Case Study
Patient Demographic: Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3)
Mental Status Exam: Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua
Presenting Problem: You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.
Other Contexts: You meet with client 3 for his individual therapy session. The client continues to be resistant, stating that he does not need to meet with you. You spend the session trying to build rapport with the client and are successful in taking down some of his walls. The client says he knew client 2 from back when he was in high school and began telling you that she slept with a bunch of guys and did a lot of drugs. You redirect the client back to focusing on himself. The client starts to open up about his relationship with his parents growing up and how he thinks they did not really try to show him affection and this made him sad talking about it. The client concludes by saying “I feel overwhelmed sharing all of this because I’ve never talked about it before.” You thank the client for sharing and you empathize with him

Question: With new information about client 2, which of the following would be the most appropriate response to this information?
(A): Be aware of how this information affects your unbiased interactions with client 2.
(B): Explore why this information matters to client 3.
(C): Bring this up when you have an individual session with client 2 to determine if it is true information.
(D): Keep this information in mind because it may help you support client 2.

Correct Answer: Explore why this information matters to client 3.
Explanation: This could be an instance of triangulation, in which client 3 is using deflection to client 2’s behavior to ease client 3’s stress in the session. For this reason, exploring why client 2’s behavior is of concern to client 3 is the most client-centered and important focus to begin with. It might be good to keep this report in mind because it may be brought up during a group session or client 2’s individual session, but you also do not know the validity of the statement unless client 2 self-reports. It is important to make sure that you do not let this information bias you, but this would not be the most pressing factor. Sharing information from your session with client 3 with client 2 would be a breach of confidentiality. Confidentiality is an important aspect to consider about DBT groups because you also provide individual therapy and need to ensure that you do not share information revealed in individual sessions in the group setting. Therefore, the correct answer is (D)
Competency: counseling skills and interventions