Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3)
Mental Status Exam: Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio
Presenting Problem: You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.
Other Contexts: The client informs you that she is upset because of a recent incident involving her two sons. She states that her teenage sons were walking in a neighborhood park when they came across a group of white men who used xenophobic slurs and threatened them. The boys said the men spit on them and told them to “go back to where they came from.” The client’s bouts of depression persist, and this is now coupled with the feeling that she has somehow failed to protect her sons. The client is also concerned that her husband is becoming increasingly intolerant of her inability to cook, clean, and care for their boys. The client states this makes her feel “worthless” and a “nobody.” She has also become more isolated and misses “having the energy” to connect with those in her community.  When the client recounts the incident with her two sons in the park, you remain open to the client’s underlying experiences in the present moment and respond authentically

Question: When the client recounts the incident with her two sons in the park, you remain open to the client’s underlying experiences in the present moment and respond authentically. This is an example of which one of the following?
(A): Providing congruence
(B): Shaping competence
(C): Increasing differentiation
(D): Supplying positive reinforcement

Correct Answer: Providing congruence
Explanation: You are providing congruence by remaining open to the client’s underlying experiences in the present moment and responding authentically. Congruence (or genuineness) is expressed when counselors accurately attend to the interpersonal and intrapersonal aspects of the therapeutic relationship. Counselors need to be mindfully aware of their own intrapersonal experiences to skillfully respond to the client’s experiences (ie, the interpersonal facet). Increasing differentiation is a Bowenian family therapy technique. Bowen believed that optimal family functioning occurs with healthy boundaries or differentiation. Shaping competence is a technique used by structural family therapists when emphasizing the positive behaviors of family members. Positive reinforcement is a behavior modification technique used to increase desired behaviors. Therefore, the correct answer is (D)
Competency: counseling skills and interventions