ckmjx/CounselingBench huggingface dataset:
Case Study
Patient Demographic:  Initial Intake: Age: 48                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Acute Inpatient Psychiatric Hospital Type of Counseling: Individual
Mental Status Exam: Sandy wandered into the ER waiting room asking for a police officer. After further conversation, it was clear that Sandy thought she was in a police station and repeatedly called once of the nurses Officer McKinney, as if she knew him.
 
During the intake, the nurse practitioner mentioned that she was running a temperature, had a rapid heartbeat and breath smelled foul. In addition, her hands were trembling as well as her tongue and lips. Sandy’s behavior was somewhat irritable and erratic. At one point she was seemed to be hallucinating and stated that that she saw rats.

Presenting Problem: Sandy was sent to the inpatient psychiatric from the emergency department for symptoms of hallucinations, memory loss, and disorientation.
 
History:
Sandy currently lives alone and is unemployed. She has a history of alcohol abuse and has been admitted to the hospital before because of this. Sandy has gotten into trouble with the law and has alienated most of her family and friends because of her alcohol use. She currently attends alcoholics anonymous.

Question: The name of the activated system central to the neurochemical process underlying addiction is?
(A): None of the above
(B): Mesocorticolimbic pathway
(C): Norepinephrine pathway
(D): Serotonin pathway

Correct Answer: Mesocorticolimbic pathway
Explanation: The mesocorticolimbic pathway is the sometimes called the "pleasure pathway" and is central to the release of dopamine and is activated by drugs. Serotonin pathway stabilizes our mood, feelings of well-being and happiness. The norepinephrine pathway is activated during stressful events and causes our fight or flight response. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake:   Age: 19 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Group home run by the Office of Children and Family Services Type of Counseling: Individual
Mental Status Exam: Elaina has little insight into her behaviors and is currently involved in an abusive relationship. Staff members are concerned for her safety, as well at the safety of her child. She is not functioning well socially or academically.
Presenting Problem: Elaina is a 19-year-old female who is living in a residence for pregnant teens in foster care. She has been displaying risk taking behaviors such as running away and fighting.
 
History:
Elaina has an extensive history of abuse and neglect. She entered foster care at the age of 5 when her mother was incarcerated for prostitution and drugs. Since then, she has been in and out of foster care homes and had several failed trial discharges back to her mother’s care. Elaina ran away from her foster homes multiple times. Another trial discharge date is set for the near future, after the baby is born.
 
Elaina never finished high school. She had difficulty focusing on her classes and was often teased because the other children knew that she was in foster care. Elaina would frequently get into fights, resulting in suspensions. She has a tumultuous relationship with the father of her child, and she recently told her case planner that he sometimes hits her.
 
Elaina walked into the counselor’s office, sighed, and stated, “Great- someone new- I have to tell my story again?”
 
The counselor responded “It sounds like you have told your story many times. I can imagine how that feels for you.”
 
Elaina stated, “It is very frustrating and annoying.” To which the counselor responded, “I like to hear from clients, their history in their own words as opposed to reading it on paper. When we make your goals, I would like you to be involved as well.”
 
Elaina visibly relaxed and began to tell the counselor about her history and current challenges. Elaina agreed to think about what she wanted her goals to be and agreed to discuss it next session.

Question: Elaina has experienced several ACEs which stands for?
(A): Adverse childhood experiences
(B): Adverse community experiences
(C): Avoidant childrearing entities
(D): Ambivalent caregiver experiences

Correct Answer: Adverse childhood experiences
Explanation: Adverse childhood experiences (ACEs) are negative experiences throughout the lifespan such as child abuse or caregiver mental illness which can lead to toxic stress. The more ACEs a person experiences, the more likely they are to have mental health and physical complications later in life. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.
Presenting Problem: You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.
Other Contexts: Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.

Question: Which of the following would be the most effective “homework assignment” for the client before the next session?
(A): Create a wall collage of her son's photos for the home
(B): Write about her son and her feelings in a daily journal
(C): Choose one day a week for family members to discuss the loss
(D): Talk with her husband about her counseling session

Correct Answer: Write about her son and her feelings in a daily journal
Explanation: Writing in a journal provides space for the client to express her feelings. These can be shared with the counselor if desired. The artwork and family interactions represent ways to require the family to engage with the client's pain, which is not serving the client effectively at this time. Therefore, the correct answer is (C)
Competency: treatment planning
Case Study
Patient Demographic:  Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.
Presenting Problem: You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.
Other Contexts: Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.

Question: Which of the following types represent the client's ISA code?
(A): Intellectual, Structured, Analytic
(B): Investigative, Social, Artistic
(C): Intuitive, Sedentary, Abstract
(D): Inventive, Scientific, Active

Correct Answer: Investigative, Social, Artistic
Explanation: The Holland RIASEC types are Realistic, Investigative, Artistic, Social, Enterprising, and Conventional. The client's type ISA shows that her personality type is Investigative, Social, and Artistic so a counselor would facilitate exploration of occupations and work environments that meet the ISA, IAS, SIA, SAI, AIS, and ASI codes. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 15 Sex: Non-binary        Gender: chose not to answer Sexuality: chose not to answer Ethnicity: East Indian Relationship Status: Single Counseling Setting: Community Outpatient Clinic Type of Counseling: Individual
Mental Status Exam: Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
Presenting Problem: Shar was brought it by their mother, Nadia, for concerns about being isolated and argumentative.
 
Mental Status:
Shar is 15-years old and looks younger than stated age due to their weight. Shar had a flat affect throughout the interview and looked down frequently. Despite there being an empty seat on the couch next to their mother, Shar sat in a chair across the room.
 
History:
Shar and Nadia reported that they used to have a close relationship. There have been no issues or discord until now. Recently, Nadia noticed Shar staying to themself more in their room, which is unlike them. Shar recently lost a significant amount of weight and teachers reported their grades have declined. Nadia shared problems started when the topic of the sophomore dance came up and Nadia asked Shar what boy they were going with.
 
When this topic came up during the intake, Shar rolled their eyes at this and stated, “Mom, you are so narrow minded. Why do I have to go with a boy, why can’t you just ask me WHO I am going with?” Nadia looked at the counselor and stated, “Do you see why I brought her here? She is so disrespectful, and she is lucky that her father did not hear her say these things. We used to be so close.”

Question: At this point the counselor should?
(A): Tell the mother that since she is the guardian, she can be told session details.
(B): Introduce client confidentiality and privacy rights.
(C): Encourage Shar to communicate what occurred in the session as they feel comfortable, with their mother.
(D): Share minimal information with the mother.

Correct Answer: Encourage Shar to communicate what occurred in the session as they feel comfortable, with their mother.
Explanation: Working with a minor often brings up issues of confidentiality. The best option out of the choices above is to help facilitate communication between Shar and Nadia. It is unethical to share with Nadia what is said in the counseling sessions unless there are safety concerns. Client confidentiality and privacy rights should be discussed at intake so this should not be the time to first introduce this. Regardless of the mother being the guardian, confidentiality and privacy rights still apply. Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic:  Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Biracial Relationship Status: Single Counseling Setting: High School Social Worker Type of Counseling: Individual
Mental Status Exam: Autumn came to intake session, during her lunch period. She appeared younger than her stated age because she was so underweight. The counselor greeted Autumn and told her that she was welcome to eat during their session if she wanted to. Autumn looked down and responded, “It’s okay- I don’t like to eat in front of anyone- I can just eat later.” Erin seemed tired during the interview but was cooperative and friendly.
Presenting Problem: History:
Autumn is a junior in high school. Her parents divorced about a month ago. Recently, the teacher noticed a change in Autumn’s mood. Autumn’s teacher also noticed that she was taking her lunch and eating it outside by herself. Oftentimes, she didn’t seem to eat much of it at all. When asked about it, Autumn seemed embarrassed and stated that she was fine.

Question: Autumn could be showing symptoms of all of the following except?
(A): Social Anxiety Disorder (Social Phobia)
(B): Anorexia Nervosa
(C): Avoidant/Restrictive Food Intake Disorder
(D): Binge Eating Disorder

Correct Answer: Binge Eating Disorder
Explanation: Autumn is not showing signs of Binge Eating Disorder in where there is "eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances". Like Autumn, someone diagnosed with avoidant/restrictive food intake disorder shows significant weight loss. This is also a symptom with Anorexia Nervosa along with a restriction of caloric intake. The counselor may also consider social anxiety disorder (social phobia) because of the avoidance of eating in social situations. Therefore, the correct answer is (D)
Competency: treatment planning
Case Study
Patient Demographic: Initial Intake: Age: 12 Sex: Male            Gender: Male Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: School Counselor Type of Counseling: Individual
Mental Status Exam: Michael came to the office and looked upset as he sat down. When asked about how he felt about what happened, Michael respectfully stated that he was sorry but that he did not want to talk about it.

Presenting Problem: Michael came to the counselor’s office after he was suspended for fighting with one of the other students.

History:
Michael, who was a new student this year, did not typically get in trouble. Michael has excelled academically since his arrival and joined several school clubs. When the teacher was questioned regarding what happened, she stated that the other student made a gesture to Michael that could not see. Suddenly, she stated that they were both throwing punches. Michael’s teacher stated that now that she thought about it, she recently noticed Michael exhibiting some repetitive movements that she never witnessed before.

Question: Which of the following interventions would NOT help Michael recognize a situation and an urge before a tic arises?
(A): Cognitive behavioral therapy
(B): Psychoeducation
(C): Insight-oriented therapy
(D): Neuroleptics

Correct Answer: Insight-oriented therapy
Explanation: Insight-oriented therapy would not be an appropriate modality. This modality helps to identify unconscious motivation in behavior. Neuroleptics, also known as antipsychotic medication, has been shown to reduce tics. CBT can help the individual recognize the urge before the tic and identify situations prior. Psychoeducation can be used to help the person learn things that may alleviate or worsen symptoms. Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 26                Sex: Female Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: Molly was initially guarded, but pleasant, during the intake session. After some time, she became tearful. Molly stated to the counselor that although she always had a level of anxiety, she never came to counseling before because she thought that only unsuccessful people with serious issues get counseling.
 
Presenting Problem: Molly came into individual counseling due to increased feelings of anxiety. 

History:
Molly began showing symptoms of anxiety when she was in high school. Molly was star of the track team and on the honor roll. During her senior year she was writing for the yearbook and preparing to attend college at an Ivy League university.  She successfully finished college and law school. Despite the symptoms she experienced throughout her educational career, she was able to ride it out and has been extremely successful in her law career.

Question: Which of the following statements about panic and anxiety is not accurate?
(A): Panic attacks usually subside within 20 to 30 minutes.
(B): Anxiety does not have an abrupt onset.
(C): In a panic attack the symptoms develop abruptly.
(D): Anxiety symptoms are always intense.

Correct Answer: Anxiety symptoms are always intense.
Explanation: Anxiety symptoms are not always intense; they can have a range in severity and are typically mild. In addition, the onset is usually not abrupt. Panic attacks have an abrupt onset and usually subside within 20 to 30 minutes. To distinguish between the two, it is important to look at brevity and intensity. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express
Presenting Problem: You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.
Other Contexts:  Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4)   ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother

Question: According to the American Psychological Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), which of the following would be a differential diagnosis for premature ejaculation?
(A): Substance-induced sexual dysfunction
(B): A specific phobia
(C): Generalized anxiety disorder
(D): Bipolar disorder

Correct Answer: Substance-induced sexual dysfunction
Explanation: Substance-induced sexual dysfunction is a DSM-5-TR differential diagnosis because substance use can affect sexual functioning. Generalized anxiety disorder covers general anxiety about many topics, but it does not necessarily lead to sexual functioning impairment. Social phobia is about a very specific situation or trigger for anxiety, and, although the client does have anxiety about sex and work, this would not meet the criteria. Bipolar disorder does not have known causes of sexual dysfunction. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 16 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: Molly muttered one-word answers during the intake session, made little eye contact and frequently rolled her eyes. She started to warm up towards the middle of the intake session, with some prompting from her mother. She reluctantly agreed to continue counseling sessions- only due to the fact her mother stated that she could not use the family car unless she went to counseling.
Presenting Problem: Molly is a 16-year-old female who was referred to an outpatient mental health clinic after a two-week admission at a local psychiatric hospital. Molly was brought to the hospital by ambulance after she disclosed to the school psychologist that she wanted to kill herself.
 
History:
When asked what brought the family to the session, Molly’s mother was tearful as she disclosed that her husband died in a car accident 11 months ago. Molly and her father had been close, spending time together as Molly played recreational softball and her father was the coach. Since her father’s death, she has been distant with her mother, and often picks fights with her. Additionally, Molly frequently complains of stomach aches, stating that the pain is so severe, she cannot go to school. Before her father’s death, Molly was in Advanced Placement classes and maintained a high average. Recently, Molly’s grades have been declining and she is no longer interested in softball. She states that when she goes to the softball field, she can almost hear her father speaking to her.

Question: All of the following areas must be reviewed during the initial interview, except?
(A): Support system
(B): Paperwork from the hospital
(C): Mental status
(D): Family mental health history

Correct Answer: Paperwork from the hospital
Explanation: Paperwork from past evaluations and hospital stays can be collected later and can be also obtained during the clinical interview and used as confirmation after the interview. Family mental health history can show depression in first degree family members, a risk factor for depression in the patient. Without knowing details of her father's car accident, some car related deaths are intentional. Molly's support system should be assessed and built upon as it is a protective factor when experiencing grief; a mental status exam can discover key areas of risk for suicide or self-harm and help the clinician understand thought processes, assess for auditory or visual hallucinations and gain insight into behaviors and judgment. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis