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
©2020 National Board for Certified Counselors, Inc. All rights reserved. 1
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
1. What baseline data would you gather about the client’s current level of functioning?
a. the length of time she stayed with her former husband
 b. how she typically spends her weekdays right now **
 c. how she interacted in the past with her mother
 d. her career interests and values
Domain: Treatment Planning
Cognitive Level: Application
2. What information would be most important to guide the development of a treatment plan?
 a. collateral information from the mother
 b. diagnostic information obtained from previous providers
 c. information gathered through direct observation of the client
 d. client’s desired outcome for therapy **
Domain: Counseling Skills and Interventions
Cognitive Level: Application
3. Which of the following would you use to build a therapeutic alliance with this client?
 a. Challenge her irrational thoughts about her self-evaluations.
 b. Advise her about how to manage painful experiences.
 c. Summarize her emotional struggles and desire for change. **
 d. Explore areas in which she could improve interpersonal relationships.
Domain: Professional Practice and Ethics
Cognitive Level: Knowledge
4. 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?
a. Suggest that the client find another resource to pay for therapy.
 b. Explain that you will provide the mother with a summary and receipt.
 c. Discuss client confidentiality and privacy rights. **
 d. State that, as a payor, the mother has a legal right to review session notes

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