Case Study
Patient Demographic: Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)
Mental Status Exam: Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c
Presenting Problem: You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.
Other Contexts: The client is now attending family therapy with his parents and has made progress. His last four drug screens have been negative, and the client is beginning to show insight into his problem. The parents have improved with limit setting and are learning how to help the client achieve a healthy sense of identity. The parents are becoming better acclimated to the United States and have developed stronger connections within their church and community

Question: According to the transtheoretical, or stages of change (SOC), model, in which stage would you currently classify this client?
(A): Precontemplation
(B): Action
(C): Contemplation
(D): Maintenance

Correct Answer: Action
Explanation: According to the SOC model, the client is in the action stage of change. This model, developed by Miller & Rollnick (2013), outlines the following stages: precontemplation, contemplation, preparation, action, and maintenance. This client has just entered the action stage. The client has been compliant with therapy and reports four negative drug screens. The SOC model is not always linear. The client has just entered the action phase and may regress toward earlier stages or may eventually reach the maintenance stage. Individuals in the precontemplation stage are not considering a change, whereas those in the contemplation stage are beginning to consider making a change. Those in the contemplation stage are still using substances but are weighing the pros and cons of cutting back or abstaining. Individuals in the action stage have a specific behavioral plan and are committed to the process of change. When individuals become more stable in their sobriety, they have reached the maintenance stage. Therefore, the correct answer is (D)
Competency: counseling skills and interventions