Case Study
Patient Demographic: Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1)
Mental Status Exam: Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors
Presenting Problem: You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.
Other Contexts: You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice.  The husband left the session

Question: The husband left the session. What would be the most beneficial intervention for the couple?
(A): Encourage the husband to return to the session.
(B): Cancel the session in order to reconvene when the couple is willing to meet together because you are providing couples counseling.
(C): Encourage both individuals to take responsibility for their contribution to the conflict.
(D): Meet individually with both partners in order to process thoughts and feelings regarding the relationship.

Correct Answer: Meet individually with both partners in order to process thoughts and feelings regarding the relationship.
Explanation: The most beneficial intervention at this point would be to separate the partners and meet with them individually. This may be helpful in creating a more comfortable environment for expression for both partners. You will gain insight into each person’s perspective in a manner that is safer than the couples setting. It might be helpful to encourage the husband to return, but the couple is having trouble communicating, and getting each individual’s unbiased perspectives could be very helpful. It is also helpful to get individuals to take responsibility for their own actions, but the couple is not capable of this at this point in therapy because they are just starting to explore their emotions regarding the wife’s affair. Therefore, the correct answer is (C)
Competency: treatment planning