Notification of Purpose and Limits of Confidentiality: The subject was notified that the school referred him for counseling in order to help him control his anger toward himself and others, be less distracting in the classroom, and help him to follow directions in a more appropriate manner, which would benefit both himself and the others in the classroom, as well as the teacher. The subject was also informed that the potential users of the report would include the school, the specific teacher, the parents of the subject, a social worker, and a nurse. While the parents would not be involved with giving referral information, the nurse, teacher, and social worker would. This was all explained in plain language to the subject, so that he would have a complete understanding of the nature of the referral and the amount of confidentiality that he could reasonably expect.

Evaluation Instruments and Sources of Information: Three evaluation instruments were used. These included a standa

Behavioral Observations: The subject arrived on time for the referral session, and was brought by his parents, who elected not to remain in the room during the referral interview. It was their assumption that the subject would speak more freely without their presence. The subject was dressed in the common fashion of the time, with baggy jeans, tennis shoes, and a T-shirt. While the subject appeared to be clean and relatively well-groomed, the general personal appearance also indicated a sullen expression and slumping posture. There was little to no motivation on the part of the subject to participate in the process. The subject did complete the tests and tasks that were asked of him, but with much fidgeting, lack of enthusiasm, and repeated distractions. There appeared to be no vision or hearing problems. The subject appeared to care little for the process, was generally listless, and seemed to have no desire to establish any kind of rapport. There was no evidence of motor skill problems or delusional ideas. While the subject seemed to understand everything that was said to him, his responses were very guarded, and the responses were as short as possible. There was no 'opening up' to the interviewer during the clinical interview that was conducted.

Summary and Recommendations: The subject's psychological state can best be described by the fact that he has no real concern for himself or others, and therefore does not see his life or others' lives as being important or having purpose, one of the main indications of depression (Jellinek & Snyder, 1998). He seems to not see a point to much of anything and due to this he is frustrated and unhappy. He is, however, also very intelligent and appears creative, and many intelligent and creative people struggle with depression and anxiety because they do not see the world in the same way that others do (Hodgman & McAnarney, 1992). The primary area of concern for this subject is the frustration that leads to the improper behavior. This has been getting worse and is the reason for the referral. It would appear that a combination of medication and therapy would be the best choice, as this combination often produces better results than only one or the other. It may also be worth considering by the school that the boy be placed in a classroom where he will be challenged more, as this might remove some of the boredom and frustration with school that he seems to have. Since there is no strong evidence of suicidal behavior or other behaviors that are exceedingly dangerous, the most immediate need is helping this subject (through therapy, medication, and the work of the school) find his niche so that he can take the high intelligence he has and begin to excel. The intelligence is a good area to work with, and the teacher and school would do well to respond to this - possibly by IQ testing and advanced classes, but the subject must be made to understand that there is benefit for him and something must spark his interest or he likely will perform well below expectations, regardless of his intelligence level. Overall, however, the prognosis for this subject is likely very good, provided that he gets the help that he n

Some common words found in the essay are:
Personality Functioning, Background Information, Cognitive Functioning, Behavioral Observations, Hodgman McAnarney, Limits Confidentiality, Reason Referral, Marsh Davis, Jellinek Snyder, Summary Recommendations, subject appeared, reason referral, social worker, depression anxiety, follow directions, reason referral subject, basis subject, subject reported, subject difficult, classes subject, daily basis, daily basis subject,
Approximate Word count = 2152
Approximate Pages = 9 (250 words per page double spaced)