Free Sample Case

Part One

Age: 14
Sex: Male
Gender: Male
Sexuality: Heterosexual
Ethnicity: Caucasian
Relationship Status: Single
Counseling Setting: Community clinic
Type of Counseling: Individual
Presenting Problem: Heightened anxiety at home and school
Diagnosis: Obsessive-Compulsive Disorder

Presenting Problem: You are a clinical counselor at a community mental health clinic. Your client is a 14-year old Caucasian male who comes to you to get help so his school day runs more smoothly. Over the past six months, the client has received numerous detentions for being late to class. He states that the issue is that when he goes to his locker to get the books he needs for the next class, he often walks away, but feels like he forgot something in his locker, so he goes back to his locker and opens it only to find that he has everything he needs. He states that he feels better after checking, but there have been times where he opens his locker five times during a class change and reports to class late.

Mental Status Exam: The client comes to session well groomed and makes good eye contact. Mood and affect are appropriate. The client is visibly anxious as evidenced by shallow breathing and tenseness. The client has a bandana that is very special to him. He wipes his brow with his bandana three times when he comes into your office.

Living Situation: The client lives with his mom in a small apartment. Mom reports that the client spends about an hour and a half each night in the shower. Mom has found the client still showering well after the hot water has run out. The client states that he has a very specific showering ritual that he must perform, and if one of the steps is out of order he has to start over. Sometimes he loses track in the middle and has to get out and start all over again. He states that he knows that if he does not complete the ritual then “something bad will happen.”

Academic History: The client has always been a good student. He has perfect handwriting and always has his supplies organized. Teachers often say that he is very responsible and a pleasure to have in class. The detention monitor, who is also the client’s English teacher, was surprised to see him in detention over the last few months, and upon learning of his situation, recommended that he see the school counselor who referred the client to your agency. The client has good grades and has not missed a homework assignment all year.

Family History: The client has three younger half siblings who live with dad full time. The client’s parents got divorced when he was 9 years old, and the client found himself caught in the middle of an intense custody battle. He had to go to numerous court hearings and met with social workers and lawyers on a regular basis. Although his parents encouraged him to always tell the truth, he found himself intimidated by all of the conversations and appointments. He recalls that many of them ended abruptly, leaving him unsure if he said something he shouldn’t have said. He says that TV was an escape for him during that time and he would often imagine himself in the cartoon worlds depicted on the screen. He also says that he developed a love for school during this time of his life because school was the one place where it didn’t feel like people were fighting over him.
- - - - - - - -

Domain: Intake, Assessment, and Diagnosis

From an Solutions-Focused Brief Therapy perspective, what would you focus on to help this client?
1. Achieving positive goals
2. The client’s ability to picture future success
3. Reducing problematic behaviors
4. Improving problem definition
Domain: Professional Practice and Ethics

As you begin working with the client, you also check in with your supervisor for continued professional development. The process that insures that a supervisee's rights are protected from start to finish refers to which of the following?
1. Informed Consent
2. Duty to Warn
3. Due Process
4. Due Liability
Domain: Counseling Skills and Interventions

From an Acceptance and Commitment perspective, what would you say to build therapeutic alliance with this client?
1. “Obsessive Compulsive Disorder is very common. There are many tools that can help. There is no shame here.”
2. “Can you tell me what goes through your mind when you are re-checking your locker. If you can commit to changing those thoughts, you'll be doing better soon!”
3. “I know how uncomfortable all this must make you feel. But finding the way through that discomfort is much better than running from it.”
4. “You have goals. But your behavior isn't really helping you achieve those goals. Are you willing to commit to taking responsibility for finding better ways to meet your goals?”
Domain: Intake, Assessment, and Diagnosis

Which of the following symptoms most affirms this client's diagnosis?
1. The client's history of shallow breathing
2. The client's history of attempting to suppress his thoughts regarding forgotten books
3. The client's attachment to his bandana
4. The client's showering ritual
Domain: Treatment Planning

Below are steps to creating a treatment plan for this client. Which step would come first?
1. Objective construction
2. Goal Development
3. Intervention Creation
4. Problem Selection
Part Two

Second session, two weeks after the initial intake

The client wipes his brow three times as he comes into your office. He states that he has felt nervous about coming to counseling because your office is located in such a big building saying, “I know it's going to collapse one of these days.” You ask the client if he has ever seen a building collapse and if it tends to happen often. He says that earthquakes and tsunamis are the cause for the collapsed buildings in the most recent videos he has watched. You point out that you are in an area where it would be impossible for a tsunami to reach, and he states that there is still enough water in the ocean to cover the entire continent. He discusses his interest in construction that he’s had over the years, and impresses you with his vocabulary about the techniques architects use that help strengthen buildings. “I know what you were getting at, though,” he says, “We both know that I’ve never actually seen a building collapse with my own eyes. It just seems like it could happen, though, you know?” The client says that his mom has limited the amount of movies client is allowed to watch since he would talk about how the plots could play out in daily life. He says his mom is being overprotective, but he has been able to sleep better since reducing the amount of movies about natural disasters he watches. The client makes a list of intrusive thoughts and images, including buildings collapsing and forgetting class materials. You help the client gather evidence about buildings and encourage the client to ask himself “What’s the evidence?” when these thoughts and images come up. You help the client brainstorm what he can do instead of opening his locker multiple times. The client states that he can start looking at the books that he is carrying instead of opening his locker again since it takes so long to put in the combination. You encourage him to experiment with this throughout the week. The client wipes his brow three times as he leaves your office.
- - - - - -

Domain: Counseling Skills and Interventions

The guided imagery technique that you used in Part Two is an example of which technique?
1. Covert Extinction
2. Covert Sensitization
3. Cognitive Rehearsal
4. Covert Desensitization
Domain: Counseling Skills and Interventions

The client's statement from Part 2 is an example of which Thinking Error?
1. Over-generalization
2. Catastrophizing
3. Jumping to Conclusions
4. Mental Filter
Domain: Intake, Assessment, and Diagnosis

From an Object Relations perspective, how would you explore the client’s behavior of wiping his brow?
1. “I see you wipe your brow a lot. It's almost like you are comforting yourself. What has comfort meant to you?”
2. “Whenever you wipe your brow, that’s called a compulsion, and that behavior comes as a result of a thought you have, called an obsession.”
3. “It seems like your bandana is a really important object to you. I wonder where that comes from? ”
4. “I notice you wipe your brow three times each time. Is it soothing to have that predictability whenever you feel anxious?”
Domain: Core Counseling Attributes

There are two primary sources of information gleaned in a counseling session: Content and Process. Process mostly focuses on:
1. Nonverbal phenomena
2. Assessment results
3. What is specifically said in the session
4. Client symptomology
Part Three

Third session, three weeks after the initial intake

The client wipes his brow three times when he comes into your office. He states that he has been experiencing less intrusive images, however he still has to wipe his brow “just in case.” The client states that it has helped to check what materials he has in his hands rather than going back to his locker, however he still usually opens it twice during class changes, but hasn’t been late to class this week. You praise the client for his progress in lowering the amount of times he has opened his locker. You teach him the concept of “one and done”. You encourage him to make observations about that this week and report back next time. He tells you about a recent conversation he had with his school counselor, who has noticed progress, including fewer detentions. He said that she quizzed him on some of the coping skills he is developing. “I just told her that I can think about things in a different way now. I mean, it’s not perfect all the time, but that’s okay. Hey, that sounds like something you’d say!”, he says with a laugh. He says that the school counselor would like to talk to you, and that she would be sending you a form that his mom filled out to allow you to speak. You ask the client if there’s anything he wouldn’t like you to mention to the school counselor, and he says he has nothing to hide and he trusts you. He gets up to leave, thanks you for helping him, and says he is excited for your appointment next week. The client wipes his brow three times as he leaves your office.
- - - - - - - -

Domain: Counseling Skills and Interventions

What insights from the homework would you hope to elicit from your client?
1. “I’m wasting a lot of time checking my locker between classes.”
2. “Therapy is working and I need to stay with it.”
3. “Buildings don’t collapse out of nowhere, and there’s no way I am responsible for something like that.”
4. “My actions are a product of my thoughts.”
Domain: Counseling Skills and Interventions

You have been working with a group of high school students for the past year. This week the group discussed how one of the members was a victim of cyber bullying, and how the group members stuck up for the bullied person by posting on social media about her good attributes. One of the members stated, “I can’t let her be treated like that. I have had the privilege to see her as if she were a sister.” You take in this shift in the group and realize that it has moved into the ___________ stage.
1. Synergy
2. Closure
3. Cooperation and Integration
4. Power Struggle
Domain: Counseling Skills and Interventions

Regarding what the client shares about his locker progress in Part 3, which of the following best describes a therapeutic response based on Cognitive Therapy?
1. “Excellent progress! How do your current thoughts regarding the locker compare to your prior thoughts”
2. “Great work! When the thought arose about going back and checking your locker, what feeling was associated with it?”
3. “Amazing! Yes, 'one and done' means you just say goodbye to that unwanted thought.”
4. “Super! Yes, have the thought, then check what is in your hands.”
Domain: Core Counseling Attributes

Which of the following skills is least associated with the others?
1. Listening
2. Attending
3. Reflecting
4. Observing

To Learn more about my Complete NCMHCE Study Program, click here:

Learn more

NBCC® and NCMHCE® are registered trademarks solely owned and controlled by the National Board for Certified Counselors, Inc. (NBCC). I am not affiliated with NBCC. NBCC does not endorse, sponsor, or otherwise support my services or products, including the examination preparation services provided on the ClinicalExamWorkshop.com website.