Case Study
Patient Demographic: Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined
Mental Status Exam: Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with
Presenting Problem: You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.
Other Contexts: her. Family History: The client says that she has a good relationship with her parents. She says that they are encouraging and supportive of her. The client says that she has a younger brother who is 6 years old and an older brother who is 16 years old. The client states that she has a good group of friends and spends time with them regularly.  You continue to have trouble assisting the client with becoming more comfortable by talking about topics that may interest her

Question: You continue to have trouble assisting the client with becoming more comfortable by talking about topics that may interest her. What else can you do in order to build a level of comfort with the client?
(A): Explain the nature of therapy and how it can be helpful to her.
(B): Use the immediacy skill to address the client’s feelings about the session and the therapist.
(C): Use the silence skill to encourage the client to talk about what is happening.
(D): Play a board game with the client.

Correct Answer: Play a board game with the client.
Explanation: Because talking has not been beneficial, playing a game may help develop comfort because play is a nonthreatening activity that does not require disclosure. Play also helps some children lower their guard, and they may begin talking or be more willing to talk while you play. You have tried talking with her, and she is resistant to talking about what is happening; therefore, explaining the nature of therapy would not provide further benefit because you did this as part of informed consent. Immediacy has been attempted because you identified the client was not comfortable and tried to support her in this feeling. Silence may make the client feel pressured and even more uncomfortable, although it may be valuable later on in therapy because it does encourage reflection and communication. Therefore, the correct answer is (B)
Competency: counseling skills and interventions