Case Study
Patient Demographic: Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)
Mental Status Exam: Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa
Presenting Problem: You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.
Other Contexts: The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening

Question: When the husband is crying, all of the following are helpful techniques for the couple, EXCEPT:
(A): Practicing immediacy
(B): Supporting the husband in using coping skills
(C): Redirecting to the wife with questions about her response to his crying
(D): Allowing space for him to cry

Correct Answer: Supporting the husband in using coping skills
Explanation: Supporting the husband in using coping skills is the least helpful technique in this situation because the husband needs to feel safe expressing his raw emotions in the manner that comes most naturally to him. Otherwise, repression of these feelings may occur. Muting those feelings with trained coping skills detracts from an important element of processing because the husband and wife both need to experience their emotions surrounding their situation to better understand and express their viewpoints. Immediacy would be helpful because it involves directly addressing the presenting emotions and behavior. Allowing space for the husband to experience his emotions is helpful for the husband (as a releasing process) and also for the wife (to allow her to actively experience how her spouse is feeling). Redirecting to the wife may also be helpful because this may provide her with appropriate tools for responding to her husband’s emotions in a way that makes him feel supported and less isolated. Therefore, the correct answer is (D)
Competency: counseling skills and interventions