National Clinical Mental Health Counseling Examination (NCMHCE)

Frank, 50, is mandated to counseling after a DUI; the intake diagnosis is alcohol use disorder, mild. He sits with his arms crossed and says, 'I'm only here because the judge said so.' The counselor wants to engage him and learn about his drinking. Which response is the BEST example of an open question?

1. A"Do you think you have a drinking problem?"
2. B"How many drinks did you have the night you were arrested?"
3. C"You know drinking and driving is dangerous, right?"
4. D"Tell me about a typical evening when you drink."Correct

Why: TIP 35 describes open questions as ones that invite clients to reflect and tell their story, including statements that begin with 'Tell me about,' while closed questions call for yes/no or short answers. Asking about a typical evening invites Frank to describe his drinking in his own words. Asking for a number of drinks and asking whether he has a problem are closed questions, and the second also invites a defensive 'no.' The last is a leading question that lectures, one of Gordon's roadblocks, and is likely to increase discord.

Gloria, 50, is referred by her employer's assistance program; the intake diagnosis is major depressive disorder. She describes 2 months of fatigue, slowed thinking, weight gain, and feeling cold all the time, and says she has not seen a physician in over 5 years. She is not taking any medications. Which step should the counselor take during the intake?

1. ARecommend a medical evaluation to rule out a physical cause of her symptomsCorrect
2. BChange her diagnosis to persistent depressive disorder because of the fatigue
3. CHold off on any treatment until she has lost the weight she gained
4. DBegin cognitive restructuring now, since her symptoms fit major depression

Why: NIMH notes that certain medical conditions, such as thyroid disorders, and some medications can cause the same symptoms as depression, and its psychotherapy guidance says a medical examination helps rule out a physical cause. Gloria has no recent medical care and physical complaints that could come from a medical condition, so a medical referral belongs in the intake. Starting treatment without it may miss the real cause. Persistent depressive disorder requires symptoms for at least 2 years, and she reports 2 months. Delaying all care until she loses weight makes no clinical sense.