ABSTRACT
This chapter highlights Raoul, a 17-year-old Mexican-American adolescent referred due to racial prejudice and drug use. How clearly and comprehensively a diagnosis of Conduct Disorder fits his case, in comparison to other DSM-V-TRTM Diagnoses, and if there is an appropriate ICD-10-CM code for him, are considered. Diagnostic exercises challenge clinical reasoning concerning whether symptoms might be a realistic response to environmental issues, including racism or the impact of violence and trauma, during development rather than reflecting personal or family dynamics. In addition, diagnostic decisions are challenged as to whether they accurately reflect a balance between client resilience and/or factors supporting resilience in comparison to the factors supporting risk in the client’s life. The interviewing skills highlighted in the chapter include empathetic comments, process comments, reflective listening, summarizing and supportive confrontation. Thought questions challenge professionals to consider their own and their clients’ possible thoughts, feelings, and actions when they first meet, and what steps they must take to develop the most effective working relationship with the client. Thought issues for building clinical reasoning skills using this client include issues in confidentiality, poverty, racism and/or harassment, and substance abuse.
