Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed
Mental Status Exam: Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc
Presenting Problem: You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.
Other Contexts: The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations.”  How would a client-centered therapist view this remark by the client?“My husband’s patients with me is growing thin. I don’t think I can ever live up to his expectations

Question: How would a client-centered therapist view this remark by the client?“My husband’s patients with me is growing thin. I don’t think I can ever live up to his expectations.”
(A): As sadness resulting from the “I’m not OK,” “You’re OK” life position
(B): As a mistaken style of life resulting from inferiority feelings
(C): As a failure identity resulting from irresponsibly meeting the need for love
(D): As incongruence stemming from a discrepancy between self-image and one’s ideal self

Correct Answer: As incongruence stemming from a discrepancy between self-image and one’s ideal self
Explanation: Developed by Carl Rogers, client-centered therapy is based on the assumption that incongruence results from a discrepancy between one’s self-image and ideal self. Conditions of worth are created when an individual takes on a significant other’s condition of regard to the extent that self-experience is circumvented (or pursued). Alfred Adler adopted the belief that feelings of inferiority contribute to a mistaken style of life. According to William Glasser, credited with developing reality therapy, a failure identity occurs when the need for love is met in an irresponsible manner. Reality therapy, also known as control theory, emphasizes the importance of one’s need for love and the need to feel worthwhile. Eric Berne, credited with developing transactional analysis, viewed depression and sadness as the result of adopting the “I’m not OK; you’re OK” life position. Therefore, the correct answer is (B)
Competency: counseling skills and interventions