It's a Dirty Job: Mental Health Consultation and the Challenges of Treating Encopresis in a Preadolescent

This case study details limitations encountered while providing indirect and direct clinical services to children in applied settings through a behavioral mental health consultation model. Specifically, the case of AB, a 13-year-old male residing at a foster care facility, who demonstrates oppositional and defiant behavior problems and symptoms of both retentive encopresis and posttraumatic stress, is presented to illustrate potential pitfalls faced by a consultant providing multiple forms of intervention in applied settings. Although the provision of supportive, individual psychotherapy is reviewed, an emphasis is placed on the difficulties of implementing a behavior modification plan to treat AB's encopresis at his residential foster care facility. The challenges associated with providing individual psychotherapy to AB while serving as the behavioral consultant at his residence are highlighted. Finally, recommendations are presented regarding how mental health consultants can work with applied service agencies to promote effective therapeutic interventions within frameworks established by those agencies.