Case 2

Case 2

Part One

Age: 12
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Caucasian
Relationship Status: Single
Counseling Setting: School Counseling
Type of Counseling: Individual
Presenting Problem: Frequent fights at school
Diagnosis: Disruptive Mood Dysregulation Disorder

Presenting Problem: You are a counselor in a school setting. During the initial counseling session, a 12-year-old boy is sent to your office and states that he doesn't want to be there. His teacher reports that he is frequently getting into verbal fights with other students. School records show that this problem has been present for over 12 months. When he isn't fighting, his general mood is grumpy.

Social History: Last summer, the client went to a neighbor’s birthday party, and the birthday boy’s parents had to call your client’s mom because he was holed up on the trampoline and told the other kids that he would push them off the trampoline if they tried to get in his space. The kids took him up on his threat, and your client pushed four of them off the side, resulting in injury. The host of the party sat him down in one of the bedrooms and told him that he would have to wait there until his mom came and picked him up. He complained that no one listened to his side of the story and that he was entitled to his personal space. His mom arrived and apologized to the neighbor, who said that the party was ruined. He reluctantly walked home with his mom to receive his consequence.

Mental Status Exam: Client presents as angry and frustrated. He is appropriately dressed. He is somewhat uncooperative, with poor eye contact. His speech patterns and content appear to be within normal limits. He denies suicidal ideation and is alert to person, place and time.

Family History: Client lives with his parents who are both professionals. He has one older brother and one younger brother with approximately two years between each sibling. He has been fighting with his brothers, creating problems at home. When asked about this, the client states that it is never his fault. The parents report that the client is often 'grounded' due to poor behavior.
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Domain: Intake, Assessment, and Diagnosis

You say to your client, “It must be a bummer getting in trouble all the time due to fighting. Did you know that sometimes we let our feelings take control and sometimes we totally shut our feelings down. But the secret is to learn how to balance the two.” This refers to which of the following Dialectical Behavioral Therapy teaching?
1. Balanced mind
2. Healthy balance
3. Healthy mind
4. Wise mind
Domain: Intake, Assessment, and Diagnosis

Which of the following would be appropriate assessments for diagnosing Disruptive Mood Dysregulation Disorder (DMDD) for this client?
1. Child Behavior Checklist
2. Behavior Assessment System for Children (BASC)
3. Vanderbilt Diagnostic Rating Scales
4. All of the above
Domain: Intake, Assessment, and Diagnosis

According to the information revealed in Part One, for this client all of the following are indicative of DMDD except which?
1. The fact that he is frequently getting into fights with other students
2. The fact that his outbursts are consistent with his developmental level
3. The fact that his general mood is grumpy
4. The fact that symptoms have been present for over 12 months
Domain: Intake, Assessment, and Diagnosis

What question would you ask the client to affirm his diagnosis?
1. “Who have you been fighting with?”
2. “How often do these outbursts happen?”
3. “Is it hard for you to concentrate in school?”
4. All of the above
Domain: Professional Practice and Ethics

You are reviewing your policies regarding managing group therapy. Which of the following is not a standard rule for clients within group therapy?
1. Anything said between any two or more group members at any time is part of the group and is confidential
2. Dating and other exclusive relationships between or among group members are not allowed
3. No group member is ever humiliated, hazed, or abused in any way
4. No group member is ever required to answer any question, to participate in any activity, or to tell anything
Part Two

Second session, 2 weeks after intake session

Client enters your office for the next session acting annoyed and says that he doesn’t know why he is angry all the time, but he got into a fight this morning and “it wasn’t his fault!” He explains that he hit his younger brother after his younger brother had called him 'bucky'. His parents grounded him for 3 days for hitting his brother. Client states, “That isn't right! He knows I hate the name bucky. My parents should have grounded him and not me!” You explore with him what the name Bucky means to him, and he tells you that it was the name of a hamster the kids had when they were younger. They called him Bucky because of the way he chewed on his food pellets and because of the noise his teeth made when he gnawed on the plastic house he lived in. Your client tells you to look at him and to see if there is any resemblance to a hamster at all. “And the worst part is,” he states, “is that we couldn’t even pick Bucky up without him biting us. If he calls me Bucky again, I might do just that and bite him if he comes near me.” You wonder whether or not he would actually bite his brother, and validate his emotions that he had about feeling made fun of and disrespected. You begin to help him to look at his 'here and now' actions involved in the fight with an eye to how he can make better choices in the future that will be more likely to satisfy is goals.
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Domain: Treatment Planning

Which of the following is considered abandonment in the therapeutic relationship?
1. Client drops out of treatment due to inability to pay.
2. The client cooperates with treatment recommendations and the treatment is ended appropriately,
3. Clinician refers the client out after the client assaulted the clinician.
4. A clinician discovers that her license has expired and cancels all of her appointments. She apologetically tells her clients that she will reach out to them to reschedule once she re-instated her license.
Domain: Intake, Assessment, and Diagnosis

The technique that you employed in the second session after intake belongs to which model of therapy?
1. The RESPECTFUL Model
2. Reality Therapy
3. Positive Psychology
4. Interpersonal and Social Rhythm Therapy
Domain: Counseling Skills and Interventions

The client's statement in Part Two regarding his punishment is an example of which thinking error?
1. Emotional Reasoning
2. Shoulds and Oughts
3. Control fallacies
4. Fallacy of fairness
Domain: Counseling Skills and Interventions

When engaging in crisis intervention, when must clinicians assess and ensure safety?
1. Early on in the crisis intervention
2. Continuously
3. At the beginning and end of treatment
4. Once immediate danger has been ruled out
Part Three

Third session, 4 weeks after the intake session

Your client’s mom calls you before the client’s session to notify you of some recent behavioral problems the school has reported to her. She is tearful, stating that she isn’t sure that therapy is working, and isn’t sure what to do at this point. You pull up some past notes and read to her the progress you have noticed so far. “I wish there were some way to somehow speed up this process. It’s so humiliating for me to walk into that school time and time again and hear what a terror he’s being. It’s one thing if he’s like this at home, but to be like this around other people, including the principal, vice principal, and several teachers I had when I went to school there years ago is just plain embarrassing,” she states, emphasizing her words. You talk about your plan for today’s session. The client arrives for the next session informing you that he has received 2 weeks of detention at school for fighting. He again insists that it isn't his fault. Though you note that he is beginning to exhibit some motivation to figure out how to not get in trouble, especially due to detentions. During this session you continue to work on goals to help him have better behavior at school and at home.
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Domain: Core Counseling Attributes

In a counseling relationship, _____________ is the attitude of complete acceptance and love, whether for yourself or for someone else
1. Non-judgmental stance
2. Unconditional positive regard
3. Empathic attunement
4. Sensitivity to individuality
Domain: Counseling Skills and Interventions

When asking the client about his homework from the past week, he states that he noticed that he calls people names during fights, which tends to make the fights worse. He recently called his younger brother an 'idiot'. From a Solutions-Focused Brief Therapy perspective, what would you say to help the client reduce name calling?
1. “Where do you think the need for name calling comes from?”
2. “Excellent job on doing your homework and paying attention to your behaviors this week! What problem do you want to solve today?”
3. “What thoughts came to mind before you called your younger brother an 'idiot'? Did those thoughts serve you or hurt you?”
4. “Imagine how much more free time you will have once you are not getting grounded anymore!”
Domain: Core Counseling Attributes

What therapeutic metaphor would you use to describe why the client needs to reduce fighting?
1. "Your words are like a loose cannon."
2. “You need to bury the hatchet.”
3. “You are shooting yourself in the foot.”
4. “Detention is just the tip of the iceberg. If you don’t fix this now, you could end up in jail as an adult.”
Domain: Counseling Skills and Interventions

Which of the following statements about abuse is false?
1. A therapist must have concrete evidence that a child or elder is being abused in order to report it.
2. Abuse is a choice.
3. A common predictor of abusive behavior is whether the perpetrator was abused themselves
4. Therapy for perpetrators often works best if the person sincerely wishes to stop abusing others.