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: The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process.  You gather information to identify factors impeding the client’s progress

Question: You gather information to identify factors impeding the client’s progress. How would you incorporate the influence of emotional, cognitive, and behavioral factors on the client’s clinical presentation and plan of care?
(A): Summarize the client’s reasons for feeling stuck.
(B): Obtain an interdisciplinary consultation.
(C): Conduct a functional behavioral analysis.
(D): Construct a case conceptualization.

Correct Answer: Construct a case conceptualization.
Explanation: The best way to identify factors affecting the client’s clinical presentation and treatment plan goals is to construct a case conceptualization. Cognitive therapists promote the use of biopsychosocial assessments to assist in building a sound clinical presentation. Sperry and Sperry (2020) promote using the eight P’s when formulating the client’s case conceptualization; these include presentation, predisposition (including culture), precipitants, protective factors and strengths, pattern, perpetuants, (treatment) plan, and prognosis. Summarizing the client’s reasons for feeling stuck may help provide context to help understand the client’s views of himself, others, and the world; however, this option is incorrect because the client’s reasons for feeling stuck serve as the impetus for revisiting and updating the case conceptualization. Although it is also helpful, an interdisciplinary consultation is not the best process because there is no indication that the counselor lacks the skill set. Instead, the need arose due to the client’s shift in clinical presentation. The purpose of a functional behavioral analysis is to identify the client’s behavioral chain to determine which behaviors are desirable and which ones are undesirable. Once this is determined, the chain can be broken down and areas can be targeted to help lead to an improved outcome. By contrast, the case conceptualization analyzes a wide range of influences that change the client’s clinical presentation rather than looking at smaller components leading to behavioral change. Therefore, the correct answer is (A)
Competency: treatment planning