ckmjx/CounselingBench huggingface dataset:
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: Of the following, which is the least important area to explore in this session?
(A): Her relationship with her mother
(B): What areas Elaina wants to explore
(C): Her suspensions in school
(D): The safety of her current relationship with her boyfriend

Correct Answer: Her suspensions in school
Explanation: It is important for the counselor to conduct a comprehensive assessment. Although understanding the situation and reasons around her fighting in school, focusing on the school sanctions is not as important as the other information that should be obtained. It is important to assess her safety in her current relationship as she and her baby could possibly be in danger. It is also important to find out more about her current relationship with her mother, especially since Elaina is going to be a mother herself. Therefore, the correct answer is (C)
Competency: counseling skills and interventions
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: This factor can exacerbate tics?
(A): Putting together a puzzle
(B): Epsom bath
(C): Stressful/exciting events
(D): Going for a hike

Correct Answer: Stressful/exciting events
Explanation: Stressful/exciting events can cause or worsen tics. An activity that is structured and requires focus such as putting a puzzle together can help suppress tics as well as enjoyable activities such as going for a hike. An Epsom bath, or any type of bath can help towards relaxation and may also help to suppress tics. It can be helpful to journal or monitor what is effective and what is not. Therefore, the correct answer is (A)
Competency: intake, assessment, and diagnosis
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 differential diagnoses should be considered for this client?
(A): Specific learning disorder
(B): Major depressive disorder
(C): Substance use disorder
(D): Generalized anxiety disorder

Correct Answer: Major depressive disorder
Explanation: Considering the client’s presenting problems, which include the identification of often feeling unhappy, assessing for major depressive disorders is appropriate because they can co-occur with ADHD. Anxiety may be present surrounding completing tasks; however, this anxiety is likely related to ADHD and is not indicated as a possible diagnosis. There are no reports of substance use, so this would not be considered for this client at this time. Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis
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: Which of the following treatment modalities would not be recommended for Sandy?
(A): Controlled drinking
(B): Insight-oriented therapy
(C): Rational-behavior therapy
(D): Cognitive behavioral therapy

Correct Answer: Controlled drinking
Explanation: Controlled drinking is an approach for those with mild alcohol problems and has been met with some controversy. In this approach an individual does not abstain from alcohol completely. Since Sandy displays more severe alcohol problems, this would not be an effective modality. Cognitive behavioral therapy focuses on modifying negative thoughts, behaviors and emotional responses associated with psychological distress which may decrease the desire to drink. Insight-oriented therapy is an approach in which one tries to understand their inner motivation for their actions. Rational behavior therapy looks at an individual's irrational or self-defeating thoughts and replaces them with positive messages. Therefore, the correct answer is (A)
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: One way to help Michael with his concern about school is to?
(A): Speak to the parents about who is bullying him
(B): Tell him to ignore the kids
(C): Talk to the teacher about possibly leaving class if the tics worsen
(D): Encourage the use of relaxation exercises in class

Correct Answer: Talk to the teacher about possibly leaving class if the tics worsen
Explanation: An appropriate intervention would be to collaborate with Michael's teacher to possibly let him leave class if the tics worsen. To tell him to ignore the kids would be difficult for Michael and doesn't really give him a tangible intervention. Speaking to the parents about who is bullying him may lead to further issues. Using relaxation exercises in class may not be a practical solution as it is a public not private setting. Therefore, the correct answer is (C)
Competency: professional practice and ethics
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: Shar's symptoms meet the criteria for
(A): Transvestic Disorder
(B): Body dysmorphic disorder
(C): Gender Dysphoria
(D): Unspecified Gender Dysphoria

Correct Answer: Gender Dysphoria
Explanation: Gender dysphoria is characterized by "marked incongruence between one's experienced/expressed gender and assigned gender" which is evident in Shar's current symptomology. In addition, they have expressed the desire to be rid of their current sex characteristics and has a strong desire to be of the other gender. The dissatisfaction of a body part in Body Dysmorphic Disorder is caused by the perception that it is abnormally formed. There is no evidence of this symptom in the facts. Transvestic disorder is characterized by sexual arousal from cross dressing. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 22 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: In a long-term relationship Counseling Setting: Adult inpatient psychiatric Type of Counseling: Individual
Mental Status Exam: Mark was unable to complete a mental status exam as he was not speaking coherently and was displaying violent behavior towards hospital staff. The ER nurse interviewed Mark’s girlfriend, Erin.
Presenting Problem: Mark came into ER after his girlfriend Erin called 911 when Mark attacked someone on the bus.
 
History:
Erin told the ER nurse that Mark has been displaying increasingly irrational behaviors. Erin shared that Mark recently took a trip to Africa. Since then, Mark told Erin that he was hearing the voice of God, telling him that it was his responsibility to rid the world of evil. At first Erin noticed Mark staying up late at night, writing all his thoughts in a journal. When Erin read the journal, the content was incoherent. Erin also shared that Mark was recently put on probation at work for going into the women’s restroom. Mark told his boss that God told him to keep an eye on one of his coworkers.

Question: Mark is displaying symptoms of?
(A): Substance/Medication induced psychotic disorder
(B): Schizoaffective
(C): Brief psychotic disorder
(D): Schizophrenia

Correct Answer: Schizophrenia
Explanation: Mark meets the criteria for Schizophrenia looking at his symptomology (hallucinations, sleep disturbances, incoherent speaking and writing, catatonia) and duration of onset. Brief psychotic disorder is ruled out as it is beyond the one month required timeframe. Schizoaffective disorder is also ruled out as there are no depressive or manic episodes. Substance/medication induced psychotic disorder is ruled out as there were no indications of substance use prior to the onset of the psychosis. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 18 Sex: Female        Gender: Female Sexuality:  Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Residence Type of Counseling: Individual
Mental Status Exam: Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.

Presenting Problem: Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

History:
Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.

Question: Which intervention should be used to immediately address Nadia's risk-taking behavior and aggression toward others?
(A): Psychoanalysis
(B): Psychoeducation
(C): Crisis planning
(D): Life skills development

Correct Answer: Crisis planning
Explanation: Crisis planning is important regarding her risk-taking behavior and aggression towards others and is helpful to use when Nadia starts to decompensate. Psychoanalysis would not be the best treatment in this case as psychoanalysis is a longer-term treatment and Nadia is requiring more immediate symptom relief. Psychoeducation may be beneficial for Nadia to understand her symptoms of disassociation as well as how her past trauma can affect the types of relationships she seeks. However, this is not as immediate as a crisis plan. Finally, life skills development is important to improve her adaptive functioning but is a longer-term intervention. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis
Case Study
Patient Demographic: Initial Intake: Age: 48 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counselor Private Practice Type of Counseling: Marital
Presenting Problem: Kathleen and Tony came in for marital counseling because of arguing due to recent events in their relationship.
 
History:
Kathleen and Tony have been married for two years and had a generally positive relationship. They have no children. Kathleen, who works in travel, is frequently away from home. Recently, when Kathleen came home early from a work trip, she found her husband in their bedroom with one of her nightgowns on. Kathleen was convinced that there was another man in their house, and they must have heard her at the door and snuck out of the back
 
Kathleen started the initial session by stating that she feels that her husband is lying to her. At this comment, Tony threw his hands up in the air and stated, “It doesn’t matter what I say- you are not going to believe me anyway!”

Question: All of the following statements are in accordance with the standards of the Code of Ethics regarding couple counseling, except?
(A): Counselors seek agreement and document in writing such agreement among all parties regarding the confidentiality of information
(B): If one part of the couple is absent for a session, individual confidentiality standards apply.
(C): In couples and family counseling counselors clearly define who is considered "the client" and discuss expectations and limits of confidentiality
(D): In the absence of an agreement to the contrary, the couple or family is the client

Correct Answer: If one part of the couple is absent for a session, individual confidentiality standards apply.
Explanation: It is up to the discretion of the counselor to determine if an individual should be seen when their partner is absent. All appropriate information which is shared during the individual session should be shared in the next session with all parties present. Choices A, B and C are all legitimate standards under the American Counseling Association Code of Ethics regarding couple counseling. It is imperative that at the onset of counseling a counselor defines who the client is as well as the limits to confidentiality. This information should be memorialized. If a single client is not identified, the couple is considered the client. Therefore, the correct answer is (D)
Competency: counseling skills and interventions