Case Study
Patient Demographic: Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9)
Mental Status Exam: Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece
Presenting Problem: You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.
Other Contexts: The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling.  You colead the client’s process-oriented group with a trained counselor

Question: You colead the client’s process-oriented group with a trained counselor. Which one of the following is LEAST indicative of a process-oriented group?
(A): Identifying and discussing group themes and patterns
(B): Allowing for the use of silence
(C): Assessing intragroup interactions
(D): Teaching the importance of medication compliance

Correct Answer: Teaching the importance of medication compliance
Explanation: Teaching the importance of medication compliance is least indicative of a process-oriented group. Psychoeducational groups are content oriented and focus on teaching and conceptual learning. According to Yalom & Leszcz (2005), “While content involves looking at what specifically was said, process involves looking at the how and the why behind what was said” Trained counselors use process-oriented groups to assess interpersonal or intragroup interactions, introduce silence, and identify and discuss group themes and patterns. Although psychoeducation can be integrated into process groups, it is content oriented rather than process oriented. Therefore, the correct answer is (A)
Competency: counseling skills and interventions