Case Study
Patient Demographic: Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)
Mental Status Exam: Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f
Presenting Problem: You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.
Other Contexts: rail. Family History: The client got divorced about 1 year ago. He states that his wife left him because he lost his job and because of his fentanyl use. The client has two children that are 18 and 22 years old. The client no longer has contact with his ex-wife or children. The client reports no known mental health history or substance use history in his family

Question: According to Abraham Maslow’s hierarchy of needs, which of the following would be the most appropriate area of clinical focus at the start of therapy?
(A): Begin substance use counseling to support the client in abstaining from fentanyl use.
(B): Assist the client with processing his feelings regarding cessation of fentanyl use.
(C): Encourage the client to reach out to his children to develop a support system.
(D): Support the client by providing referrals to local soup kitchens and processing barriers to housing.

Correct Answer: Support the client by providing referrals to local soup kitchens and processing barriers to housing.
Explanation: Maslow’s hierarchy of needs has five levels that include, in order from bottom to top, physiological, safety, love/belonging, esteem, and, finally, self-actualization. The more basic needs starting with physiological must be met in order for an individual to begin working on the other areas. The client’s housing and food situation are both physiological and safety needs and should be addressed and supported. Although working on cessation from fentanyl use and his feelings regarding stopping its use are important, the client is homeless and does not have resources, so this is the most important. The client’s relationship with his children would be classified under the “love and belonging” level in the hierarchy and would not be the area of initial focus. Therefore, the correct answer is (B)
Competency: treatment planning