Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express
Presenting Problem: You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.
Other Contexts: The client comes to the session reporting that he and his girlfriend attempted to have sex the past week, and he wrote down some thoughts he was having on his CBT thought log. The client and the clinician reviewed his thoughts and engaged in cognitive reframing to support him in creating new scripts to use when engaging in sex. The client also wrote down physical responses to anxiety that he was experiencing before and during sex that included muscle tension and increased heart rate.  The client states that he thinks that his girlfriend would be better off without him and that he should break up with her so she can find what she wants in a man. You decide to use the counseling skill of confrontation to challenge him

Question: The client states that he thinks that his girlfriend would be better off without him and that he should break up with her so she can find what she wants in a man. You decide to use the counseling skill of confrontation to challenge him. Which of the following would demonstrate the most beneficial use of confrontation based on what you know about the client?
(A): You tell the client that this is not an appropriate response because he is using all-or-nothing thinking and extrapolating his thinking about his own worth as a man as equated to her feelings about him.
(B): You tell the client that responding to these feelings by breaking up might be risky because the client’s girlfriend has not shown that she is bothered by his sexual performance.
(C): You tell the client that he would be making a big mistake by breaking up with his girlfriend because he might be able to improve their relationship.
(D): You tell the client that he should continue to be with his girlfriend because although he has these thoughts it does not mean that they are the reality.

Correct Answer: You tell the client that responding to these feelings by breaking up might be risky because the client’s girlfriend has not shown that she is bothered by his sexual performance.
Explanation: It would be most helpful to support the client with identifying that his feelings are risky because he does not have evidence to support his thoughts to break up. Telling the client that his thoughts are not an appropriate response is an aggressive response that has not been proven to be a helpful confrontation technique. Although the focus of improving the relationship is helpful, it would validate the client’s thoughts and would not confront them. Telling the client that he should continue to be in this relationship just because he has thoughts about breaking up and how these may not be true would be more directive than confrontational. Therefore, the correct answer is (B)
Competency: counseling skills and interventions