Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem
Presenting Problem: You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.
Other Contexts: You meet with the client, and she comes and sits down and appears happy because she is smiling and sitting with an open posture. The client’s food log shows improvement in engaging in healthier eating habits and minimal restriction. You and the client review her progress in treatment and agree that she has met all of the treatment goals. The client reports several situations in which she wanted to restrict, purge, and binge, but instead she engaged in cognitive reframing and was able to manage her reaction to the trigger. You praise the client and express that she should be proud of herself for her management of her symptoms. The client reports that she has gained weight and is in a healthy weight range at this point. She continues that her husband has made comments of concern about her weight gain and that the frequency of sex has decreased recently. The client says that she and her husband have been arguing about her eating recently and that she does not feel that he supports her in recovering from her eating disorder. You empathize with the client.  You are frustrated because the client’s husband does not support her progress

Question: You are frustrated because the client’s husband does not support her progress. Which one of the following is the most appropriate first response?
(A): You support the client in developing communication skills to discuss her progress and health with her husband.
(B): You provide a referral for couples counseling.
(C): You and the client discuss coping skills in order to help her cope with her husband’s expression of frustration.
(D): You encourage the client to invite her husband to another session in order to discuss his frustration with her weight gain.

Correct Answer: You support the client in developing communication skills to discuss her progress and health with her husband.
Explanation: As your first response, it would be most helpful to support the client in having an effective conversation with her husband regarding her health and progress. If this is unhelpful, providing a referral for couples counseling might be the next best course of action. You would not invite the husband to sessions because you are the client’s individual therapist and would therefore not be an appropriate fit as the couple’s therapist due to the potential for bias. It can be helpful to support the client in coping with her husband’s level of frustration, but this is not the most helpful course of action because it implies acceptance of a situation that is potentially harmful to her progress. Therefore, the correct answer is (B)
Competency: professional practice and ethics