Case Study
Patient Demographic: Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate
Mental Status Exam: Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent
Presenting Problem: You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”
Other Contexts: The client has made steady progress toward reducing maladaptive eating. After several weeks of collecting self-monitoring data, you and the client successfully identify patterns that maintain the problem of binge eating. The client’s depressive symptoms have improved, and she is seeking interpersonal connections. She has set appropriate boundaries with her family and distanced herself from their church. The client briefly attended a more liberal church, experienced biphobia, and did not return. She explains, “In my parent’s church, I’m not straight enough. In the LGBTQ community, I’m not gay enough.” You have introduced her to dialectical behavioral therapy, and she attributes mindfulness to improved depressive symptoms

Question: Using the Transtheoretical Model (TTM) of the Stages of Change Model (SOC), which technique helps move the client from the contemplation stage to the preparation stage?
(A): Tipping the decisional balance
(B): Flexible pacing
(C): Commitment and activation
(D): Rolling with resistance

Correct Answer: Tipping the decisional balance
Explanation: Tipping the decisional balance (DB) is essential for moving the client from the contemplation stage to the preparation stage of change. Prochaska and DiClemente (1984) developed the Transtheoretical Model (TTM) of the Stages of Change Model (SOC) that serves as the foundation for enhanced motivational interviewing (MI). The stages of change are precontemplation, contemplation, preparation, action, and maintenance. Tipping the decisional balance is used to move clients from ambivalence toward commitment and change. DB exercises include examining ambivalence and advocating for change talk. Commitment, activation, and taking steps (CAT) help move clients from preparation to action. Rolling with resistance is used to decrease sustain talk (ie, what is keeping them in the problem) and is mainly used in the earlier SOC. Flexible pacing is an MI strategy used to help the counselor stay with the client and resist the urge to jump ahead or push the client forward rather than move at their own pace. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis