Case Study
Patient Demographic: Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)
Mental Status Exam: Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner
Presenting Problem: You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.
Other Contexts: The client comes into your office and says hello in a quiet voice and then sits down, slumps his shoulders, and does not make eye contact. You inquire about what you see, and the client says that he has been feeling more depressed over the past week. The client says that he is experiencing low appetite, a down mood, fatigue, and irritability. You empathize with the client and discuss coping skills for depressive symptoms. The client expresses frustration with his church because he worked part-time in the church office until recently when they encouraged him to resign because he is divorced and he is now unable to work in the church because of this. You empathize with the client regarding his situation at church.  The client states, “I don’t understand how a loving God would approve of disqualifying me from working at church because of a decision my wife made.” The client then begins to cry

Question: The client states, “I don’t understand how a loving God would approve of disqualifying me from working at church because of a decision my wife made.” The client then begins to cry. Which of the following responses would be considered an expression of validation?
(A): “If I am understanding you correctly, it sounds like you’re feeling depressed and frustrated following the finalization of the divorce and the church encouraging you to resign.”
(B): “It does sound frustrating to be encouraged to resign when the choice to divorce was not yours. I think it is perfectly understandable to be sad and frustrated about this.”
(C): “It sounds like you are frustrated that the church encouraged you to resign because of a situation that you do not have control over.”
(D): “I can see how that would be frustrating for you because it might feel incongruent with your beliefs.”

Correct Answer: “It does sound frustrating to be encouraged to resign when the choice to divorce was not yours. I think it is perfectly understandable to be sad and frustrated about this.”
Explanation: Reflecting the emotion of being frustrated about the resignation and then moving to agreeing that the client’s feelings are understandable is validation because it goes a step past reflection to normalizing his emotions. Understanding that a situation is frustrating aligns more with empathy. Simply acknowledging frustration regarding the situation would just be reflection because you are reflecting his emotion. Expressing understanding about frustration regarding the church situation and depressive symptoms is simply a summarization of what the client has said. Therefore, the correct answer is (B)
Competency: counseling skills and interventions