Case Study
Patient Demographic: Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam
Presenting Problem: You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.
Other Contexts: You learn that the client withheld information during the intake interview because of a negative experience with psychiatric treatment. Two years previously, the client presented at the emergency room with symptoms of depression and suicidal ideation. The emergency department clinician recommended hospitalization, and the client complied. During his hospital stay, he was placed on an antipsychotic medication for paranoia and was diagnosed with schizoaffective disorder. Although the client admits to suicidal ideation, he denies ever experiencing paranoia. He reports having side effects from the medication and immediately discontinued it after discharge. The client states that he has been very depressed since the breakup with his girlfriend and was willing to give counseling another try before his depression “hit rock bottom

Question: Which of the following would you select to evaluate the client’s cognitive distortions by testing them against sound logic and reason?
(A): Socratic questioning
(B): Counterconditioning
(C): Assuming responsibility
(D): Forceful disputing

Correct Answer: Socratic questioning
Explanation: Cognitive therapists use Socratic questioning to help challenge cognitive distortions and evaluate their automatic thoughts by testing them against sound logic and reasoning. For example, the counselor may ask, “What is the evidence for or against this thought?” The client then learns to recognize automatic thoughts and their associated cognitive distortions independently, which is all part of a process known as cognitive restructuring. Counterconditioning is an unrelated term used by behavioral therapists to refer to an experimental procedure in which a subject is trained to respond to a stimulus incompatible with a previously learned response to the same stimulus. Forceful disputing is a rational-emotive behavioral therapy technique used to challenge irrational thoughts and beliefs. Assuming responsibility is a gestalt therapy technique. Gestalt therapists using this technique ask clients to add the phrase, “and I take responsibility for it,” to statements to help promote personal responsibility for their thoughts, actions, and feelings. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis