Case Study
Patient Demographic: Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses
Presenting Problem: You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.
Other Contexts: You meet with the client after he requested an emergency appointment. The client says that he had a supervised visit with his children and he had used inhalants prior to the visit because he was anxious. The supervisor noted the intoxication and ended the visit early. The client says that this was 3 days ago and that he has used inhalants several times daily since the visitation. Due to his intoxication at the visit, all future visits have been canceled until the next hearing in court regarding visitations. The client says that he has been very depressed and that is why he is using inhalants. During the session, the client asks if he can go to the lobby to get water and you tell him that this is fine. The client returns, sits down, and appears listless because he is not displaying any emotion and has a very flat affect. You suspect that he is now intoxicated.  You want the client to know that you are listening because he is expressing strong emotions and you want to support him

Question: You want the client to know that you are listening because he is expressing strong emotions and you want to support him. All of the following demonstrate therapeutic listening, EXCEPT:
(A): Refraining from the use of “mm-hmm” and similar responses
(B): Identifying and discussing verbal/nonverbal inconsistencies
(C): Attentive silence
(D): Mirroring

Correct Answer: Refraining from the use of “mm-hmm” and similar responses
Explanation: A balanced use of affirmative sounds (“mhmm,” “yeah,” etc). lets the client know that you are listening to him. Be conscientious about how often you use these responses because they can be distracting, may appear as though you are rushing the client, or may appear as though you are disinterested. Silence generally does not provide the client with the feedback that you are listening to him. However, attentive silence with body language that demonstrates you are listening can allow the client the space to speak freely. Mirroring involves repeating key words or phrases that the client uses to demonstrate that you heard the important pieces of what was said. Identifying and expressing that you notice inconsistencies in verbal and nonverbal communication is important but needs to be done carefully. This demonstrates to the client that you hear him and recognize how he feels. Therefore, the correct answer is (C)
Competency: counseling skills and interventions