Case Study
Patient Demographic: Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00)
Mental Status Exam: Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam
Presenting Problem: You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.
Other Contexts:    ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer.”  You are using the transtheoretical model of change (Prochaska & DiClemente, 1992) to examine the client’s reticence to participate in counseling

Question: You are using the transtheoretical model of change (Prochaska & DiClemente, 1992) to examine the client’s reticence to participate in counseling. This model suggests that change is least likely to occur in which of the following stages:
(A): Action
(B): Maintenance
(C): Contemplation
(D): Preparation

Correct Answer: Contemplation
Explanation: Of the stages listed, contemplation is the one that is least likely to produce change. Prochaska and DiClemente’s (1992) transtheoretical model of change consists of the following linear stages: precontemplation, contemplation, preparation, action, and maintenance. Individuals in stage 1, or the precontemplation stage, lack awareness of behaviors that may require change. In stage 2, the contemplation stage, individuals are aware that changes need to be made but are ambivalent about taking action. In stage 3, the preparation/determination stage, individuals acknowledge the detrimental consequences of their behavior and get ready to make a change. The action stage, or stage 4, is also known as the willpower stage because the person acknowledges that a change needs to be made and is taking steps to change. Finally, in stage 5, the maintenance stage, individuals take the action steps required to sustain change. Termination or relapse may follow the maintenance stage if changes are not necessary or sustained. Therefore, the correct answer is (D)
Competency: counseling skills and interventions