Case Study
Patient Demographic: Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography
Presenting Problem: You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.
Other Contexts: The client comes into the session smiling and says that he is excited to share his log this week. The client shares that he masturbated an average of one to two times daily and that he even went a day without masturbating. You express your excitement for the client achieving his goals. Through processing, the client identifies that he refrained from masturbating most often by leaving his bedroom and finding something to structure his time late at night. The client says that he had difficulty refraining from masturbating mostly when he came home from a difficult day at work, or when he struggled to sleep. You and the client discuss calming techniques to use when he is stressed after work. You also recommend approaches to address difficulty sleeping. On days when the client masturbates, he explains that he often decides that since he already messed up, he can do it again. The client says that he is happy at his new place of employment and that it is just a hard job. You support the client in challenging his past cognitive distortion that his future employment experiences will be the same as his past experiences

Question: Which of the following is the most accurate definition of mindfulness?
(A): Meditation focused on being aware of thoughts and feelings and interpreting what those thoughts and feelings mean to you
(B): Being aware of how you feel in the moment and then engaging that awareness through the use of cognitive reframing
(C): Using deep breathing, progressive muscle relaxation, and radical acceptance of how you feel and what you are thinking
(D): Meditation focused on being aware of thoughts and feelings, being present in the moment without judgment or interpretation, and using grounding techniques such as deep breathing

Correct Answer: Meditation focused on being aware of thoughts and feelings, being present in the moment without judgment or interpretation, and using grounding techniques such as deep breathing
Explanation: The best definition of mindfulness includes meditation that involves being aware of thoughts and feelings with no judgment or interpretation and that involves grounding techniques. The goal of mindfulness is to be completely present in your body and to be aware of thoughts and feelings but not to engage in them. Interpretation or radical acceptance of thoughts and feelings would likely escalate thoughts and feelings because they were already distressing for the client. Just controlling cognitions or just controlling the body’s response to a situation does not completely support the definition of mindfulness. Therefore, the correct answer is (C)
Competency: counseling skills and interventions