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 would be the most appropriate response to the client's question?
(A): I'm so sorry that you feel this way.
(B): You feel torn between caring for your parents and caring for yourself at the same time.
(C): You are not terrible. Culture is important but so is what you need and want.
(D): Have you tried talking to your parents and explaining what you are trying to do?

Correct Answer: You feel torn between caring for your parents and caring for yourself at the same time.
Explanation: The most appropriate response is paraphrasing the client's problem, giving her the opportunity to hear her dilemma restated. This provides an opening for the client to talk about how her collectivist culture and individualism are struggling within her and gives her the opportunity to begin processing this. Telling the client "I am so sorry" puts the focus on the counselor rather than the client and is likely to make the client regret sharing her distress, especially if she believes it is negatively impacting the counselor. Telling the client she is not terrible can provide some normalization, however, minimizing the importance of culture to the client suggests the counselor is not aware of its importance to the client. Asking if the client has tried talking to her parents suggests the counselor lacks cultural awareness and may be bringing her own cultural biases into the session by suggesting the client tell her parents what she wants to do. Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis