Case Presentation – Work Stage

Basic Data

Client Demographics

The client selected for this presentation will be referred to as Marcus to protect his identity. Marcus is a 33-year-old African American male who identifies as male and uses he and him pronouns. He comes from a lower socioeconomic background and is currently unemployed, which he noted as one source of his stress: Case Presentation – Work Stage.

Marcus completed high school but did not pursue higher education due to early substance use and imprisonment in his twenties. He seeks to build a more stable life and is interested in getting his general educational development and pursuing trading.

Presenting Problem

Marcus presented to counseling at Serenity Recovery Centers following a court-mandated referral due to a second driving under the influence (DUI) charge within five years. He stated that he initially did not feel he had a problem but began questioning his substance use after losing contact with his daughter and facing possible jail time. While he was resistant at first, he shared during the intake session that he wanted to make changes to stay out of jail and possibly regain custody of his daughter. His presenting problem is centered around substance misuse, strained family relationships, and low motivation.

Social Context

In our initial conversation, Marcus described a strained relationship with his family, particularly with his mother and younger sister, with whom he used to live. He has a four-year-old daughter but has not seen her in over a year due to a protective order filed by the child’s mother. He stated that he has no close friends and often feels isolated.

Marcus admitted that his former peer group consisted of individuals who also misused alcohol and drugs, which contributed to his behavior. He feels unsupported and is uncertain about rebuilding trust within his social circle.

General Impressions of the Client

Marcus presented generally untidily but was alert during the first session. He wore wrinkled clothing, had minimal eye contact, and seemed fatigued. His mood was subdued, and he often answered questions in a flat, almost detached tone, suggesting possible depressive symptoms. His effect was restricted, and while he did not express strong emotions verbally, his body language indicated discomfort.

He initially appeared guarded but gradually opened up as rapport was built. Marcus is a voluntary client who agreed to attend sessions to comply with court requirements, though his motivation for personal change is slowly emerging.

Case Presentation – Work Stage

Skills to Assist Marcus During the Counseling Process

I would use various counseling skills to support Marcus’s progress during the work stage. These approaches include active listening, showing empathy, reflective responding, motivational interviewing, goal setting, confrontation, and cultural sensitivity (Zhang et al., 2022). They will assist in creating a trusting relationship, appreciating what he has faced, and encouraging him to overcome negative beliefs. Marcus will open up and share more information if he realizes his side of the story is acknowledged, understood, and appreciated.

Reflective responding will guide him in realizing and voicing emotions like guilt or shame about his daughter. Motivational interviewing and setting clear goals will help the client be interested in restoring his relationships with family members (Bischof et al., 2021). Using empathy and confrontation while facing Marcus can tackle his resistance and denial and prevent him from becoming defensive.

It will be much easier to build trust by acknowledging his culture and struggles as a black man in a systemically unjust world. All of these skills support the process of growth and participation in making change.

Skills, Interventions, and Techniques

Motivational interviewing, active listening, and reflective responding are the first skills I would try with Marcus. Using motivational interviewing will assist Marcus in making decisions for change, both concerning his use of drugs and being a father. I can explore what is important to him by asking open questions and encouraging him to picture a brighter future.

Listening actively and fully to Marcus helps me stay in touch, providing support and building a trusted relationship (Tennant et al., 2023). Meanwhile, reflective responding allows Marcus to see his thoughts mirrored, which often helps him learn more about himself. With these basic skills, Marcus feels more comfortable being open with me.

Moreover, goal setting, confrontation, and empathy would be part of my intervention plan. By setting goals, Marcus can guide and focus on what matters most to his future, mainly education and parenting. A respectful confrontation can assist him in seeing that both wanting to stay in touch with his daughter and using drugs counteract each other and cannot work.

Every lesson will focus on empathy, ensuring that setting goals and addressing issues does not seem unkind (Moudatsou et al., 2020). With these skills, Marcus can see what prevents him from reaching his goals.

The final skill I would use is cultural sensitivity, alongside two specific techniques: the decisional balance and the miracle question. Cultural sensitivity is necessary to understand Marcus’s worldview, particularly his mistrust of counseling systems due to past discrimination (Bobel et al., 2022). This ensures interventions are not only practical but respectful.

For the decisional balance technique, a decisional balance worksheet will be introduced to help Marcus weigh the pros and cons of continuing versus ceasing substance use. The miracle question technique will help him imagine what his ideal life would look like without alcohol and with restored relationships. These tools make abstract goals tangible, motivating Marcus to commit to real change.

Applying Skills and Interventions in the Change Process

I would use motivational interviewing to facilitate change and enhance Marcus’s intrinsic motivation. During early sessions, Marcus showed signs of defensiveness and low self-worth, which motivational interviewing can address by affirming his agency. By using open-ended questions like “What do you want your daughter to remember about you in five years?” Marcus is prompted to reflect on the deeper values driving his change. This approach fosters autonomy and reduces resistance, which are key factors in the work stage.

Once Marcus shows interest in changing, goals and confrontations are very effective. By using goal setting, he can transform his future objectives into particular, practical actions. According to Stewart et al. (2024), introducing specific, measurable, achievable, relevant, and time-bound (SMART) goals will help Marcus stay focused and track progress.

When a parent keeps drinking despite their goals for their children, handled with respect, confrontation can help them reassess. The strategies guide him so that he becomes more dependable and consistent over time.

Throughout Marcus’s change, cultural sensitivity and empathy mean a great deal. Having dealt with systemic unfair barriers himself, Marcus feels better recognized and understood through the provision of non-judgmental therapeutic support. When people face difficult truths, empathy strengthens the therapeutic bond and removes some of their resistance (Opland & Torrico, 2024).

Being sensitive to culture allows for adjusting treatment strategies that match his past and background. Using all these approaches makes the client feel more confident, secure, and supported in the counseling experience.

Setting Up and Debriefing the Techniques

As I introduce the worksheet, I would tell Marcus its purpose is to list the positives and negatives, and that each choice is just one example of many possibilities. I would guide him to fill in the form with me, helping him consider both the pros and cons of drinking versus being sober. For the miracle question, I would introduce it in a calm, open-ended way, asking, “Suppose tonight, while you sleep, a miracle happens, and your life is just how you want it.

What would be different when you wake up?” After implementing these techniques, I would debrief Marcus by summarizing insights he shared and asking him to reflect on what stood out the most. This process reinforces his awareness and encourages goal-oriented thinking. I would also check in on how the exercises felt emotionally, ensuring Marcus leaves the session with clarity and emotional stability.

Use of Skills During  Counseling Session

During a recent session, I intentionally applied reflective responding, motivational interviewing, and active listening. As Marcus talked about his daughter, his voice got softer, and he mentioned he had missed her birthday. I reflected, “It appears that day made you sad and regretful.” As a result, Marcus confessed that he thought he was not doing well as a parent.

I continued with a question based on motivational interviewing: “In your opinion, what steps could you take to be a better father?” He wished to become sober and enter a general educational development program. Paying close attention to him helped me support him well.

All those skills helped make an environment where Marcus could reveal his struggles and highlight what was most important in his life. The session helped change the atmosphere from defensiveness to important self-evaluation and prepared the way for future plans.

Outcome

Everything went well in the session, and the results were promising. For the first time, Marcus stated he was ready to change and not simply in order to follow the court’s demands. By using motivational interviewing and active listening, he noticed how his drug use was tied to his feelings.

After Marcus’ experiences were validated and he was led gently through thinking, sobriety became a much more appealing path to recovery for him. We could shift our counseling methods from simple compliance to meaningful future changes by reaching this point.

Client Reactions

Initially, Marcus was cautious, but he developed stronger engagement as time passed. After I used the miracle question, he paused for a long while and described an image of himself waking up in a house and receiving a hug from his daughter. Seeing the powerful image moved him so much that he realized he had never considered what it would mean to live without alcohol.

He remarked, “Maybe we still have some time left,” as he was beginning to think the situation could improve. The emotional moment advanced our therapy relationship and made me more hopeful for future sessions.

References

Bischof, G., Bischof, A., & Rumpf, H. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Ärzteblatt International, 118(7), 109–115. https://doi.org/10.3238/arztebl.m2021.0014

Bobel, M. C., Hinai, A. A., & Roslani, A. C. (2022). Cultural sensitivity and ethical considerations. Clinics in Colon and Rectal Surgery, 35(05), 371–375. https://doi.org/10.1055/s-0042-1746186

Moudatsou, M., Stavropoulou, A., Philalithis, A., & Koukouli, S. (2020). The role of empathy in health and social care professionals. Healthcare, 8(1), 26. https://doi.org/10.3390/healthcare8010026

Opland, C., & Torrico, T. J. (2024, October 6). Psychotherapy and therapeutic relationship. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK608012/

Stewart, V., McMillan, S. S., Hu, J., Collins, J. C., El-Den, S., O’Reilly, C. L., & Wheeler, A. J. (2024). Are SMART goals fit-for-purpose? Goal planning with mental health service-users in Australian community pharmacies. International Journal for Quality in Health Care, 36(1). https://doi.org/10.1093/intqhc/mzae009

Tennant, K., Long, A., & Toney-Butler, T. J. (2023, September 13). Active listening. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK442015/

Zhang, X., Tanana, M., Weitzman, L., Narayanan, S., Atkins, D., & Imel, Z. (2022). You never know what you are going to get: Large-scale assessment of therapists’ supportive counseling skill use. Psychotherapy, 60(2), 149–158. https://doi.org/10.1037/pst0000460

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Unit 4 Introduction
You will demonstrate work-stage counseling skills. You will learn how to identify the work stage and review accompanying work stage counseling skills. 

For this case presentation, you need to review clinical and intervention skills, and theory related techniques. The focus is on working with the client to effectuate a change.

Considering your client: What are some skills that you would use to assist the client during the counseling process? Select seven skills and interventions as well as two techniques. Discuss how you would use the skills and interventions in the change process and why?

Case Presentation – Work Stage