Case Study
Patient Demographic: Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses
Presenting Problem: You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.
Other Contexts:    sion. Family History: The client has three sons that are 11, 13, and 16 years old. The client is divorced as of 3 years prior and reports a contentious relationship with his ex-wife due to his difficulty following through with visits with their children. The client and his ex-wife were married for 17 years and dated for about 5 years before they were married. The client states that he loves his ex-wife but that she has currently been dating another man for the past 2 years and he knows they likely will not reconcile. He says that he understands why she does not want to be with him, and he thinks that he is not good for her or his children at this time

Question: To better understand the client’s behavior and relationship patterns, which of the following would be the most useful?
(A): Conduct a mental status exam during each session.
(B): Request a release of information in order to communicate with the client’s ex-wife to get input on his behavior.
(C): Complete a genogram.
(D): Assign the client homework to complete a thought log regarding inhalant use and his relationships.

Correct Answer: Complete a genogram.
Explanation: A genogram would give more information regarding family dynamics, relationship quality and status, family patterns, and family substance use. Genograms are a great tool to use to understand how the client’s family contributed to where he is at currently. Discussing the genogram will give a lot more information because it presents many opportunities to discuss his relationships and history. You will conduct a mental status exam each session, but this will likely not provide much information regarding behavior and is more about the client’s presentation in session. A thought log would be helpful over time to understand how the client processes information and is also helpful for the client to become more aware of how thoughts, feelings, and behaviors affect his functioning, but the genogram would be more helpful in providing information and encouraging conversation regarding his behavior and his past relationships. It might be helpful to communicate with the client’s ex-wife; however, she would likely be a biased party, which could complicate the counseling relationship. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis