Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af
Presenting Problem: You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.
Other Contexts:    fect. Family History: The client reports a strained relationship with his parents, but he says that he does not want to talk about them because they are not the reason that he is in therapy. The client says that he has a younger sister (age 23) and that they are not close. The client reports that he currently has a girlfriend

Question: Which of the following would be the most appropriate short-term goal to focus on first in therapy for this client?
(A): Identify the current ADHD behaviors that cause the most difficulty for the client.
(B): Encourage the client to invite his girlfriend to a session so they can work through how ADHD affects their relationship.
(C): Learn and implement planning and organization skills.
(D): Identify, challenge, and reframe self-talk that reinforces behaviors associated with ADHD.

Correct Answer: Identify the current ADHD behaviors that cause the most difficulty for the client.
Explanation: Identifying the current ADHD behaviors that cause the most difficulty for the client is the most important first step in this client’s therapy, followed by determining the impact of symptoms on functioning. Encouraging the participation of the client’s girlfriend may provide insight into the client’s functioning and may also provide a social support for the client; however, relationship issues were not indicated in the first sessionOrganization skills and cognitive reframing are important parts of therapy for treatment of ADHD; however, they are not the first step. Psychoeducation on reframing and organization must be prioritized as well, but you need to identify the behaviors that cause the most difficulty to begin working on these skills. Therefore, the correct answer is (B)
Competency: treatment planning