NCMHCE Practice Test 10

Presenting Problem

You are a licensed mental health counselor working in a community counseling agency. Marcus, a 38-year-old father, brings his 8-year-old son, Theo, to intake at the suggestion of Theo's pediatrician, who found no medical cause for his morning stomachaches. Theo's mother, a Navy officer, deployed overseas five months ago and is expected home in about seven months.

Marcus reports that about two months after she left, Theo began crying and clinging to him at school drop-off almost every morning. Over the past ten weeks Theo has missed nine school days because of stomachaches that "disappear by ten o'clock if he's home." Theo will not fall asleep unless Marcus lies down in his room, and he has stopped going to sleepovers and to his Saturday swim lessons unless Marcus stays on the pool deck. "He follows me from room to room. If I go out to the mailbox, he's at the window," Marcus says. When Marcus is late for pickup, Theo asks the office to call him again and again. Theo tells you, "What if something happens to Daddy while I'm at school? Then nobody would be home." He has nightmares "about once a week" about getting lost in a store.

His teacher reports that he is quiet during class discussions but plays easily with two close friends at recess. His reading grades have slipped because of missed days. Marcus notes that Theo also throws tantrums when asked to turn off video games, "but that's been going on since he was six." Theo denies wanting to hurt himself or anyone else, and Marcus reports no self-harm or aggression. Theo's mother calls by video about once a week, and Theo is "clingy and weepy for the rest of the night" after each call.

Mental Status Exam

Theo is dressed in a clean school uniform and appropriately groomed for his age. He is oriented to person, place, and time and knows he is visiting "the feelings doctor." He sits pressed against his father for the first ten minutes, then moves to the play table while Marcus stays in the room. His affect is anxious and brightens during play; he describes his mood as "scared sometimes." Eye contact is shy at first and improves. Speech, motor activity, and gait are age appropriate, and memory for recent events appears intact. Thought process is logical for his age; thought content centers on his parents' safety. He denies hearing or seeing things others do not and denies wishes to hurt himself or others. No elevated mood or substance exposure is reported.

Psychosocial and Family History

Theo is the only child of Marcus, a self-employed landscaper, and his mother, who also deployed once when Theo was 3. The family moved to the area 18 months ago and has no relatives nearby. Marcus describes the household as close and says money is "fine, just stretched" since he cut back his work hours to handle school pickups. The family attends a nondenominational church, where Theo enjoys the children's program. A trauma screen is negative. Marcus says that in a military family "you just suck it up," and he doesn't want Theo "thinking it's okay to fall apart." He signs the consent for treatment and, at the end of intake, asks that you tell him "everything Theo says" in individual sessions so he can pass it along to Theo's mother on their calls.