Case Study
Patient Demographic: Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9)
Mental Status Exam: Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam
Presenting Problem: You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.
Other Contexts:    ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family.  You are a certified counselor who has never worked with a client diagnosed with MND. You assess your ability to work with this client based on your credentials and the information provided thus far

Question: You are a certified counselor who has never worked with a client diagnosed with MND. You assess your ability to work with this client based on your credentials and the information provided thus far. At this point in treatment, which of the following statements is the most accurate?
(A): You should refer the client to a counselor who specializes in neurocognitive disorders.
(B): You should proceed with the client only after obtaining specialized training and consultation.
(C): You should proceed with the client unless the results of the PET scan indicate advanced memory impairment.
(D): Your background and training should permit you to work with this client.

Correct Answer: Your background and training should permit you to work with this client.
Explanation: Despite never working with a client diagnosed with MND, your education, experience, and training should provide you with the skills to treat the client’s anxiety, apathy, and depression. You can provide supportive counseling, address psychosocial symptoms, teach coping skills, and suggest compensatory memory strategies. Section C2 of the ACA Code of Ethics states that counselors must only practice within the boundaries of their competence, which is specifically based on “their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” Counselors have an ongoing ethical responsibility to remain current and increase their knowledge base by obtaining continuing education, but this would not be a prerequisite for working with this client. The counselor would not necessarily need the PET scan results to proceed because a mental status exam and neuropsychological report both show MND and associated behavioral disturbances. Therefore, the correct answer is (A)
Competency: professional practice and ethics