Case Study
Patient Demographic: Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng
Presenting Problem: You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.
Other Contexts: The client enters the room and appears distracted when she sits down because she has a furrowed brow and is looking off to the side of the room. You ask her what is on her mind, and she reports that this morning she had a panic attack that led to her throwing up. You ask her to talk through the moments when she noticed it starting and how the panic attack progressed. She says that she woke up and was worried that she might have a panic attack because she typically has one on school days, and this turned into worry that she might be late for class, which compounded into worry about how it might affect her grades and eventually into certainty that she would fail. The client then experienced an increased heart rate, chest tightness, difficulty breathing, a feeling of impending doom, shaking, and finally vomiting. You empathize with the client and provide psychoeducation on the management of panic attacks

Question: Which of the following would be considered a negative attending behavior?
(A): Consistently matching the client’s posture and repeating her statements throughout the session
(B): Leaning forward
(C): Turning your body 30 degrees in relation to the client throughout the session to present a less aggressive posture
(D): Using hand gestures for emphasis

Correct Answer: Consistently matching the client’s posture and repeating her statements throughout the session
Explanation: Overusing mirroring with your posture and reflection can present as unnatural or manipulative to clients (Sommers-Flanagan & Sommers-Flanagan, 2015) and would therefore be considered a negative attending behavior. Leaning forward, using hand gestures, and turning your body about 30 degrees in relation to the client are typically not a negative experience for the client unless they are excessive. Overturning your body (past 45 degrees), can be considered a negative attending behavior (Sommers-Flanagan & Sommers-Flanagan, 2015). Therefore, the correct answer is (B)
Competency: counseling skills and interventions