Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3)
Mental Status Exam: Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio
Presenting Problem: You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.
Other Contexts:    n and Family History: You obtain a signed release of information before the client’s session today, which has enabled you to receive the client’s hospital records. The client was admitted due to hallucinations and suicidal ideation. The hospital psychiatrist provided a diagnosis of brief psychotic disorder and bipolar II disorder. The client was prescribed antipsychotic medication and an antidepressant. She reports that she discontinued the antipsychotic medication shortly after discharge because it caused excessive sleepiness. Regarding the antidepressant, the client states, “I just take it on the days when I’m really having a hard time.” The client has two teenage sons and lives near her extended family

Question: How might you use motivational interviewing to elicit change talk from the client?
(A): Evoke the client’s optimism for change by asking about a previous change she successfully made in her life.
(B): Confront the client on how maintaining the status quo is detrimental to progress.
(C): Persuade the client to attend a psychiatric evaluation for medication.
(D): Help the client to reevaluate the nature of the relationship with her husband.

Correct Answer: Evoke the client’s optimism for change by asking about a previous change she successfully made in her life.
Explanation: Using motivational interviewing, you would elicit change talk by evoking the client’s optimism for change by asking about a previous change that she successfully made in her life. Motivational interviewing uses various techniques to reduce ambivalence and enhance motivation to change. The spirit of motivational interviewing focuses on collaborating with the client, evoking reasons for change, and honoring the client’s autonomy. Helping the client reevaluate her relationship with her husband would not be aligned with the spirit of motivational interviewing because the client did not establish this as an area in need of change. Using persuasion and confrontation is not in alignment with the spirit of motivational interviewing. Exploring disadvantages of the status quo is a component of motivational interviewing; however, the counselor must guide the client in this process rather than confront the client to take action. Therefore, the correct answer is (D)
Competency: counseling skills and interventions