Case Study
Patient Demographic: Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th
Presenting Problem: You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.
Other Contexts:    e  The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family.  The client shares her worries about her less-than-perfect performance on the tennis court

Question: The client shares her worries about her less-than-perfect performance on the tennis court. This is an example of which of the following?
(A): Black-and-white thinking
(B): Emotional reasoning
(C): Disqualifying the positive
(D): Mind reading

Correct Answer: Disqualifying the positive
Explanation: Disqualifying or discounting the positive is a cognitive distortion associated with the client’s worry. Disqualifying the positive is the belief that one’s accomplishments don’t count. For example, the client is the number-one ranked player on her high school varsity tennis team, yet she is dissatisfied with her less-than-perfect performance on the tennis court. Mind reading is a cognitive distortion that happens when one claims, without evidence, that other people’s reactions to them are negative. Emotional reasoning is also a cognitive distortion; it occurs when one engages in self-judgment based on emotional reactions. It is the belief that negative emotions define an individual as a person (eg, “I’m experiencing anxiety; therefore, I am in danger”). Black-and-white, or all-or-nothing, thinking happens when there is no acknowledgment of any “shades of gray” (eg, “Either I fail or I succeed”). Therefore, the correct answer is (B)
Competency: counseling skills and interventions