Case Study
Patient Demographic:  Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual
Mental Status Exam: Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.
Presenting Problem: Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.
Other Contexts: Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.

Question: Given Taylor's level of distress in the first session, how should you proceed?
(A): Validate her feelings
(B): Justify her reaction with words of approval
(C): Remain silent and offer her a tissue
(D): Challenge her irrational beliefs

Correct Answer: Validate her feelings
Explanation: The practice of validating your client's feelings is not the same as justifying their thought process or approving of their reaction to their problem. Validation of feeling is the quickest and most effective way to gain your client's trust and show that you will help them resolve their issue and reduce their stress while showing compassion and understanding for their perceptions. Your job will be to work with them on identifying cognitive distortions and challenge them on their own. Silence has an important function in the listening process, but your client has just told you they feel no one cares and has concluded their sharing for the moment. It is appropriate to respond at this moment in this counseling interaction. Offering someone a tissue while they are crying can be considered a disruption in their emotional process, signifying, "here is a tissue, so you can stop crying". The counselor should always have tissues available or provide them when asked. Therefore, the correct answer is (D)
Competency: counseling skills and interventions