Case Study
Patient Demographic: Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Hallucinations and Delusions Diagnosis: Schizophrenia 295.90 (F20.9)
Mental Status Exam: Mental Status Exam: The client displays an angry affect, and his mood is irritable. His speech is disorganized and pressured. He is oriented to person, place, time, and situation. He reports audiovisual hallucinations, which include seeing “the shadow man” and hearing voices others cannot hear. The client exhibits tangential and disconnected thinking. He is firm in his conviction that he is being poisoned and says he is exhausted from constantly trying to maintain vigilance. The client’s insight and judgment are poor. He denies suicidal ideation, homicidal ideation, and command hallucinations. The client first experienced symptoms of schizophrenia in his late teens but was misdiagnosed with bipolar disorder until rece
Presenting Problem: You are a counselor working in an outpatient community mental health center serving clients with severe psychiatric disorders. A 26-year-old male, accompanied by his caseworker, presents for counseling due to symptoms of schizophrenia. The caseworker reports that the client was doing well until he stopped taking his prescription medication. He resides in assisted living, where he was placed after being discharged from the hospital last month. The client claims someone he calls “the shadow man” is following him and putting poison in his food. The caseworker reports that the client has been more agitated recently and has engaged in verbal altercations with other residents. The client is refusing to take his medication because of the side effects. He had an initial therapeutic response to Haldol, an antipsychotic, but stopped taking it because it made him restless and nervous. He explains, “I felt like I constantly had to keep moving.” The client is adamant about his desire to stay off medication and becomes angry when his caseworker mentions the possibility of going back into the hospital.
Other Contexts: The client is attending group therapy and reports it helps him feel less isolated and alone. He has learned from the group leader and group participants that other medications (i\. e., second-generation atypical antipsychotics) have fewer side effects, and he has requested a psychiatric medication evaluation. The client states he is constantly worrying about “the shadow man,” which has taken its toll physically. He recounts a recent visit with his parents where his father blamed him for his mother’s anxiety. During the same visit, his father criticized the client’s poor choices in life and, according to the client, “He guilt-tripped me for not being more like my brother.” The client believes his parents are to blame for his current situation because they ignored his needs once he reached adolescence and refused to help when he was struggling.  Which of the following best explains the parents’ emotional expression (e\. g

Question: Which of the following best explains the parents’ emotional expression (e.g., criticism, anger) when interacting with the client?
(A): Fundamental attribution error
(B): The Dunning-Kruger effect
(C): External locus of control
(D): Self-serving bias

Correct Answer: Fundamental attribution error
Explanation: Families high in emotional expression ascribe symptoms of mental disorders to internal attributes (eg, personality, intentionality). The fundamental attribution error occurs when people overemphasize personality traits and disregard situational or external explanations for behavior. Psychoeducation for families high in emotional expression uses a revised attribution model to help families shift from attributing behavior to personality towards attributing behavior to illness. Self-serving bias occurs when individuals assume personal success related to internal attributes and personal failures are related to external attributes. Individuals with an external locus of control believe that luck, environment, or other external features serve as explanations for events or outcomes. The Dunning-Kruger effect occurs when there is an overestimation of personal knowledge and skills due to an inaccurate self-appraisal. Therefore, the correct answer is (D)
Competency: counseling skills and interventions