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: Since the start of counseling and services with the local government mental health agency, the client has maintained sobriety from fentanyl and has been moved into stable housing via assistance from the agency. The client reports that the management of his anxiety has been better, but that he often feels lonely and unengaged. The client states that he is not sleeping well and thinks it is because he does not do much during the day. He continues to participate in Narcotics Anonymous daily in order to have interactions with other people. The client says that he tried to reach out to his children but they would not answer his phone call. You empathize with the client regarding his difficulty reaching out to his children. You and the client use this session in order to review progress and identify new goals

Question: Which of the following would be the most effective cognitive reframing of the statement “My kids hate me and don’t want anything to do with me”?
(A): “I hurt my kids, and I need to learn to be okay without them.”
(B): “My kids are done with me, and I should learn to move on.”
(C): “My kids don’t like me right now, but eventually they will come around.”
(D): “I hurt my kids, but I can take steps to rebuild my relationship with them.”

Correct Answer: “I hurt my kids, but I can take steps to rebuild my relationship with them.”
Explanation: “I hurt my kids, but I can take steps to rebuild my relationship with them” is the most effective cognitive reframing statement. This reframing addresses the reality that the client hurt his children, and it provides the motivation to make changes to improve his relationship with them, but it does not promise an outcome because its focus is on taking steps. It is important to instill hope that the future can be better because a common cognitive distortion is that past experiences will be the same in the future. Expecting the children to “come around” does not acknowledge the work that is required on the part of the client for positive change to occur. Expressing the need to “learn to move on” or to “learn to be okay without them” does not provide the client with motivation to change. Therefore, the correct answer is (C)
Competency: counseling skills and interventions