Case Study
Patient Demographic:  Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Health Type of Counseling: Individual
Mental Status Exam: The client presents as a thin young woman, whose weight is appropriate for her age. Her clothing is appropriate for her age and to the situation. She identifies her mood as happy and her affect is congruent. The client shows some retardation in movement but no spasticity or physical or abnormal movements. The client appears open and honest in her responses, though responses are short. She responds to closed questions without pause but appears to struggle to answer open-ended questions as evidenced by staring and smiling without speaking or saying “I don’t know.” On examination, the client shows little insight into her mother’s concerns and uses childlike judgement when responding to hypothetical questions. The client denies suicidal or homicidal ideations or intent, delusions, or hallucinations, but does admit to playing a game with children at her maternal grandmother’s house where they attempt to see ghosts in the bathroom mirror.
Presenting Problem: You are a counselor in a community health setting which includes in-office sessions as well as home visits. Your client is a 16 year-old female who presents with a history of academic difficulties, problems following rules at home, and fighting with her sister, which recently included threatening to cut her sister with a kitchen knife. Her mother tells you that the client has always had some problems in school but they are getting worse. Her teachers say that she doesn’t pay attention and struggles with simple concepts, but is always polite and friendly to others. When asked to tell you how she thinks things are going, she answers “good” and smiles. You notice that she often smiles while her mother is talking but when her mother talks about the problems at home, the client looks away from both of you and stares out the window. The client’s mother reports that the client does not clean her room, has to be told to attend to her hygiene, and does not complete chores when they are assigned, such as cleaning out the refrigerator or vacuuming the living room. Mother reports that the client stays at home alone or with her two younger sisters when her mother or mother’s boyfriend are at work or away from home during the day.
Other Contexts: Family History:
The client is the oldest of three children born to her mother. Her siblings have different fathers and her youngest sister’s father currently lives in the home and is identified as “mom’s boyfriend” or “Robert.” Client’s mother reports no family history of mental health disorder or substance abuse. The client reports that she often spends several nights a week with her grandmother “to give Mom a break” and plays games and spends time with the neighborhood children. The client states that her grandmother “makes me sit and she reads the Bible to me” for several hours each day. She reports that she likes spending time at her grandmother’s house because she and her sister watch “scary movies” including movies about monsters, murders, and witchcraft.

Question: Which of the following is not part of the termination process?
(A): Review company policies for uses and limits of social media
(B): Provide contact information in case the client or her mother have questions for you
(C): Provide the new clinician with a copy of your notes
(D): Introduce the client and her mother to the clinician who will be working with them

Correct Answer: Provide contact information in case the client or her mother have questions for you
Explanation: Termination is often as hard on counselors as it is on clients. However, the counselor is responsible for terminating ethically, legally, and professionally. Relationships with clients after counseling are discouraged by the ACA Code of Ethics. The counselor should provide only contact information for the new clinician and for the agency as the current counselor will no longer be involved with this client. It will be helpful to use some of the current session to introduce the new clinician and help the client and her mother begin building a relationship with that counselor. Reviewing company policies about social media is important as the counselor should not accept or allow the client access or expectations of access to the counselor through social media. It is appropriate for the retiring counselor to provide a copy of notes to the new clinician to facilitate continuity of treatment. Therefore, the correct answer is (B)
Competency: treatment planning