Case Study
Patient Demographic: Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)
Mental Status Exam: Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.
Presenting Problem: You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”
Other Contexts:     History of Condition: The client first noticed symptoms of social anxiety when her family moved north during the summer of her 8th-grade school year. When she began high school, she received unwanted attention for being the “new girl.” She explains that she was often teased because of her Southern accent and was labeled “country” and “ignorant.” Before meeting her husband, the client remembers drinking before going on a date stating, “It just helped settle my nerves.” Her social anxiety lessened after becoming a stay-at-home mom to her two now-teenage children. However, she noticed a sharp increase in social anxiety after her divorce, particularly when attempting to reenter the job force and trying to find new social circles. She denies current drug use and states that she is a social drinker. Family History: The client’s parents both live out of town and run a business together. The client’s father has been treated for alcohol use disorder and is now in recovery. Her mother takes medication for anxiety and depression. The client has two teenage girls. Both girls have had a difficult time with the divorce. Her youngest child is seeing a therapist for depression. The client’s ex-husband is a prominent attorney in their town. This is the client’s first experience with counseling, and she asks many questions when filling out the intake paperwork.  You help the client create self-affirmations to counter the anxiety that she experiences during job interviews

Question: You help the client create self-affirmations to counter the anxiety that she experiences during job interviews. According to self-affirmation theory, what is the first step to developing these mental processes?
(A): Replace a crossed transaction with a complementary transaction.
(B): Identify a significant core value.
(C): Identify the activating event.
(D): Model unconditional positive regard.

Correct Answer: Identify a significant core value.
Explanation: The first step in developing self-affirmations is to identify a significant core value. Core values are stable beliefs upon which a person acts or aspires to act. Self-affirmations are used to affirm a person’s self-worth. Core values create positive emotional states. Self-affirmation theory is based on the premise that a person’s core values provide a more global view of themselves. When self-affirmations are based on core values, the other parts of a person are reinforced and self-concept is better protected. Individuals engaging in self-affirmations are less likely to attribute negative feedback to the current experience and are less likely to distort information. Identifying the activating event is the first step in CBT. Providing the client with unconditional positive regard rather than modeling it is a person-centered technique. Crossed and complementary transactions are concepts associated with transactional analysis. Therefore, the correct answer is (B)
Competency: counseling skills and interventions