Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem
Presenting Problem: You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.
Other Contexts: You meet with the client in your office 1 week after the intake session. The client reports that her husband was out of town for half of the past week and she engaged in bingeing and purging. You review the client’s food log with her and can see the difference between when her husband is home and when he is gone based on her documentation. The log included the client’s thoughts following bingeing, purging, and restricting, and you and the client work on creating new scripts for the thoughts that have led to unhealthy eating and compensatory behaviors in the past.  The client’s food log has the following statement: “I’m not worth anything if I get fat, and I’m going to die

Question: The client’s food log has the following statement: “I’m not worth anything if I get fat, and I’m going to die.” All of the following are more rational ways of reframing this thought, EXCEPT:
(A): “Although being overweight isn’t healthy, my worth isn’t defined by weight.”
(B): “My body isn’t letting me down, and my husband loves me.”
(C): “The reality is that I could get fat, which may result in my husband’s unhappiness and my own death, but I can be healthy and keep this from happening.”
(D): “My worth isn’t defined by my weight, and there are ways that I can be healthy to reduce my chances of dying younger than I want to.”

Correct Answer: “The reality is that I could get fat, which may result in my husband’s unhappiness and my own death, but I can be healthy and keep this from happening.”
Explanation: While identifying the reality of becoming overweight and its possible consequences may carry elements of truth, there is a balance that needs to be found when reframing this client’s cognition. The thought that she could become overweight and suffer the consequences (her husband’s unhappiness and her own death), but that she can do something to keep that from happening may accept a reality, but it also encourages the unhealthy behavior that the client already engages in. In this situation, identifying that her body is not letting her down and that her worth is not defined by weight is a healthier balance in thinking. Therefore, the correct answer is (A)
Competency: counseling skills and interventions