NCMHCE Practice Test 14
10 free NCMHCE practice questions in the real exam format, covering the official content areas, with an explanation for every answer.
Question 1 of 10
Core Counseling AttributesCase study: Adult with contamination fears (telehealth)
| Client | |
|---|---|
| Age | 29 |
| Gender | Female |
| Sexuality | Bisexual |
| Ethnicity | Latina (Mexican American) |
| Relationship Status | In a committed relationship, cohabiting |
| Counseling Setting | Private practice (telehealth, secure video) |
| Types of Counseling | Individual |
| Provisional Diagnosis | Obsessive-compulsive disorder (insight specifier to be determined) |
Presenting Problem
You are a licensed mental health counselor in a private practice that provides counseling by secure video. Daniela, a 29-year-old dental hygienist, schedules a telehealth intake after her girlfriend, Tess, told her, "I can't keep living like this." For about 18 months, since her sister's newborn son spent a week in a neonatal intensive care unit with a serious infection, Daniela has had intrusive thoughts that she will carry germs home and make him or someone else gravely ill. She says, "The thought just lands on me, like a picture of him hooked up to tubes, and I have to scrub it off." She washes her hands 40 to 60 times a day using a fixed 20-step routine, and if she is interrupted she starts over. She showers for 45 minutes after work, launders her scrubs twice and wipes her phone, keys and door handles with disinfectant every evening. She estimates that washing and cleaning take "at least three hours a day." Her knuckles are cracked and bleeding, and her employer has noticed she runs behind with patients. She has not held her nephew in 4 months and declines family dinners at her sister's house. She asks Tess, "Are you sure I'm clean?" many times each evening, and Tess has started washing the couch cushions to calm her. Daniela says, "I know other people think it's extreme. But honestly, if I skip it, I think there's probably a real chance he gets sick. I can't be 100 percent sure, but it feels true." Describing her routine, she adds, "You probably think I'm disgusting." She denies obsessions about symmetry, violence or religion and denies motor or vocal tics, now or in the past. She feels "exhausted and ashamed" and has stopped going to her climbing gym. When asked about suicide, she says, "No. I'm tired, not suicidal." She denies plan, intent and past attempts and denies homicidal ideation.
Mental Status Exam
Daniela joins the video session on time from a home office, casually dressed and well groomed; her hands are visibly red, with cracked knuckles. She is oriented to person, place, time and situation and confirms her address for the emergency plan. Eye contact with the camera is good. Her mood is "on edge"; affect is anxious and congruent. Speech is rapid but coherent. Thought process is linear; thought content is dominated by contamination fears, with no delusional content; she says the feared outcome feels "more likely than not," though she knows others see her routine as extreme. She denies hallucinations. Memory is intact. She rubs her hands frequently, and twice during the intake, after touching her phone screen, she leaves the camera frame to wash and returns saying, "Sorry, sorry." She denies suicidal and homicidal ideation and any history of mania. She drinks one or two glasses of wine on weekends and denies other substance use.
Psychosocial and Family History
Daniela grew up in a close family; her parents and sister live 20 minutes away, and Sunday dinners at her sister's house were "the center of my week" until she stopped going. She and Tess have lived together for 3 years; Tess is supportive but "running out of patience." Daniela has worked at the same dental office for 6 years and has a steady income; her insurance covers telehealth. A maternal aunt "cleaned all the time" but was never treated. Daniela has had no prior counseling, and her trauma screen is negative. At the end of the intake, Daniela asks whether she could join some sessions from her car in the dental office parking lot during her lunch break, adding that on other days Tess works from home in the room next to the office she uses for sessions.
What response would you make after Daniela says, "You probably think I'm disgusting"?