Case Study
Patient Demographic: Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9)
Mental Status Exam: Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam
Presenting Problem: You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.
Other Contexts:    ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family

Question: How can you best engage the client and her daughter in the early stages of treatment?
(A): Constructing a multigenerational genogram
(B): Summarizing key concerns and identified areas of focus
(C): Normalizing feelings associated with the aging process
(D): Advising against “catastrophizing” and “negative predictions”

Correct Answer: Summarizing key concerns and identified areas of focus
Explanation: Summarizing the client’s key concerns and identified areas of focus would best engage the client and her daughter. The daughter is not the client; however, she presents today as a collateral contact and an individual who may impact engaging the client in treatment. Summarizing is a communication skill used to tie together various issues and feelings expressed by the client. This is helpful because it narrows the client’s identified areas of focus, helps the client feel heard, and allows the counselor to ask for corrections and clarifications. Individuals with MND have cognitive difficulties beyond the normal aging process, making answer A incorrect. Although constructing a genogram provides valuable information on the family, it is not the best way to engage the client in treatment. Giving advice does not contribute to engagement and should be reserved for safety issues and should be used sparingly, if at all, during treatment. Catastrophizing and negative predictions are cognitive distortions and irrational beliefs found in rational-emotional therapy and cognitive therapy, respectively. Therefore, the correct answer is (B)
Competency: treatment planning