Case Study
Patient Demographic: Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3)
Mental Status Exam: Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua
Presenting Problem: You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.
Other Contexts: You meet with client 3 for his individual therapy session. The client continues to be resistant, stating that he does not need to meet with you. You spend the session trying to build rapport with the client and are successful in taking down some of his walls. The client says he knew client 2 from back when he was in high school and began telling you that she slept with a bunch of guys and did a lot of drugs. You redirect the client back to focusing on himself. The client starts to open up about his relationship with his parents growing up and how he thinks they did not really try to show him affection and this made him sad talking about it. The client concludes by saying “I feel overwhelmed sharing all of this because I’ve never talked about it before.” You thank the client for sharing and you empathize with him.  Due to resistance, you choose to use motivational interviewing techniques with client 3

Question: Due to resistance, you choose to use motivational interviewing techniques with client 3. Which of the following would be an approach in engaging the client in treatment planning that uses motivational interviewing?
(A): You realize that you are imposing your goals for engagement, so you support the client in identifying what is important to him.
(B): You decide to support the client in reframing thoughts about counseling and its ability to improve his life.
(C): You assess the client’s personality by discussing birth order and its effects on functioning.
(D): You realize that the purpose of the client’s behavior is to escape counseling, so you continue to engage the client in order to prevent escape.

Correct Answer: You realize that you are imposing your goals for engagement, so you support the client in identifying what is important to him.
Explanation: Using the client’s motivation and focusing on what they want to work on may help in building rapport and would be using motivational interviewing techniques. Reframing thoughts uses CBT techniques. Focusing on addressing escape behaviors would be an example of a behavior therapy technique. Discussing birth order is related to Adlerian therapy. Therefore, the correct answer is (A)
Competency: counseling skills and interventions