Service Areas for Referred Client

Counseling Services for a Client at a CMHC

The client is a 31-year-old female referred by her managed care company for depression, insomnia, and nightmares. The client is employed full-time, but reports loss of interest in work, feeling like she is losing her mind, difficulty concentrating, and delusions about heaven. She reports a history of sexual abuse by an uncle and an attempt at suicide that led to hospitalization at the age of 14. She has a strong history of street drugs, but has been drug-free since 2004 and currently attends a church support group for people in recovery. She suspects that the precipitant of the current wave of depression is dysfunction at work and the fact that her boss is promoting a closeness that she feels is incestuous. She is currently on Paxil, but has been erratic in taking the medication and keeping appointments. Based on the available information, this text identifies the tasks that might be carried out on the client when offering indirect care, direct care, crisis services, case management support, and prevention psycho-education.

Direct Care

Having carried out the clinical interview, the next task under direct care would be to carry out a mental status examination, which is a series of questions assessing behavior and appearance. The mental status examination would assess the client’s mood and affect, organization of thought processes, awareness about her surroundings, speech, memory, grooming, and body posture. The mental status exam covers areas not covered in the clinical interview and identifies areas to be investigated further (Washington State University Module, 2021).

Another task in direct care would be the administration of psychological tests and inventories to assess cognitive ability and social functioning, and thus, help in making the diagnosis. The client reports some classical symptoms of post-traumatic stress disorder, and it may thus be necessary to administer relevant screening instruments such as the Trauma Screening Questionnaire or the Primary Care PTSD Screen for DSM-V.

Indirect Care

The mental health professional may refer the patient to their primary care physician for a physical examination. This is because some organic conditions such as hormonal irregularities or hyperthyroidism may manifest in behavioral symptoms that are similar to mental illness and it may be prudent to rule the same out (Washington State University Module, 2021). Another task under indirect care would be behavioral assessment. Behaviors are what a person thinks/feels, says and does in response to a certain stimuli (Washington State University Module, 2021). The behavioral assessment would help to understand the antecedents, behaviors, and consequences of the patient’s reactions through the patient’s self-monitoring (Washington State University Module, 2021). The information gathered from behavioral assessment would be useful in reducing habit disorders and treating phobias (Washington State University Module, 2021).

Crisis Services

The primary task in regard to crisis services would be to initiate crisis counseling, which is an intervention to help the client deal with the crisis that they are facing by offering supports and assistance. Crisis intervention is not psychotherapy as it is focused on providing emotional support and improving the client’s coping strategies in the here and now (Pau, Ahmad & Tang, 2020). Crisis intervention would involve assessing the client’s current situation to determine what they need to cope effectively, educating them about their current condition and the steps they need to take, and providing supports/resources to provide stabilization and help them develop coping skills to deal with the immediate crisis (Pau et al., 2020).

Case Management Support

Case-management support focuses on improving coordination and continuity of care by managing the services that the client is receiving in different domains. The first task under case management support would be to develop a treatment plan that would preferably involve both pharmacotherapy and psychotherapy. However, to induce compliance with the plan and minimize the risk of non-adherence, the clinician could organize to meet the client’s parents or close friends at work, who would help to ensure that she sticks to the treatment plan. The second task would be active engagement, which would involve accompanying the client to one or more of their church support group sessions. The third task would be to conduct follow-up with the client’s PCP to obtain feedback and chart a way forward on the treatment plan based on the findings of the physical examination. The clinician will be continuously monitoring outcomes, troubleshooting, and modifying the plan whenever necessary (Pau et al., 2020).