The client lives in a conjugal family with his mother and step-father, with no siblings. Has never met his biological father. The parents do not have a stable relationship and at least one of them is abusive. Both seem to have mental health issues. The family has a concerning history of heart conditions. A history of mental illness and suicidality is also present, which might affect the client. The client enjoys activities most other boys his age enjoy doing, and, aside from possible mental health issues, seems to be a relatively healthy child.
Physical appearance of the client after the first session: his figure is tall and he is of average weight. Nothing much stands out, besides awkward hand placement; the client keeps his hands placed on his lap at all times. According to his mother, such hand placement has been present ever since the client was a young child. Affect is flat; not many facial expressions are shown besides a polite smile and a look of discomfort. Otherwise, the client looks like an ordinary teenage boy. He keeps pulling his sleeves down, as if trying to hide his wrists. Understanding the reason behind that may help me in diagnosing him. Other than that, there is nothing else to mention.
I thought I'd pat the client on his head as a way to show that I'm happy he's doing well. However, upon doing so, he paused for a second before vomiting. I'm not exactly sure why that happened, he really didn't seem to be unwell right before throwing up. He even seemed to have cracked a smile right before that happened. I need to look into this before doing anything else, as this could be something more than just coincidentally vomiting after something that might or might not have felt good.