Case Study
Patient Demographic: Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual
Mental Status Exam: Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.
Presenting Problem: Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.
Other Contexts: Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.

Question: Which of the following should be included in treatment plan goals in addition to "emotional management"?
(A): communication skills
(B): autism family support group
(C): academic advisement
(D): family interventions

Correct Answer: communication skills
Explanation: It is apparent that Taylor is having difficulty communicating her concerns clearly to her family and within her relationship with her boyfriend since she has reported yelling at all of them and is seeking out a counselor to talk to instead. Teaching communication skills would be the most helpful intervention to help Taylor independently handle her own relationship issues. Conducting family interventions is not appropriate when Taylor, who is an adult, is the only one in the family who has requested help. Offering a support group as a resource is always an option to provide your clients but does not have to be a goal within itself; listing attendance to a relevant support group can fall under an objective within the greater goal of communication skills or emotional management. Academic advisement can be addressed by her school and is not necessarily a treatment provided by a mental health counselor. The subject of improvement in concentration relevant to her academic performance may be presented throughout counseling, however. Therefore, the correct answer is (A)
Competency: treatment planning