ckmjx/CounselingBench huggingface dataset:
Case Study
Patient Demographic: Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3)
Mental Status Exam: Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua
Presenting Problem: You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.
Other Contexts: rded. Family History: Most of the clients report distressed relationships with their parents or guardians and that they have not had stable relationships throughout their lives

Question: Which of the following is considered a differential diagnosis for borderline personality disorder?
(A): Post-traumatic stress disorder (PTSD)
(B): Alcohol use disorder
(C): Conduct disorder
(D): Reactive attachment disorder

Correct Answer: Alcohol use disorder
Explanation: Alcohol use disorder and other substance use disorders are important to consider for these clients with suspected borderline personality disorder. Although the symptoms that these individuals experience may be due to the substance use that is common in individuals with borderline personality disorder, alcohol use disorder must first be ruled out as the primary cause of the individual’s symptoms. Reactive attachment disorder has similar symptoms but is typically a childhood disorder and would not be considered for an adult. Although conduct disorder does have behavioral or relational issues, it would not be considered a differential diagnosis. PTSD commonly co-occurs with BPD, but it is not considered a differential diagnosis. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic:  Initial Intake: Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Chinese Relationship Status: Single Counseling Setting: College Counseling Center Type of Counseling: Individual
Mental Status Exam: The counselor noticed that Darrel’s clothes look disheveled, he had bags under his eyes and made very little eye contact. When asked, Darrel stated that he was working late the day before and he just needed to rest.

Presenting Problem: Darrel is an 18-year-old freshman who comes into the college counseling center for some career counseling.
 
History
Darrel is a transfer student from China, living with a boarding family close to the college campus. He is an Advertising major at college. Darrel stated that he is unhappy at school. He didn’t know if he was unhappy with his major selection even though he couldn’t see himself doing anything else. Darrel described how recently he just doesn’t like anything he used to, including anything that has to do with Advertising. Darrel stated that his parent would be greatly disappointed if they knew that he was switching his major.  He questioned why he had to do what they want anyway. The counselor suspected that the issues may be deeper than Darrel’s initial intake suggested.

Question: While the counselor gains information, the counselor should not?
(A): Deny any cultural biases the counselor is feeling
(B): Gain an understanding of his spheres of influence
(C): Find out about his interests and hobbies
(D): Ask Darrel what he does for work

Correct Answer: Deny any cultural biases the counselor is feeling
Explanation: Counselors are obligated to be aware and sensitive to other cultures. It is also necessary to acknowledge cultural biases and not try to deny them. Acknowledging one's own biases is the only way to effectively work on overcoming them. A comprehensive assessment not only includes the counselor's self-awareness, but also includes information on many aspects of the person's life including strengths, interests, and hobbies. Finding out what Darrel does for work can give pertinent information on why he looks so tired. Finding out about his spheres of influence can give the counselor an even larger picture of Darrel's support system and other factors that may be influencing his feelings and behaviors. Therefore, the correct answer is (D)
Competency: professional practice and ethics
Case Study
Patient Demographic: Initial Intake: Age: 4 Sex: Female        Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Clinic Type of Counseling: Individual
Mental Status Exam: Destiny was engaging with the counselor throughout the interview although her affect was flat. She played by herself while the counselor spoke to Darlene and Tony. She did not look up at her parents or engage with them during the entire session.
Presenting Problem: Destiny is a 4-year-old who was referred for therapy by her preschool teacher. Destiny arrived at the intake session with her adoptive parents, Darlene and Tony Mase. Darlene and Tony shared that they were concerned about Destiny because she never wants to interact with other children, rarely smiles or laughs, and has mood fluctuations with little or no pattern or trigger. Reactions include irritability, sadness, and tearfulness.

History:
Destiny arrived at the Mases’ when she was two years old and was nonverbal at the time. Destiny also showed cognitive delays in her early intervention screening. Darlene and Tony noticed Destiny’s lack of interest in playing with other children when Destiny arrived and she did not want to interact with the other children in the home. The irritability and mood fluctuations began over a year ago. Darlene and Tony were hopeful that once Destiny started preschool that she would start interacting with others, however this is not the case.

Question: Destiny is displaying symptoms of Reactive Attachment Disorder. Differentiators between Autism spectrum disorder and Reactive attachment disorder may include all of the following except?
(A): Restrictive interests and repetitive behaviors are associated with Autism spectrum disorder
(B): Both can exhibit a range in intellectual functioning
(C): Reactive attachment disorder does not have cognitive and language delays
(D): Those with reactive attachment disorder have a history of severe social neglect

Correct Answer: Reactive attachment disorder does not have cognitive and language delays
Explanation: Individuals diagnosed with reactive attachment disorder and autism spectrum disorder may show cognitive and language delays, as well as a range intellectual functioning. However, individuals diagnosed with autism spectrum do not have to have a history of severe social neglect. Additionally, restrictive interests and repetitive behaviors can be seen with autism spectrum disorder but not reactive attachment disorder. Therefore, the correct answer is (A)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital
Presenting Problem: Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”

Question: Tony asks that the counselor not tell his wife about wearing her clothes prior to the time she walked in on him. How should the counselor respond?
(A): Are you sure that is what you want to do?
(B): I understand that it may be intimidating, let's talk about how we can bring it up so you are most comfortable
(C): That goes against the ground rules we set last week
(D): Okay, only this time

Correct Answer: I understand that it may be intimidating, let's talk about how we can bring it up so you are most comfortable
Explanation: This choice validates Tony's feelings but also talks about a way to honor was agreed upon before the individual session. Prior to the session with Tony, all parties agreed that whatever is stated in the individual session will be shared in the next session. If this is not done, this may disrupt the therapeutic relationship. If the counselor agrees to it just one time, Tony may ask again to keep something from Kathleen and an alliance may form between Tony and the counselor. This would be a violation of trust if Kathleen found out. Selection b does not directly address the issue at hand and choice c may cause Tony to be defensive. Therefore, the correct answer is (D)
Competency: counseling skills and interventions
Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express
Presenting Problem: You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.
Other Contexts:  Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4)   ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother

Question: Which one of the following would be the most beneficial collaborator(s) for holistic treatment planning in this scenario?
(A): The client’s PCP
(B): A psychiatrist
(C): The client’s friends
(D): The client’s girlfriend

Correct Answer: The client’s PCP
Explanation: The client’s PCP would be the most beneficial contact for collaboration in a holistic approach because the concern includes the influence of a medical condition. A psychiatrist is an important collaborator for mental health needs, especially when psychopharmacy is required, but this would neglect the focus on the client’s medical needs. The client’s girlfriend and the client’s friends also do not address the physical needs of the client’s medical condition and therefore would not characterize the most holistic approach. Therefore, the correct answer is (A)
Competency: treatment planning
Case Study
Patient Demographic: Initial Intake:   Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Employee Assistance Program Type of Counseling: Individual
Mental Status Exam: Harold comes into the office, visibly upset, stating, “I really don’t know why I am here, but I am sure you will see that too after some time together. And I am sure that anything I say here- you can’t report it to anyone anyway, right?” Harold did not display any self-awareness of his actions when speaking to the counselor. At times he showed defensiveness and irritability and other times he was making jokes and complimenting the counselor.
Presenting Problem: Harold, an accounting executive, was referred for counseling by his supervisor after Human Resources received several complaints about Harold’s attitude towards others.
 
History:
Harold has been successful in his career and is knowledgeable in his field. However, he stated that he is often not well liked. Harold attributes this to people being envious of him. Harold told the counselor that recently he was called to human resources because of complaints from his peers. Complaints included allegations of rude remarks, bullying, and Harold taking credit for work that others did. One coworker stated that Harold took frequent breaks and suspected he may be using drugs.

Question: To obtain more information the counselor should first?
(A): Interview Harold's coworkers
(B): Determine a diagnosis
(C): Conduct a drug test
(D): Conduct a biopsychosocial

Correct Answer: Conduct a biopsychosocial
Explanation: A comprehensive biopsychosocial is usually the first step of the intake and assessment process to gain information on a client's past in the main life domains. It is not the counselor's responsibility to interview Harold's coworkers because of the complaints, and meeting with them may cause suspicion from Harold. It is too early to determine a diagnosis. Although Harold's coworker indicated possible drug use, a drug test is not yet indicated. A drug screening is usually part of the initial biopsychosocial. A drug test may be necessary if the drug screening indicates so. Therefore, the correct answer is (A)
Competency: counseling skills and interventions
Case Study
Patient Demographic:  Initial Intake:   Age: 82 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Widowed Counseling Setting: Community Clinic Type of Counseling: Individual
Mental Status Exam: Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.
Presenting Problem: Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.

History:
Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.
 
Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.

Question: Which of the following diagnoses can be ruled out based on the symptoms Theodore is exhibiting?
(A): Normal grief reaction
(B): Hoarding
(C): Adjustment disorder
(D): Persistent Depressive Disorder (Dysthymia)

Correct Answer: Persistent Depressive Disorder (Dysthymia)
Explanation: There is not enough information yet to rule out anything except Persistent Depressive Disorder (Dysthymia) in which one criterion is that the symptoms persist for at least two years. Adjustment Disorder is a possibility as the initial criteria is an emotional response to an identifiable stressor, within three months. Hoarding is another diagnosis to consider as Theodore does not want to get rid of anything that reminds him of his wife. However, it is also important to consider normal reactions to grief before finalizing a diagnosis. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual
Mental Status Exam: Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.

Presenting Problem: Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.

Question: Nadia is showing symptoms of?
(A): Disruptive dysregulation disorder and autism
(B): Disruptive dysregulation disorder and intellectual disability
(C): Bipolar disorder and autism
(D): Bipolar disorder and intellectual disability

Correct Answer: Bipolar disorder and intellectual disability
Explanation: Nadia is showing symptoms of bipolar disorder by risk taking behaviors as well as manic and depressive episodes. She is also showing intellectual development disorder with an IQ less than 70 to 75. Disruptive Mood Dysregulation disorder is ruled out as irritability is not the prominent feature. Although intellectual disability is common among individuals with autism spectrum disorder, Nadia is not showing apparent discrepancy between level of social-communicative skills and other intellectual skills. Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual
Mental Status Exam: Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.
Presenting Problem: Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.

Question: ?When the counselor responded “It sounds like you have told your story many times…” she was utilizing?
(A): Reflection of feeling
(B): Paraphrasing
(C): Focusing
(D): Clarification

Correct Answer: Paraphrasing
Explanation: Paraphrasing can be used to reiterate or clarify information. It shows the client that the counselor is listening and understands what they said. Clarification is asking the client to confirm what they said or a counselor's interpretation of what they said. A reflection of feeling focuses on the feelings of the client. In this instance there was no feelings mentioned. Focusing is a technique that happens internally where they consciously direct their attention to something in the session. Therefore, the correct answer is (C)
Competency: counseling skills and interventions