Case Study
Patient Demographic: Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography
Presenting Problem: You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.
Other Contexts: You meet with the client and review a log that he brings in that documents how often he masturbated over the past week. The client’s log showed that he masturbates about three to four times per day. The client appears to masturbate more when his roommates are not in the apartment and late at night when his time is less structured. The client reports that he has a job interview in a few days at a nonprofit agency that works with children to ensure that they have clothing. He feels that this will be meaningful work and is encouraged because he knows the supervisor there from a previous job, and he thinks that the supervisor is a respectful person. The client expresses worry that he will not be competent at the job based on how he is doing at his current place of employment. You support the client with reframing his anxious thoughts about the interview.  You complete a mental status exam during every session

Question: You complete a mental status exam during every session. Which one of the following domains would most likely be affected by the client’s presenting diagnoses?
(A): Mood
(B): Eye contact
(C): Orientation
(D): Suicidality

Correct Answer: Mood
Explanation: Mood is the most likely element of the mental status exam to be affected during this client’s sessions because he has verbalized feelings of anxiety, guilt, and shame in discussing his struggles, all of which may impact his mood. Eye contact may have been difficult during the early sessions for this client because he was still in the process of building rapport; however, this is your fourth session and the client is less likely to be experiencing social anxiety and discomfort with the therapeutic relationship. Suicidality is not a reported or observed concern due to the client’s diagnoses or reports. Orientation does not appear to be affected because the client is alert and oriented to time, location, self, and situation. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis