Case Study
Patient Demographic: Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate
Mental Status Exam: Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam
Presenting Problem: You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.
Other Contexts: The client reports fewer symptoms of hopelessness and depression. He discloses that he has been seeing a guy he met at his previous job. He is happy with this new relationship but says he’s still “fighting against” feelings of guilt and shame surrounding his sexual orientation and his parents continued rejection of him. The client says he has attended Metropolitan Community Church (MCC) with his boyfriend and was surprised to hear their messages of acceptance and inclusion. He has stopped going to bars and nightclubs since dating and reports less substance and alcohol misuse. The client states it has been quite some time since he felt like he had no purpose in life

Question: You have selected acceptance and commitment therapy (ACT) and mindfulness to best address which of the following?
(A): Shame and guilt
(B): Sexual desire
(C): Social isolation
(D): Negative self-talk

Correct Answer: Shame and guilt
Explanation: Acceptance and commitment therapy and mindfulness are evidence-based mental health interventions for various mental health disorders, including depression. The premise of ACT is that moving individuals toward acknowledging and accepting (rather than fighting) their thoughts and feelings in the present moment influence behavioral changes. The fact that the client is fighting against feelings of guilt and shame makes ACT and mindfulness an effective means for helping the client learn to gradually accept these feelings, as well as the thoughts that accompany them. Although some consider ACT a form of cognitive-behavioral therapy (CBT), ACT seeks to accept (rather than change) thoughts and feelings, whereas CBT aims to change thoughts so one’s feelings can change. Sexual desire is a physiological concept rather than a thought or feeling. When appropriate, behavioral therapy best addresses sexual desire. Social isolation is a behavior. There are thoughts and feelings underlying social isolation, but social isolation as a behavior is better addressed through behavioral modification or other behavioral therapy techniques. Therefore, the correct answer is (C)
Competency: counseling skills and interventions