Case Study
Patient Demographic: Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9)
Mental Status Exam: Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam
Presenting Problem: You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.
Other Contexts: You are on maternity leave, and your supervisor is covering your cases while you are out of the office. The supervisor meets with the client and daughter for the first time today and discusses the client’s progress and her treatment plan goals. The client and her daughter report measurable improvements with symptoms of depression and apathy. During today’s session, the supervisor also learns that you and the daughter went to high school together and share multiple acquaintances. There is no documentation in the client’s chart indicating that the risks and benefits of multiple relationships were reviewed with the client. At the end of the session, the supervisor asks the client for her copay. The daughter and the client state that you have “always just waived the copay,” indicating that the final bill would eventually be “written off by the agency.”  The client has met her goals for reducing symptoms of depression and apathy; however, her memory has not improved

Question: The client has met her goals for reducing symptoms of depression and apathy; however, her memory has not improved. How should you proceed?
(A): Continue to work with the client and create treatment plan goals addressing memory impairment.
(B): Discuss termination due to the client meeting her goals related to depression and apathy.
(C): Continue to work with the client and renew treatment plan goals for depression and apathy.
(D): Discuss referring the client to another professional who can address her memory impairment.

Correct Answer: Discuss referring the client to another professional who can address her memory impairment.
Explanation: The best choice for this client is to refer her to another professional who can address her memory impairment. Because the client’s PET scan identified changes associated with Alzheimer’s disease, you would need to find a specialist, such as a neuropsychologist, who could better address the client’s cognitive impairment. Discussing termination is a possibility, but it precludes the client benefiting from additional resources. Continuing to work with the client on improving her memory impairment is also a possibility. However, research shows cognitive impairment is progressive, and there is little more the counselor can do to help with this. Renewing client treatment goals for depression and apathy is unnecessary because the client has already achieved them. This would only apply if the client met her short-term goals and the counselor and client decide together to focus on long-term goals. Therefore, the correct answer is (B)
Competency: treatment planning