Case Study
Patient Demographic:  Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.
Presenting Problem: You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.
Other Contexts: Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.

Question: Which of the following will be least helpful for the client in managing her stress or panic?
(A): Closing eyes and breathing slowly through her nose
(B): Find one object to focus on while breathing slowly
(C): Avoid places and situations that trigger her stress or panic
(D): Using a grounding technique to remind herself that she is safe

Correct Answer: Avoid places and situations that trigger her stress or panic
Explanation: Avoiding places and situations that trigger stress or panic do not help the client to manage her emotions and instead may create more fear of those triggers. Instead, it is helpful for clients to either close their eyes and breathe slowly through the nose to control hyperventilation, or to find one object to focus on while breathing slowly. Noticing everything possible about the object helps the client to distract her mind from her panic and allows her to regain control. Using a grounding technique such as 3 things I can see, 3 things I can feel, and 3 things I can hear allows the client to distract themselves from their anxiety or panic and allows them to separate themselves from their heightened emotions. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis