NCMHCE Practice Test 12

Presenting Problem

You are a licensed mental health counselor working in an outpatient community behavioral health agency. Dennis, a 44-year-old trucking company operations manager, comes to the intake after his wife, Monique, found a past-due notice for a credit card she did not know existed. "She said either I get help or she's taking the kids to her mother's. So here I am."

Dennis says he began betting on sports through phone apps about three years ago, "just twenty dollars on a game to make watching more fun." Within a year he was placing bets of $300 to $500 because smaller wagers "didn't feel like anything." He thinks about upcoming games and point spreads "pretty much all day at work" and checks the apps during meetings. When he loses, he usually returns the next day with a bigger bet: "I tell myself I just need to get back to even." He has tried to quit three times in the past year by deleting the apps but reinstalled them within two weeks each time. He has hidden the extent of his betting from Monique, telling her that money missing from savings went to car repairs. Four months ago he asked his sister for $4,000 to cover the mortgage and told her it was for a medical bill.

Dennis now has about $38,000 in combined credit card debt, is two months behind on the mortgage, and has emptied a college savings account for his two children. He also admits that last year he signed Monique's name on a personal loan application. "I know, I'm a grown man who gambled away his kids' college fund." For the past two months he has slept poorly, stopped playing in his Saturday basketball league, and felt "like a failure as a father."

When asked about safety, Dennis denies current suicidal ideation, intent or plan and denies any past attempts. He denies homicidal ideation and any thoughts of harming Monique or the children.

Mental Status Exam

Dennis arrived 5 minutes early, clean shaven and dressed in work clothes. He was oriented to person, place, time and situation. His affect was dysphoric and somewhat restricted, congruent with his stated mood, "stressed and ashamed." Recent and remote memory were intact. He bounced his leg frequently; gait was normal. Eye contact was fair and decreased when he discussed the debt. Thought process was logical and goal directed; thought content focused on finances and on Monique's ultimatum. He denied perceptual disturbances and suicidal or homicidal ideation. He denied any history of mania or hypomania, including periods of decreased need for sleep or unusually elevated mood. He drinks one or two beers while watching games on weekends and denies drug use.

Psychosocial and Family History

Dennis has been married to Monique for 14 years; they have a 12-year-old son and a 9-year-old daughter. He describes his late father as a "weekend card player" who "always had a scheme." Dennis has worked for the same trucking company for 16 years and was recently promoted; his job is not at risk, but he worries a coworker has noticed him on the betting apps. The family relies on both incomes, and Monique manages the household budget except for the accounts she did not know about. He attends a Pentecostal church with his family most Sundays. A trauma screen was negative. At the end of the intake, Dennis asks whether Monique can join a session at some point, then adds, "But she still doesn't know about the second credit card, and I'm not ready for her to find out."