NCMHCE Practice Test 3

Presenting Problem

You are a licensed mental health counselor working in a private practice. Mina, a 15-year-old tenth grader, is brought to counseling by her mother after the school counselor noticed that Mina eats lunch alone in a library study room most days. Her mother signed consent for treatment, and Mina agreed to attend "for now." Early in the interview Mina said, "My mom made me come. Talking about it doesn't fix anything."

Eight months ago, while Mina gave an oral report in history class, her voice shook and she lost her place. Two classmates recorded her, and the clip circulated in a class group chat with mocking comments; one of them still calls her "Shaky" in the hallway. Since then Mina has avoided speaking in class, refused two oral presentations (her history grade fell from a B to a D), quit the school orchestra after nine years of violin, and asks her mother to order for her at restaurants. When a teacher calls on her, she blushes and trembles, and her mind "goes blank." She says, "Everyone is just waiting for me to mess up again so they can laugh." She worries for days before any class where she might have to speak and has missed six school days this semester, usually with stomachaches on presentation days. She is comfortable talking with her one close friend, Ji-woo, at home, and says she was "pretty normal" before the video.

Her mother reports that Mina spends most evenings in her room scrolling the group chat and sleeps poorly on school nights. Mina says she sometimes wishes she could "just disappear for a while," but she denies suicidal ideation, intent, or plan and denies any self-harm. She denies homicidal ideation. Mina adds, "My mom thinks I'm being dramatic. She says she got teased too and got over it."

Mental Status Exam

Mina wore an oversized hoodie with the hood partly up; grooming and hygiene were adequate. She was oriented to person, place, time, and situation. She described her mood as "fine," while her affect was anxious and constricted, incongruent with her stated mood. Memory was intact, and motor activity and gait were normal; she sat with her arms wrapped around her knees and blushed when school was discussed. Eye contact was minimal, and she often looked at her phone. Her answers were brief, but her thought process was logical and goal directed. Thought content focused on fears of being judged and humiliated. She denied perceptual disturbances, suicidal or homicidal ideation, and any history of elevated or expansive mood. She denied alcohol, vaping, or other substance use.

Psychosocial and Family History

Mina lives with her mother, a nurse who works night shifts, and her 11-year-old brother. Her parents divorced when she was 7; her father lives out of state, and she talks with him by video monthly. Her mother emigrated from Korea as a young adult. The family speaks Korean and English at home and attends a Korean Presbyterian church, where Mina used to play violin during services. Before this year Mina earned mostly A's and B's. Her trauma screen identified the bullying and the video but no physical or sexual abuse. Her mother signed a release allowing you to exchange attendance information and school-based recommendations with the school counselor. As the intake ends, her mother steps out to move the car, and Mina asks quietly, "Are you going to tell my mom everything I say in here?"