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:    sion. Family History: The client has three sons that are 11, 13, and 16 years old. The client is divorced as of 3 years prior and reports a contentious relationship with his ex-wife due to his difficulty following through with visits with their children. The client and his ex-wife were married for 17 years and dated for about 5 years before they were married. The client states that he loves his ex-wife but that she has currently been dating another man for the past 2 years and he knows they likely will not reconcile. He says that he understands why she does not want to be with him, and he thinks that he is not good for her or his children at this time.  When discussing the informed consent form, you cover the risks of counseling

Question: When discussing the informed consent form, you cover the risks of counseling. Which one of the following is NOT an expected risk of counseling?
(A): The client may need to meet with multiple counselors prior to finding a match.
(B): The client might choose to discontinue therapy earlier than recommended.
(C): Therapy can make the client feel worse initially.
(D): The counselor might not have the skill set needed to best provide benefit for the client.

Correct Answer: The client might choose to discontinue therapy earlier than recommended.
Explanation: The client may choose to discontinue therapy early; however, this is not a risk of the counseling process, rather, a decision on the part of the client. Therapy can make things worse initially because the client may have to discuss or confront situations, thoughts, and feelings that may cause distress. This is an expected part of the therapeutic process. The client may need to meet with multiple counselors prior to finding a match who meets his needs for building rapport and who also has the skill set needed to best support the client. Therefore, the correct answer is (D)
Competency: professional practice and ethics