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.  At the end of today’s session, you respond, “While on the one hand you really enjoy using and don’t want to give it up, on the other hand you feel guilty about how your drug use affects your family

Question: At the end of today’s session, you respond, “While on the one hand you really enjoy using and don’t want to give it up, on the other hand you feel guilty about how your drug use affects your family.” How would you classify this response?
(A): Empathetic reflection
(B): Summarization
(C): Encourager
(D): Reframing

Correct Answer: Empathetic reflection
Explanation: This response is an example of an empathetic reflection, or more specifically, a double-sided empathetic reflection. A double-sided reflection is a motivational interviewing strategy used to help examine ambivalence and look at both sides of the client’s discrepancies. Counselors use reframing to help clients view situations, feelings, and relationships in a more positive light. Summarization ties together multiple concepts, feelings, or ideas. Counselors can use summarization at the end of the session or throughout the session to narrow the focus or examine a particular theme. An encourager is also called a prompt or a furthering response and involves a word, phrase, or nod used to encourage the client to continue talking. Therefore, the correct answer is (C)
Competency: counseling skills and interventions