Case Study
Patient Demographic:  Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.
Presenting Problem: You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.
Other Contexts: Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.

Question: Which of the following will be most beneficial to help the client understand about panic attacks?
(A): Panic attacks feel like you are dying, but they will not hurt you
(B): Once you experience panic attacks, you are likely to keep experiencing them
(C): All of the above
(D): Everyone experiences a panic attack at least once in their lifetime

Correct Answer: Panic attacks feel like you are dying, but they will not hurt you
Explanation: Many individuals have described panic attacks as feeling like they are dying because of hyperventilating, racing heart, chest pain, and feeling a loss of control. However, panic attacks are an emotional response with physical symptoms and will not cause lasting physical damage or kill an individual. It is true that some people have experienced a panic attack and have gone on to experience a panic disorder, which is recurrent panic attacks; however, this is not true for all people and many individuals experience no more panic attacks once their acute stress is relieved. Not everyone experiences panic attacks; only 11% of people in America experience them during their lifetime. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis