NCMHCE Practice Test 6

Presenting Problem

You are a licensed mental health counselor working in a community family services agency. Megan, 36, requested family counseling for her 10-year-old son, Owen, after his fourth-grade teacher sent home three behavior notes in one month. Megan remarried 14 months ago, and about nine months ago she and Owen moved into the home of her husband, Daniel, 41, and his daughter, Hana, 12. Megan says the problems started "right around the move and haven't let up."

Megan and Daniel describe Owen as arguing with them "about everything" on most days and refusing chores, homework, and bedtime. When Daniel asks him to do something, Owen often answers, "You're not my dad." He hides Hana's belongings and repeats her words back to her until she yells, and he blames her when he is caught. Megan says Owen is "touchy and easily set off" and loses his temper several times a week, yelling and slamming his door; the outbursts are verbal, end within about 15 minutes, and between them he is "his normal funny self." His teacher reports that Owen argues when corrected, refuses to redo work, and has called her "unfair" in front of the class. He has not hit anyone, destroyed property, stolen, or run away. Owen spends every other weekend with his father, Travis, who tells Megan that Owen is "an angel" there.

During his individual portion of the intake, Owen said, "Everybody's on Hana's side. Nobody asked me if I wanted a new family." He said he likes his dog, video games, and soccer, and that school is "fine except for my teacher." He denied wanting to hurt himself or anyone else, and Megan and Daniel report no self-harm statements or behaviors. Daniel says, "I've tried being his buddy, and I've tried being strict. Neither works." Megan adds, "I just want us to feel like a family."

Mental Status Exam

Owen was neatly dressed in a soccer jersey, with good hygiene. He was oriented to person, place, time, and situation. He described his mood as "bored"; his affect was irritable when discussing home and brightened when he talked about soccer and his dog, and it was congruent with content. Eye contact was good. Memory was intact for recent events. Motor activity was somewhat fidgety but within age expectations, and gait was normal. Thought process was logical and goal-directed; thought content focused on unfairness at home. He denied hallucinations, and none were observed. He denied suicidal and homicidal ideation. Megan reports no periods of unusually elevated mood or decreased need for sleep. No substance use was reported.

Psychosocial and Family History

Owen's parents separated when he was six. Travis lives 20 minutes away, and Megan describes their communication as "texts only, and they usually turn into fights." Megan is a middle school librarian and Daniel is an electrician; Hana's mother lives out of state. Owen earns average grades and plays on a recreational soccer team. Megan reports on-time developmental milestones and no history of abuse or exposure to violence, and a trauma screen was negative. The family spends holidays with Daniel's large extended family, whom Owen calls "their family, not mine." At the end of the intake, Megan says, "Please don't contact Travis. Owen lives with me, so I make the decisions." She mentions a parenting plan from the divorce but did not bring a copy.