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: Regarding her relationship and the allegations that her boyfriend is hitting her, the counselor should immediately?
(A): Encourage Elaina to leave him
(B): Provide Elaina trauma focused CBT to help her understand her relationship patterns
(C): Encourage Elaina to invite her boyfriend to a session
(D): Complete a crisis plan that Elaina can use if she feels that she is in danger

Correct Answer: Complete a crisis plan that Elaina can use if she feels that she is in danger
Explanation: A crisis plan is important to have if a client is in frequent crises or a possibly dangerous situation. It should include practical steps with accessible resources for the client. Considering the allegation that Elaina's boyfriend is hitting her, a crisis plan should be made if Elaina feels that things are beginning to escalate. It is not up to the therapist to tell Elaina to leave her boyfriend, this may damage the therapeutic relationship or Elaina may not return to therapy. Trauma focused CBT would be a good intervention for Elaina, after the crisis plan is constructed. Inviting Elaina's boyfriend to a session may or may not be a good idea, depending on how open he would be to this suggestion. Knowing that Elaina told the counselor may anger the boyfriend. Therefore, the correct answer is (C)
Competency: counseling skills and interventions