NCMHCE Sample Case Studies

NCMHCE Sample Case Studies Section A Client

Age: 35

Sex: Female

Gender: Female

Sexuality: Heterosexual

Ethnicity: Caucasian

Relationship Status: Single

Counseling Setting: Agency

Type of Counseling: Individual

Presenting Problem: Depression and anxiety

Diagnosis: Persistent Depressive Disorder with Anxious Distress (Dysthymia), Provisional (F34.1)

Presenting Problem:

You are a counseling intern in a private practice setting. During the initial counseling session, a 35-year-old divorced female, mother of two young children, reports she feels lost and alone. She is unsure of what to do with her life, especially in terms of a career, relationships, and finding a home for herself and her children. She is currently involved in a tumultuous relationship with a man who, she reports, demeans her and is reluctant to commit to a monogamous relationship. She has decided that she needs to make some changes and wants guidance in doing so.

Mental Status Exam:

Client presents as well-groomed with good hygiene. She is appropriately dressed. Motor movements are within normal limits. Her eye contact is good. She is cooperative and engaged. She denies present suicidal or homicidal ideation, intent, or plan, although she admits she daydreams about what it would be like to die in her sleep. She states she feels sad most of the time and cries almost daily. She reports she does not recall ever feeling happy. Client reveals she has daydreamed about dying in her sleep off and on since she was a teenager. She is alert and oriented to person, place, and time. She is anxious, tearful, and wringing her hands. She reports she has frequent anxiety Section B

CASE STUDY 1

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attacks and night-waking. She reports low self-esteem, difficulty making decisions, a lack of energy, and that she no longer looks forward to gardening on the weekends. She reports she has lost weight but does not know why. Her clothes appear to fit loosely. She reports she has been increasingly nervous and sad since she divorced her husband two years ago.

Family History:

The client has one sister, two years younger, who lives out of state. Client’s parents are still married, though the father lives in another state. Client never felt valued in her family. She feels hopeless around them because they question her ability to achieve anything worthwhile, including maintaining a job or going to school. Client denies any physical or sexual abuse or other trauma. Client reports significant financial difficulties, which have led to her needing to live with her mother despite a conflicted relationship. Her mother has agreed to subsidize her counseling.

Domain: Intake, Assessment, and Diagnosis

Cognitive Level: Comprehension

• What baseline data would you gather about the client’s current level of functioning?
• the length of time she stayed with her former husband
• how she typically spends her weekdays right now **
• how she interacted in the past with her mother
• her career interests and values

Domain: Treatment Planning

Cognitive Level: Application

• What information would be most important to guide the development of a treatment plan?
• collateral information from the mother
• diagnostic information obtained from previous providers
• information gathered through direct observation of the client
• client’s desired outcome for therapy **

Domain: Counseling Skills and Interventions

Cognitive Level: Application

• Which of the following would you use to build a therapeutic alliance with this client?
• Challenge her irrational thoughts about her self-evaluations.
• Advise her about how to manage painful experiences.
• Summarize her emotional struggles and desire for change. **
• Explore areas in which she could improve interpersonal relationships.

Domain: Professional Practice and Ethics

Cognitive Level: Knowledge

• The client’s mother has agreed to pay for the counseling. The client is concerned that her mother

will want to know what transpires in her sessions. Which of the following is the best choice for responding to the client’s concerns?

• Suggest that the client find another resource to pay for therapy.
• Explain that you will provide the mother with a summary and receipt.
• Discuss client confidentiality and privacy rights. **
• State that, as a payor, the mother has a legal right to review session notes.

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Section C First session, three weeks after the intake session Client initially informs you she is doing better. She reports she and the boyfriend are not fighting as much. Further exploration reveals she believes her current boyfriend has become less affectionate and is not interested in intimacy. She then reports her ex-husband always wanted to have sex with her. She goes on to say he would force her to have sex with him and she would cry until it was over. You reflect the client’s emotional state and summarize client statements to communicate understanding. The client seems detached and presents with flat affect as she describes the incident.

Domain: Core Counseling Attributes

Cognitive Level: Application

• What are you trying to accomplish by reflecting and summarizing what the client has shared about

her relationships?

• demonstrate empathy **
• decrease the client’s negative self-talk
• set the stage for confronting the client
• minimize focus on self-destructive behaviors

Domain: Counseling Skills and Interventions

Cognitive Level: Application

• How should the client’s disclosures about her ex-husband’s forced intimacy impact the direction

of treatment?

• Link the current statements to the client’s goals for therapy. **
• Refocus therapy on the client’s poor decision making.
• Re-evaluate the diagnosis and consider referral.
• Assess the safety of her children with her current partner.

Domain: Intake, Assessment, and Diagnosis

Cognitive Level: Comprehension

• Considering the client’s history of relationship issues, which of the following assessment tools

would you select to better understand her relationship dynamics?

• Minnesota-Multiphasic Personality Inventory-2 (MMPI-2)
• Adverse Childhood Experience (ACE) Survey
• family genogram **
• Hamilton Anxiety Rating Scale (HAM-A)

Second session, six weeks after the intake session Client arrives for the session on time. She appears thinner with dull, dry hair, which is not her norm.She is less talkative this session. She reluctantly talks about a possible reason for her weight loss.She says, “Sometimes I make myself throw up a little. I feel fat.” Client appears somewhat agitated, repeatedly crossing her legs, covering herself with a throw pillow, and avoiding eye contact. Her speech is somewhat rapid with soft volume.©2020 National Board for Certified Counselors, Inc. All rights reserved.3

Domain: Professional Practice and Ethics

Cognitive Level: Application

• The client is less forthcoming and is reluctant to talk during session. How should you respond to

the client’s disclosure about weight loss?

• “I’ve struggled with weight issues in the past, too.”
• “I wonder if you should think about keeping a food diary.”
• “I appreciate your willingness to discuss this issue.” **
• “You don’t appear overweight to me.”

Domain: Professional Practice and Ethics

Cognitive Level: Comprehension

• You are not sure of your ability to work with this client. What information is irrelevant when

considering a referral?

• the client’s desire to continue to work with you
• the client’s financial situation **
• the client’s history of abuse
• the client’s medical issues

Domain: Counseling Skills and Interventions

Cognitive Level: Application

• You ask the client to rate her progress in counseling. What is the value of asking the client to

evaluate her treatment?

• It helps you understand the client’s level of denial.
• It allows you to compare her experience to your observations. **
• It helps prevent challenges of your assessment by the client.
• It allows you to assess your value as a counselor.

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