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: The client attends a process-oriented CBT group that is nearing the middle stage of group development. The client presents today with a bright affect and arrives early to converse with two other women in the group. During group activities, she is reticent to share and is sensitive to a conflict between two members that has started to emerge. One member becomes openly critical of the group tasks and their usefulness. Other members start to weigh in and take sides. The conflict quickly escalates between two members, with one shouting at another, “You have monopolized every session with your opinions. You are the most judgmental person I know! This group would be so much better without you.” Other members nod in agreement.  How would a gestalt therapist describe the boundary disturbance that characterizes the group member’s statements of “You have monopolized every session with your opinions

Question: How would a gestalt therapist describe the boundary disturbance that characterizes the group member’s statements of “You have monopolized every session with your opinions. You are the most judgmental person I know! This group would be so much better without you”?
(A): Projection
(B): Confluence
(C): Deflection
(D): Introjection

Correct Answer: Projection
Explanation: Gestalt therapists use the term boundary disturbance to describe various forms of resistance. Boundary disturbances include projection, introjection, retroflection, confluence, and deflection. Gestalt therapists address boundary disturbances in the here and now, making it applicable to this client’s process-oriented group. Projection is the tendency for a person to blame the environment (ie, other people) for personality traits, thoughts, feelings, and behaviors that originate in themselves. Individuals use projection to disown or deny aspects of their personality by blaming others for their circumstances. Disowning aspects of one’s personality makes the person a victim of circumstance by assigning hidden meanings to others. During group conflict, the member’s statement, which consists of personality aspects consistent with social anxiety (ie, feelings of not being wanted, included, or judged), likely originate in elements of the member’s self and other members being in agreement. Introjection, which is the opposite of projection, is the process of assimilating information from the environment without critical discernment. This tends to develop in childhood when information from parents or authority figures is passively incorporated so that there is no identification of what one wants and needs. Deflection occurs when a distraction is created to avoid aspects of the environment that may be threatening. Examples of distractions include the use of humor, speaking for others, and asking questions. Confluence occurs when aspects of one’s internal and external environments are blurred or diffuse, which prevents one from differentiating the two. Confluence often occurs when individuals avoid conflict and possess an increased need to be accepted. Therefore, the correct answer is (D)
Competency: counseling skills and interventions