Case Study
Patient Demographic: Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th
Presenting Problem: You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.
Other Contexts: The client is responding well to your therapeutic interventions. School has ended, and her summertime athletic and academic commitments have lessened. The client reports that she is happy to be out of school and spoke again about not fitting in with her peers. She states that there are limited opportunities for sustaining friendships and worries that she will never find a romantic interest. She reports that her mother has suspended her social media account because the client was overly consumed by the number of “likes” that she received for her online posts. You explain that you will be starting a 12-week group of diverse teens who also experience anxiety and would like her to join. She agrees and is eager to participate

Question: The preaffiliation, or forming, stage of group development is characterized by which of the following?
(A): Dependency and inclusion
(B): Structure and trust
(C): Separation
(D): Power and control

Correct Answer: Dependency and inclusion
Explanation: Dependency and inclusion describe the preaffiliation, or forming, stage of group development. This initial phase of group development is marked by apprehension and tentative exploration. The group leader’s involvement is most pronounced during this stage. Healthy time-limited or closed groups have distinct beginning, middle, and end stages (ie, forming, storming, norming, performing, and adjourning). Power and control describe the middle stage of group development. Other descriptors for this stage include storming, counterdependency, and flight. Competition and the struggle for control emerge as the authority of the group leader is challenged during this stage. Structure and trust describe the norming stage, which transpires during the working stage of development. The leader’s role is less pronounced during this stage, and the group members form closer connections. Separation, or adjourning, is associated with the last stage of group development. Therefore, the correct answer is (B)
Competency: professional practice and ethics