Case Study
Patient Demographic: Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9)
Mental Status Exam: Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam
Presenting Problem: You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.
Other Contexts: The client presents today with a blunted affect and an irritable mood. The daughter accompanies the client and states that the results of the client’s recent PET scan show changes in the brain that may indicate Alzheimer’s disease. You process the results with the client and her daughter and provide psychoeducation on cognitive impairment, including counseling risks, benefits, and limitations. The client would like to focus on improving psychosocial issues associated with her cognitive impairment.  The client states, “People must think I’m so stupid when I can’t even remember whether or not I paid a bill.” You respond, “You feel embarrassed when you are unable to complete a task that you used to do with ease

Question: The client states, “People must think I’m so stupid when I can’t even remember whether or not I paid a bill.” You respond, “You feel embarrassed when you are unable to complete a task that you used to do with ease.” This is an example of which of the following?
(A): Empathetic reflecting
(B): Reframing
(C): Paraphrasing
(D): Attending

Correct Answer: Empathetic reflecting
Explanation: Empathetic reflecting or empathetic responding is used when a counselor responds to the client’s verbal expressions and underlying emotions. Paraphrasing is used when a counselor responds to the client’s main idea or literal meaning without using the client’s exact words. Counselors use attending by demonstrating listening and paying attention to the client. This occurs when making eye contact or assuming an attentive posture. Reframing is a communication skill that counselors use to help clients view things from a different and more positive perspective. Therefore, the correct answer is (D)
Competency: counseling skills and interventions