Case Study
Patient Demographic: Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1)
Mental Status Exam: Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors
Presenting Problem: You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.
Other Contexts:    eful. Family History: The couple has been married for 25 years. They have two children,a 14-year-old son and a 17-year-old daughter, and they report good relationships with their families of origin.  The wife’s anxiety appears to be clinically significant because it impacts the relationship

Question: The wife’s anxiety appears to be clinically significant because it impacts the relationship. Which would be an appropriate first course of action regarding the wife’s treatment for anxiety?
(A): Incorporate cognitive reframing and coping skills for anxiety in couples counseling sessions.
(B): Provide individual counseling to the wife for anxiety.
(C): Provide a referral for individual counseling for anxiety.
(D): Provide a referral for medication management.

Correct Answer: Provide a referral for individual counseling for anxiety.
Explanation: The first course of action would be for the wife to receive individual outpatient therapy for her anxiety because it is clinically significant. You would not provide individual therapy for her because this would create bias in your provision of couples counseling. Medication management might be beneficial for the wife, but it would be helpful for the individual therapist to make this referral because they will be working specifically on her anxiety. Your focus with the couple is their relationship and not the wife’s anxiety. Although cognitive reframing may be helpful for the couple, couples counseling should be focused on the couple’s needs and not on the wife’s individual diagnosis. Therefore, the correct answer is (D)
Competency: treatment planning