Case Study
Patient Demographic: Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22)
Mental Status Exam: Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor
Presenting Problem: You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.
Other Contexts:    k and Family History: The client obtained her bachelor’s degree in teaching and is currently a certified teacher. She comes from a family of educators, with her mother working as a teacher and her father as a high school guidance counselor. Before college graduation, she worked odd jobs, including waiting tables and working in a public library with preschool groups. She remembers enjoying her student teaching position but states that the class was “nothing like” what she has now. She explains that her student-teaching classroom contained 16 students and that she now struggles to stay on top of her current class of 24. She plays on a tennis team and serves as a “big sister” to a child through a local nonprofit organization. The client is married, and she and her husband do not have children. She reports that her husband has a high-stress job working as an attorney. The client says that he has “little patience with me when I complain about my job stress.”  You ask the client to tell you about a time when her problem did not exist or was less severe

Question: You ask the client to tell you about a time when her problem did not exist or was less severe. Which one of the following approaches reflects this stance?
(A): Solution-focused brief therapy
(B): Gestalt therapy
(C): Freudian psychoanalysis
(D): Transactional analysis

Correct Answer: Solution-focused brief therapy
Explanation: One technique of solution-focused brief therapy is to ask the client about a time when her problem did not exist or was less severe; this technique is known as the exception question. Solution-focused brief therapy is a short-term, solution-oriented best practice used to help clients establish and reach goals by improving motivation and creating measurable behavioral change. Freudian psychoanalysis focuses on how a client’s unconscious influences affect how they think, act, and feel. Eric Berne, credited with developing transactional analysis, used techniques such as script analysis to explore the interaction of ego states (eg, parent, adult, and child). Gestalt therapists emphasize the integration of mind and body through an awareness of the present moment. Therefore, the correct answer is (B)
Competency: counseling skills and interventions