Case Study
Patient Demographic: Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate
Mental Status Exam: Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam
Presenting Problem: You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.
Other Contexts: The client reports fewer symptoms of hopelessness and depression. He discloses that he has been seeing a guy he met at his previous job. He is happy with this new relationship but says he’s still “fighting against” feelings of guilt and shame surrounding his sexual orientation and his parents continued rejection of him. The client says he has attended Metropolitan Community Church (MCC) with his boyfriend and was surprised to hear their messages of acceptance and inclusion. He has stopped going to bars and nightclubs since dating and reports less substance and alcohol misuse. The client states it has been quite some time since he felt like he had no purpose in life

Question: How should the client’s disclosures about dating and attending church affect the direction of therapy?
(A): It allows you to explore if the client has the ego-strength required for dating and finding a new church.
(B): It determines the need for you to help the client establish his own LGBTQIA+ identity.
(C): It causes you to re-evaluate potential risks associated with the client being “out” in the community.
(D): It helps connect these events to the client’s management of his hopelessness, depression, and social isolation.

Correct Answer: It helps connect these events to the client’s management of his hopelessness, depression, and social isolation.
Explanation: By connecting dating and attending church with the client’s treatment plan goals, you and the client can best determine the direction of therapy. The client is in the mid to late stages of treatment. Evaluating these events in the context of his treatment plan goals will help clarify the client’s readiness for termination. The client already has established his identity as a gay male, making answer A incorrect. Determining the client’s ego-strength could undermine the client’s confidence and self-efficacy, making this option incorrect. Re-evaluating the potential risks associated with being out in the community is also incorrect because the client is already well aware of the risks. Therefore, the correct answer is (B)
Competency: counseling skills and interventions