Case Study
Patient Demographic: Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.
Presenting Problem: You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.
Other Contexts: Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.

Question: You are evaluating interventions that will help the client better cope with the loss of her son. Which of the following will be most beneficial for the client at this time?
(A): Client will engage in concurrent prolonged exposure (PE) therapy to process her grief.
(B): Family members will attend therapy to provide support and gain understanding of client's needs.
(C): Client will ask family members to encourage her not to carry out her grieving behaviors.
(D): Client will attend a concurrent grief therapy group.

Correct Answer: Client will attend a concurrent grief therapy group.
Explanation: Attending a grief therapy group while pursuing individual counseling will provide a safe place for the client to express her feelings and where she can be challenged by other group members about the effectiveness and appropriateness of her grieving behaviors. PE is an effective intervention but has high drop-out rates due to imaginal exposure. At this time, the client is not likely to be suited for PE as she is at higher risk for drop-out due to her depression symptoms. Having family members engage in therapy when they do not wish to do so or acting as accountability partners for a distressed client may cause further ruptures in family relationships. Therefore, the correct answer is (B)
Competency: treatment planning