Case Study
Patient Demographic: Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1)
Mental Status Exam: Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors
Presenting Problem: You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.
Other Contexts: You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice

Question: Which of the following cognitive distortions operates from the husband’s premise that his “wife is always going to do what benefits her and not us because she is incapable of doing positive things for the relationship”?
(A): Jumping to conclusions
(B): Mental filter
(C): “Should” statements
(D): Catastrophizing

Correct Answer: Mental filter
Explanation: The client is focusing only on the negatives and ignoring positive interactions (such as when the wife tries to engage the husband in quality time and attempts to improve their relationship). This is an example of the cognitive distortion called mental filter, which is filtering out positive interactions and focusing on negative interactions. Catastrophizing is assuming that the worst will happen, which is not the focus of his thoughts. Jumping to conclusions involves coming to a conclusion without evidence. This client is not jumping to conclusions because his assumptions contradict the available evidence (assuming that his wife does not put her relationship first even with evidence that she is attempting to improve her relationship). “Should” statements involve expectations that are not met, but this does not apply because the client is not expressing an expectation of what the wife should do to alleviate the problem. Therefore, the correct answer is (B)
Competency: counseling skills and interventions