Case Study
Patient Demographic: Client Age: 27 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Career Counseling Center Type of Counseling: Individual Presenting Problem: Employment-related Stress; Anxiety Diagnosis: Adjustment Disorder with Anxiety 309.24 (F43.22)
Mental Status Exam: Mental Status: The client was well-groomed and dressed appropriately. She appears nervous and jittery and quickly places her hands under the table when she notices them shaking. The client states that she is not sleeping well and says it is difficult making it to work each day knowing that “things rarely go as planned.” She explains that she has irritable bowel syndrome, which is exacerbated by stress. The client reports that there are no known medical conditions that would cause her chronic headaches. The client denies homicidal or suicidal ideations but remarks that she has felt like this in the past. Wor
Presenting Problem: You work in a career counseling center, and your intake is a 27-year-old white female employed as a fourth-grade elementary schoolteacher. The client has been a teacher for 3.5 years and has become increasingly dissatisfied with her job. The client explains that she is “at her breaking point” and relays that her stress level has increased sharply within the past 3 months. This is her first school year with a newly hired principal who has been “unreasonably demanding and unsupportive.” The client states that she was already second-guessing her career choice and explains that disruptive students and a lack of parental involvement have made teaching incredibly challenging. She reports “stress-induced physical symptoms,” which include acute stomach distress and chronic headaches. She worries that her skill set is nontransferable.
Other Contexts: The client reports that she and her husband have separated and she is now living with her parents. She is tearful and says that the past few days have been challenging. She reports an increase in headaches and stomachaches. The client has interviewed for a teaching position at a private school but doesn’t think she can afford a pay cut. Nevertheless, the client continues to be motivated to continue with counseling and believes that she will find a good career fit, but it may take some time. You discuss using a cognitive information processing approach with the client, and she is receptive. You explain that this approach will enable you to examine the communication, analysis, synthesis, valuing, and execution (CASVE) cycle of career decision-making skills

Question: How would you use core counseling skills to respond to your client?
(A): “Your marriage is in trouble. Let’s look at how this will impact your career choices.”
(B): “I’m encouraged that you are committed to the process, but I can’t help but notice the sadness you are experiencing today.”
(C): “I know how you feel. I also experienced difficult times with my husband. It took a while, but we are best friends now.”
(D): “You and your husband are getting a divorce, and you believe this will negatively affect your future career choices.”

Correct Answer: “I’m encouraged that you are committed to the process, but I can’t help but notice the sadness you are experiencing today.”
Explanation: “I’m encouraged that you are committed to the process, but I can’t help but notice the sadness you are experiencing today” is the statement that best reflects core counseling skills. The counselor acknowledges the client’s underlying feelings, provides feedback grounded in the here and now, and allows space for the client to explore these feelings. Answer A is incorrect because it is an inaccurate account of what the client expressed. There was no discussion of divorce or the implication that it would affect all of her future career choices rather than the ones with lower pay. Answer B does not acknowledge the underlying feelings of sadness. Answer C is an example of a poorly timed and poorly constructed self-disclosure. When appropriately used, self-disclosures should promote client growth and leave clients with the feeling that they are understood. Therefore, the correct answer is (D)
Competency: counseling skills and interventions