Case Study
Patient Demographic: Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)
Mental Status Exam: Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta
Presenting Problem: You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.
Other Contexts: You have been working with the client weekly and are meeting with the mother today to discuss interventions that she can use at home. She relays that her husband does not support the diagnosis of ADHD and has reached out to their faith community instead. The mother is conflicted about counseling and explains that it is viewed as a sign of weakness in her community. She continues to voice concern over the school’s lack of diversity and her belief that the client is being treated differently because of his race

Question: Which of the following would help you engage the client’s mother in treatment?
(A): Explore the influence of her biases toward the school’s majority culture.
(B): Denote the incongruence between historical trauma and here-and-now experiences.
(C): Refute the core cultural beliefs surrounding mental health stigma.
(D): Recognize the impact of the intersectional contexts of privilege and marginalization.

Correct Answer: Recognize the impact of the intersectional contexts of privilege and marginalization.
Explanation: Recognizing intersectional contexts of privilege and marginalization would best help engage the mother in treatment. Intersectionality considers each individual’s privileged and marginalized status in terms of all intersecting sociocultural contexts (eg, race, ethnicity, religion, socioeconomic background, education). Culturally responsive therapists consider the client and the counselor’s intersectional identity’s impact on the client’s presenting problem, treatment engagement, and treatment adherence. Validating rather than refuting core cultural beliefs surrounding mental health stigma can enhance the therapeutic relationship. Exploring the influence of the biases toward the school’s majority culture is not conducive to engaging the mother in treatment. Finally, it is essential to validate historical trauma (and not denote its incongruence), particularly the trauma’s connection to here-and-now experiences, values, and assumptions. Therefore, the correct answer is (B)
Competency: counseling skills and interventions