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.  Because you do have experience counseling individuals with substance use, you decide to use a motivational interviewing approach for this client

Question: Because you do have experience counseling individuals with substance use, you decide to use a motivational interviewing approach for this client. Which of the following statements defines the focus of motivational interviewing?
(A): Challenging irrational thoughts and feelings in order to create more productive beliefs
(B): Changing unhealthy behaviors in order to improve functioning
(C): Focusing on improving present situations and relationships, rather than examining past events
(D): Facilitating and creating an internal desire for change

Correct Answer: Facilitating and creating an internal desire for change
Explanation: Focusing on internal desire for change is the core focus of motivational interviewing because it is centered on identifying and cultivating an individual’s motivation for change and assisting the person with moving forward in therapy. Focusing on unhealthy behaviors alone is part of behavior therapy. Challenging irrational thoughts and feelings is the focus of rational emotive behavior therapy. Reality therapy focuses on improving present situations and not on the effects of past experiences on present functioning. Therefore, the correct answer is (C)
Competency: counseling skills and interventions