Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af
Presenting Problem: You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.
Other Contexts: It has been 1 month since you last saw the client because he has canceled many sessions in a row without explanation. You process attendance with him and then ask him for updates regarding how symptoms have been over the last month. The client says that there were many reasons for cancellations, such as going to dinner with friends, being too tired, and forgetting about the session and making other plans. The client says that he got a new job and states that he is doing much better managing his ADHD symptoms in the new position. You and the client process what was difficult about his last position and then identify that these tasks are not present in the current position. A majority of this session was spent assessing the level of symptomatology experienced over the past month and the client reporting on events that occurred since the last session

Question: Which of the following is the most therapeutic manner of determining the root of the client’s inconsistent attendance?
(A): Asking the client, “What is most important to you for us to be working on in sessions?”
(B): Asking the client, “Why have you been canceling sessions?”
(C): Reviewing progress toward goals
(D): Discussing scheduling to determine if the time or frequency is not working for the client

Correct Answer: Asking the client, “What is most important to you for us to be working on in sessions?”
Explanation: Identifying goals by determining what is important to the client would likely be the most helpful next step because the client has not been prioritizing his sessions. Refocusing on what is now most important to the client might increase motivation and participation. Over the course of therapy, needs change and therapy needs to be refocused to maintain motivation and to work toward meaningful goals. Asking “why” questions often puts the client in a position in which he feels the need to justify himself and can create defensiveness, which is not helpful in processing the client’s behavior. Reviewing previous treatment goals likely would not help very much because the client does not seem to be finding those goals meaningful anymore. Discussing scheduling likely would not be helpful because the client is actively scheduling other activities over the current scheduled sessions, which demonstrates that he has availability during this time but he is prioritizing other activities. Therefore, the correct answer is (C)
Competency: treatment planning