Case Study
Patient Demographic:  Initial Intake:   Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: VA Type of Counseling: Individual
Mental Status Exam: Carl came to the intake session alone and angrily stated, “I really don’t know why they are making me come to therapy - it doesn’t help anyway.” Carl appeared edgy throughout the interview and responded to questions with minimal effort.

Presenting Problem: Carl is a 38-year-old Army Veteran who is attending counseling at the local VA. Carl was referred after he was arrested for a DUI last week.

History:
Carl has been on four deployments to the Middle East, he returned from the most recent tour 11 months ago, after he was injured during a military strike. Some of his team members were injured as well.
Since his return, Carl and his civilian wife, Lori, have discussed separation because of their frequent arguing and Carl’s drinking. Carl began drinking when he was deployed and since then has used it as a coping mechanism to combat the frequent flashbacks and nightmares that he gets. Carl and Lori mostly argue about money since Carl has not been able to sustain employment as a construction worker because of his drinking problems. Carl has been arrested several times for assault and disorderly conduct. Carl recently assaulted his last counselor after he had made a comment about Carl not being able to sustain work.

The counselor thanked Carl for his service and reviewed with him that he was referred as a part of his probation. He must attend individual therapy and an anger management group for veterans. The counselor then described to Carl the purpose of the meeting and what would be reviewed and discussed during their time together. This included the intake paperwork, including informed consent and several assessments.

Question: Carl and Lori have decided that they want to work out their marital issues. A technique that the counselor should not use is?
(A): Allowing the couple to argue so they can release their feelings
(B): Video tape couple's therapy sessions to playback
(C): Behavioral therapy
(D): A non-directive client Rogerian approach

Correct Answer: Allowing the couple to argue so they can release their feelings
Explanation: It is important for the counselor to prevent the heightening of emotions to the point where therapy cannot be accomplished. If the counselor feels that tension is escalating to the point of an argument, the role of the counselor is to bring down the emotions and guide the couple to effective communication techniques. Additionally, it is to help the couple gain insight into their relationship patterns and to provide techniques to improve relationship functioning. By videotaping couple interactions and replaying this in sessions, couples gain more insight on how they may appear to the other person. Other couples may find a more non-directive approach useful, where the focus is on listening to one another and clarifying intention. Lastly, behavior therapy using positive reinforcement and rewarding behavior when one person in the couple does something that the other one finds positive may be effective. Therefore, the correct answer is (A)
Competency: treatment planning