Case Study
Patient Demographic: Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate
Mental Status Exam: Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam
Presenting Problem: You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.
Other Contexts:    ily and Work History: The client was recently laid off from his job as a server at an upscale restaurant in the downtown area. He misses the sense of family he had with his previous co-workers and feels “stuck” and “unable to move forward.” The client is a third-generation Cuban American whose paternal grandparents immigrated to the United States during Castro’s regime. His parents worked hard to put him and his siblings through Catholic school and instilled in him traditional heteronormative religious values and “familism” (i\. e., the belief that the family unit is more important than individual needs). The client also has a strong work ethic but states he is poorly motivated to seek another job because he doesn’t want to be “shot down.” History of Condition: The client reports that he has struggled with bouts of depression from a very early age. He explains that he never felt like he fit in. In middle school, he was bullied and harassed. He remembers locking himself in his room, crying, and asking God for help during this time. He continued to ask for forgiveness and bargain with God as he grew older. In his mid- to late-teens, he began drinking and vaping, “because I couldn’t keep my end of the bargain,” he explains. Despite finding acceptance in the community, he still feels guilty for disappointing his parents. The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation.  Your client is unmotivated to seek employment because he doesn’t want to be “shot down

Question: Your client is unmotivated to seek employment because he doesn’t want to be “shot down.” According to person-centered theory, what is the root of your client’s maladaptive behavior?
(A): The client has an underlying irrational belief that he must be capable in all areas of life or else he is worthless.
(B): The client has developed a failure identity as the result of not taking responsibility for change.
(C): The client has adopted the unhealthy life position of “I’m not okay. You’re not okay.”
(D): The client has developed incongruence between the value of being employed and the behavior of not seeking employment.

Correct Answer: The client has developed incongruence between the value of being employed and the behavior of not seeking employment.
Explanation: Person-centered therapy is a non-directive approach designed to help clients recognize incongruence between their personal values (ie, the value of being employed) and behavior (not seeking employment). Core facilitative conditions used to help the client obtain this goal are empathy, genuineness, and unconditional positive regard. Glasser’s reality therapy helps clients transform failure identities into success identities by encouraging personal responsibility. Rational-emotive behavioral therapy (REBT) would attribute the client’s maladaptive behavior to the irrational belief that he must be capable in all areas of life or else he is worthless, leading to remaining stuck. Healthy and unhealthy life positions are characteristics of transactional analysis. Therefore, the correct answer is (C)
Competency: counseling skills and interventions