other substances, he has communicated that he has experimented with tobacco and nicotine products. However, there is no known history of substance experimentation, peer pressure, or exposure to high risk behaviors due to related substance use. K does not express curiosity or concern about substances as his goals in school and competition supersede compulsions for altered states of consciousness. With no evidence of behavioral changes suggesting hidden use, K does not currently engage in substance use. While his impulsivity, risk-taking tendencies, and desire for peer validation suggest that preventative education and discussion about peer pressure and decision making could be beneficial, a majority of his collateral contacts are not concerned with his sex, drug, and alcohol history.

Considerations for K’s Sex, Drug, and Alcohol History:

It might be worth considering sexual health education and preventative measures for K related to these topics and his Mental Status Examination. Sexual health education should focus on healthy relationships, emotional intelligence, and communications skills, while preventive discussions on substance use and peer influence may help reinforce healthy decision making and risk awareness. Moreveoer, K’s competitive and dominant social behaviors could impact his future relationships, highlighting the importance of guidance on respect, consent, and emotional regulation.

Assignment 6: Social Work Perspective - Clinical Assessment of K:

Overview:

Ki is a 14 year old Black and Hispanic male from the Bronx, New York. He identifies as Musline and is currently in the 7th grade, having been held back a year. He lives with his mother and two sisters and has a close relationship with his older brother, who serves in the military. K demonstrates strong intellectual abilities, particularly in math and STEM subjects, and is highly motivated in structured environments such as competitive sports. However, he struggles with emotional regulation, impulse control, and authority figures, leading to behavioral challenges at school and broader society. His referral for individual counseling followed the termination of group counseling in the previous academic year.

Presenting Concerns:

K was referred for counseling by his school principal, social worker, and mother due to difficulties with emotional regulation, impulsivity, and conflicts with peers and authority figures. He has a history of disciplinary incidents, including bringing a knife and a toy knife soon after to school, which he justified as different from the real weapon. His interactions often escalate into verbal or physical confrontations, particularly in competitive environments where he perceives unfairness. While he does not report current engagement in high-risk behaviors such as substance abuse or sexual activity, he has a history of experimenting with tobacco and has demonstrated behaviors reflecting rigid gender expectations and social dominance.

Incorporating a Strength Based Perspective Assessment

While K presents with multiple behavioral challenges, his strengths offer critical points of intervention. K is highly capable academically, particularly in subjects that engage him. The scholar thrives in problem solving contexts and strategic thinking, suggesting that an applied learning approach may enhance his educational engagement. Moreover, k’s skills show in his commitment to sports, particularly soccer, where he exhibits discipline, teamwork, and leadership skills. His ability to channel energy towards structured activities is a major asset but needs fine tuning. K also has strong ties to his family despite exposure to domestic violence. He seeks stability in his life and admires his older brother in the military for his structured and attainable goals of service. Despite impulsivity and defiance, K is aware of his emotional struggles and demonstrates responsiveness to truly structured support. With a strong desire to succeed and improve his emotional regulation skills as long as these tasks are framed in ways that align with his interests, K’s strengths are incredibly important to his case.

Challenges and Risk Factors in K’s Case:

Despite K’s strengths, challenges and risk factors pertaining to K’s case are vital to a well rounded assessment. K struggles with frustration tolerance and frequently reacts aggressively in stressful situations highlighting emotional dysregulation and impulsivity issues. His rapid speech, topic shifting, and occasional  difficulty with attention suggests potential ADHD related executive functioning challenges. K also has a strong sense of justice but struggles with abstract moral reasoning, rigid thinking, and competitive lenses that lead to interpretation of events as dichotomous. This can contribute to his interpersonal conflicts and difficulty in constructive feedback. Along these lines is K’s challenges with authority and discipline as he responds positively to adults he respects, but frequently challenges rules and resists guidance perceived as unfair. Tangential, K’s exposure to domestic violence and gender dynamics from witnessing and embodying experiences may inform his rigid views of gender and social dominance behaviors. His mother and sister have expressed concerns about his misogynistic attitudes, highlighting the need for interventions around emotional intelligence and healthy relationships.

Assessment from Social Work Perspective:

Applying a Person-in-Environment (PIE) framework (Dziegielewski, 2014), K’s behaviors must be understood within the context of his social, familial, and systemic environment. His competitive nature, difficulties with authority, and impulsive behaviors do not exist in isolation, but are influenced by structural and cultural factors–including racial disparities in school discipline (Finn, 2021). From Metzl and Hansen (2014) comes emphasis on structural competency approaches to address systemic barriers affecting K’s development. Black and Hispanic youth are disproportionately subject to punitive school measures, and K’s behavior challenges should be met with restorative justice approaches rather than criminalization or pathologization. Additionally, his academic potential highlights the necessity of culturally responsive pedagogy that keeps him engaged and challenged in the classroom.

K’s resistance to traditional counseling methods suggests the need for engagement strategies tailored to his strengths and interests. Using goal directed interventions, mentorship from figures he respects, and cognitive-behavioral techniques aligned with his competitive mindset may be the most effective approach.

Conclusion:

K is an intelligent, driven, and ambitious young scholar with significant potential for academic and athletic success. However, his challenges with emotional regulation, impulsivity, and authority figures require targeted interventions that balance structure with empowerment. A holistic approach integrating trauma informed care, restorative justice, and culturally responsive engagement will be essential in fostering K’s development while mitigating systemic barriers that contribute to his struggles. By leveraging his strengths, providing structured mentorship and interventions, and addressing rigid cognitive frameworks, K can develop healthier emotional coping strategies and fulfill his potential in a manner that supports both his individual growth and broader social wellbeing.

Assignment 7: Social Worker Positionality Considerations Related to Assessment of K

Positionality refers to the social worker’s awareness of their own background, biases, and power dynamics in the therapeutic relationship. Hardy (2016) emphasizes that clinicians must critically assess their own perspectives on race, privilege, and oppression when working with marginalized populations. In K’s case, considerations must include how cultural and racial biases may shape interpretations of his behaviors and emotional expressions (Jani et al., 2016).

Given that Black and Hispanic youth are disproportionately disciplined in school settings, K’s behavioral tendencies may be viewed through a punitive lens rather than as symptoms of distress (Finn, 2021). Structural awareness must guide the assessment to avoid pathologizing normative adolescent behaviors that may stem from systemic challenges rather than intrinsic psychopathology.

With my positionality as a White, Jewish, able bodied, Cisgendered Male, Social Work Student from Columbia University and the upper middle class, being cognizant of how I show up in spaces for marginalized identities includes the area I occupy in my individual and group counseling efforts. With K, the power dynamic of being an authority figure with the knowledge I have on biases, diagnosis, social work principles, and many more topics can create a power imbalance rooted in perceived knowledge. This power tends to show up in the capacity for social workers to make diagnosis or jump to conclusions, something I wanted to refrain from with K. This is incredibly problematic as academic and professional understandings viscerally and linguistically range compared to embodied understandings of the world. What I learn about K’s life in a classroom cannot compete with K’s experiences of his world, but can inform how I proceed with a grain of salt. Moreover, as a white person who came from a private school background despite being raised through domestic issues and adversity, my implicit understanding of how K’s world revolves may be rooted in biases that misinterpret his behaviors as individual qualities rather than systemic inequities. To mitigate the bias rooted in my positionality, consulting with professionals and collateral who understand K’s lived experiences can account for bias and ensure a fair and accurate understanding of his needs.

Other positionality concerns exist including my role as an intern because of the ethical responsibilities related to social work. Being a novice in the field, many of my social work foundations are in the process of concretizing and might lead me to defer any pivotal decisions to my supervisor. In other words, whether I help K or not might be deferred to my supervisor. Lastly, Finn (2021) reminds that social workers are encouraged to utilize teaching-learning techniques that help center the client and deprioritize the practitioner’s perspective. In other words, social workers must let their clients lead them in the direction of change by adopting values of humility and accountability on a journey of engagement. No matter their, social workers meet their clients in the midst of the issues they desire help addressing and we must let our clients guide us towards their understanding of change. From here, the social worker can help maintain positive change via taking a backseat and following the client in their journey.

It is my intention to let K lead me in the direction of change that he is needing, though I recognized as a student, he might not know the best route. While there are power dynamics systematically and inherently rooted in my positionality, encouraging K to lead me in directions of change that he desires helps to mitigate harm in the engagement process.

Assignment 8: DSM 5 Diagnosis

A Diagnostic and Statistical Manual of Mental Disorders diagnosis should be made with caution, acknowledging the critiques of medicalizing distress (Eriksen & Kress, 2005). Based on K’s symptoms, a possible provisional diagnosis includes Attention-Deficit/Hyperactivity Disorder (ADHD) due to his impulsivity, distractibility, and rapid speech. (Dzięgielewski, 2014). Another consideration is Disruptive Mood Dysregulation Disorder (DMDD), given K’s difficulty with emotional regulation, intense competitiveness, and reactive behaviors. However, diagnostic biases must be considered as Black, Indigenous, and youth of color are often misdiagnosed with conduct disorders rather than mood disorders or anxiety disorders. This is why I have refrained from an oppositional defiant disorder diagnosis (ODD). and am leaning more towards a diagnosis of ADHD.

The DSM-5 has many issues, but one that it consistently tackles with each new rendition is comorbidity. For K’s many symptoms, they correspond with many DSM-5 diagnostic labels. The DSM-5 might make more room for measuring overlapping symptoms rather than rigid categories (Clarke & Kuhl, 2014), but a comprehensive approach integrates a strength based assessment to ensure that diagnosis does not become an oppressive label limiting K’s conception of self. Additionally, social and environmental factors must be considered, as traditional DSM diagnosis often fails to capture the broader systemic and relational influences on a client's mental health (Dziegielewski, 2014). It is essential to frame any diagnosis in a way that highlights K’s capacity for growth and adaptation rather than reinforcing narratives of deficit that hinder his perception, confidence, and engagement with therapy interventions.

Diagnostic Considerations:

K’s symptomology suggests possible underlying conditions that include

1. ADHD (Attention-Deficit/Hyperactivity Disorder (Combined Type):
1. Impulsivity, distractibility, difficulty with sustained attention, hyperfocus, and executive functioning challenges.
1. This is the preferred diagnosis for K
2. ODD (Oppositional Defiant Disorder):
1. Reactivity to authority, argumentativeness, externalization of blame, and defiant behaviors.
3. Anxiety or mood-related concerns:
1. Frustration intolerance, rigid thinking, competitive fixation, and mild sensory sensitivities

The impact of Functioning on K:

1. School: strong academic potential but distracted, reactive, and inconsistent performance due to competitive preoccupations, frustrations, and difficulty with revision tasks.
2. Social: intense peer engagement but frequent conflicts due to competitiveness, defensiveness, and difficulty accepting loss or criticism.
3. Home: likely tension around authority and control dynamics, with strong attachment to personal interests and external motivators.

Symptom Picture Conclusion

K’s symptom picture is complex, marked by impulsivity, emotional dysregulation, executive functioning difficulties, and oppositional behaviors. While he demonstrates strong cognitive abilities in goal-directed areas, his rigid thinking, competitive fixation, and emotional reactivity contribute to social, academic, and behavioral challenges. A structured, goal-oriented approach with emotional regulation strategies and cognitive flexibility training will be critical in addressing these concerns.

Assignment 9: Listing of Prioritized Treatment Goals

The following treatment goals were identified using a collaborative approach, ensuring that both K’s personal priorities and external support structures are acknowledged. These goals are a combination of Client-driven, therapist driven, and externally driven factors, reflecting K’s self identified challenges, the social worker’s expertise, and environmental influences such as school and family expectations.

1. Improve Emotional Regulation (Collaborative): This goal aligns with teaching K coping strategies to manage his frustration and competitive tendencies without resorting to aggression or defiance. It includes practices ranging from mindfulness, self monitoring techniques, and structured problem solving exercises that promote emotional awareness and impulse control. This goal was mutually agreed upon, as K acknowledges his struggles with frustration regulation, and school staff report concerns regarding emotional reactivity.
2. Enhance Impulse Control (Social Worker / Therapist Driven): this goal centers behavioral interventions that help K recognize and slow down impulsive reactions. Cognitive-behavioral techniques like delayed response training and structured decision making exercises can support improved self-regulation abilities. This goal is clinician driven, as K does not necessarily recognize impulsivity as an issue but benefits from structured exercises to improve self regulation.
3. Increase Academic Engagement (Externally Driven and Scholar Driven): This goal tasks working with educators to provide intellectually stimulating coursework that aligns with K’s abilities and interests. Strategies may include differentiated instruction, project-based learning, and goal-setting interventions that match K’s strengths and learning style. K himself has expressed a desire for more engaging coursework, while school staff and mother recognize that increased academic engagement can reduce disruptive behaviors if removed of stressors.
4. Strengthen Peer and Authority Relationships (Collaborative): This goal centers facilitating social emotional learning to help K navigate authority figures and peer dynamics more effectively and responsibly. While his behaviors are negatively effective, role-playing scenarios, group therapy, and mentorship opportunities (like the mentorship he has with his history teacher) can provide K with social models and reinforcement around prosocial interactions. This goal is collaborative, as both K and his schooling staff acknowledge the need for improvement in these areas.
5. Address Structural Barriers (Externally Driven and Clinician Driven): This goal tasks with advocating for support systems in school that are culturally responsive interventions and that acknowledge systemic inequalities affecting K’s behavior. While this goal leaves room for K to relinquish responsibility and accountability, this may involve engaging with school administrators to implement restorative justice practices, culturally competent disciplinary approaches, and increased access to resources for youth mental health in a school setting. While this goal is externally driven, it also aligns with the clinicians drive for advocacy to ensure that K is not subject to unnecessary punitive measures.

The focus of treatment is to support K’s emotional and behavioral growth while advocating for systemic changes that foster a supportive and empowering environment. Ensuring that interventions are strength based, culturally responsive, and centering the client will help K develop the skills necessary to navigate his social, academic, and emotional challenges more effectively.

Assignment 10: Self-Reflection on the Use of Self in Assessing Client

Reflexivity or self reflection is critical in ensuring that assessment remains client-centered and free of bias (Raines, 1996). As a clinician or social worker, reflecting on personal assumptions about masculinity, competition, and authority is necessary when working with K, who exhibits strong but sometimes maladaptive expressions of these traits. The principle of self disclosure must be used with good judgment, ensuring that any personal sharing is done with therapeutic intent rather than personal validation (Raines, 1996).

Considering my positionality and use of self in K’s assessment involved a continuous process of self examination to recognize and mitigate potential biases, K's defiant tendencies and reactivity to authority meant it was essential I approach him without assumptions of defiance–but rather as an adolescent managing environmental and systemic pressures. My understanding of his behaviors shifted from being seen as purely oppositional to recognizing them as responses to structural and interpersonal challenges.

Engaging in critical reflectivity allowed me to assess how my own experiences, values, and perceptions of discipline and self regulation might influence the assessment process (Ferreira, 2019). It was important to ensure that interventions aligned with K’s lived experiences rather than imposing externally defined norms of behavior.

Furthermore, my role as a clinician required me to establish trust and rapport by validating K’s experiences while also challenging misleading cognitions and providing alternative frameworks for understanding his interactions. This balance was critical in preventing K from internalizing negative self-concepts and instead fostering resilience, self-efficacy, and positive sense of self.

Assignment 11: Consideration of PROP: Power, Race, Oppression, and Privilege in K’s Case

K’s experiences cannot be fully understood without examining the role of systemic racism, educational inequalities, and societal biases in shaping his development (Hardy, 2016). Black and Hispanic youth, particularly in urban school settings, often experience disproportionate discipline, harsher punitive measures, and limited access to mental health resources (Metzl & Hansen, 2014). These systemic inequalities contribute to the criminalization of behaviors that may otherwise be addressed through restorative justice practices and culturally responsive interventions.

K’s interactions with authority figures and peers are shaped by these broader systemic forces. His perceived defiance and emotional reactivity must be understood within the context of racialized discipline disparities (Finn, 2021). Social workers must recognize the intersectionality of race, socioeconomic status, and institutional oppression in order to advocate for equitable treatment and access to supportive services.

Moreover, the clinicians positionality plays a role in how K’s behaviors are interpreted. Bias in diagnostic frameworks (Jani et al., 2016) and traditional mental health paradigms often pathologize behaviors that could be reframed as adaptive responses to oppression. A structural competency approach (Metzl & Hansen, 2014) highlights the importance of addressing these systemic barriers rather than solely focusing on individual pathology.

Ultimately, a social work approach to K’s case must be grounded in anti-oppressive, strength-based interventions that empower him rather than reinforce systemic inequalities. By integrating advocacy, culturally responsive care practices, and structural awareness, the intervention can foster a more equitable and supportive environment for K’s development that serves as an example for other scholars, adolescents, and clients.

Bibliography in APA 7th Edition

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Dziegielewski, S. F. (2014). DSM-5 in action (3rd ed.). Wiley.

Eriksen, K., & Kress, V. E. (2005). The price of diagnosis. In Beyond the DSM story: Ethical quandaries, challenges, and best practices. Sage Publications.

Ferreira, S. B., & Ferreira, R. J. (2019). Fostering awareness of self in the education of social work students by means of critical reflectivity. Social Work/Maatskaplike Werk, 55(2). https://doi.org/10.15270/52-2-679

Finn, J. L. (2021). Just practice: A social justice approach to social work (4th ed.). Oxford University Press.

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Snowden, L. R. (2003). Bias in mental health assessment and intervention: Theory and evidence. American Journal of Public Health, 93(2), 239-243. https://doi.org/10.2105/AJPH.93.2.239