Case Study
Patient Demographic: Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)
Mental Status Exam: Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c
Presenting Problem: You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.
Other Contexts: The client continues to be compliant with therapy but is having difficulty discontinuing his drug use. He states he uses because it changes his mood and helps him forget about not fitting in at home or school. He explains that when he speaks English or dresses in non-traditional clothing, his family says they feel like, “I’ll forget where I came from. But when I leave the house, all I hear is, ‘Go back to where you came from.’” The client states he began using at the end of 7th grade and started using daily approximately four months ago. He admits to feeling guilty about how his use affects his family but claims, “It’s not like I’m an addict or anything.” His parents arrive today with an interpreter and attend a concurrent parenting group with a psychoeducational component that addresses adolescent substance abuse

Question: Using a motivational interviewing (MI) approach, how would you respond to the client’s uncertainty regarding his problematic drug use?
(A): “Your disease affects your rational thinking. Can you identify and challenge those thoughts?”
(B): “Your screening assessment tells a different story. What role is denial playing for you in this present moment?”
(C): “You may not be ready to stop. What is it about using that you really need to hold onto?”
(D): “Your addiction continues to harm your parents. What is the payoff for you today?”

Correct Answer: “You may not be ready to stop. What is it about using that you really need to hold onto?”
Explanation: The use of MI is reflected in the following: “You may not be ready to stop. What is it about using that you really need to hold onto?” This statement stands apart from the other choices because it is non-confrontational, and the question appropriately addresses the client’s ambivalence. MI is used to address ambivalence and promote change. One aspect of this approach is to avoid argumentation. Avoiding argumentation is accomplished by refraining from accusations of denial or using terms like disease or addict. The idea is to roll with resistance by allowing the client to discover discrepancies between where they see currently see themselves and where they’d like to be in the future. Therefore, the correct answer is (B)
Competency: counseling skills and interventions