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: You meet with the client, and he reports that he was able to improve his productivity by organizing his day based on organization techniques that you discussed in therapy. The client says that he really wants to focus on getting into writing stories again and that he also wants to learn to play guitar. He explains that his attempts at learning guitar are disrupted because, when he tries, he becomes frustrated, stops quickly, and often does not revisit playing for weeks. You ask the client about thoughts that he has that are a barrier to writing and playing the guitar, and he identifies that he often anticipates that he will just get frustrated and stop, so there is no point in trying. You support the client in cognitive reframing

Question: Which of the following is a helpful goal following this session to support the client in writing and playing the guitar more often?
(A): Recommend that the client choose two nights this week to play guitar for at least 30 minutes.
(B): Refocus the goals back to management of ADHD because this is why the client came to counseling.
(C): Identify goals that are easily achievable within the week.
(D): Identify goals that are slightly difficult in order to push the client.

Correct Answer: Identify goals that are easily achievable within the week.
Explanation: To build momentum with new goals, it can be helpful to identify goals that are easily achievable to increase the client’s confidence in goal attainment. Considering that playing guitar and writing are new goals, you would not focus on identifying slightly more difficult goals because these are new skills and rigor should start lower and slowly build. Recommending a specific interval of attempts toward the goal does not consider what the client thinks is achievable and likely would not build confidence and momentum toward a goal. Although the client came to counseling for ADHD, his symptoms of concern are likely linked to his desire to play guitar more and to start writing again. For this reason, refocusing back more explicitly and specifically on his initial ADHD difficulties at work would not be appropriate. Therefore, the correct answer is (A)
Competency: treatment planning