Case Study
Patient Demographic: Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5)
Mental Status Exam: Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam
Presenting Problem: You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.
Other Contexts: The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client

Question: Which cognitive distortion operates from the premise that his wife’s refusal to conform to the client’s high standards is associated with ineptitude and defiance?
(A): Personalization
(B): Mind reading
(C): Overgeneralization
(D): Black and white thinking

Correct Answer: Black and white thinking
Explanation: Black and white thinking is the cognitive distortion associated with the belief that anyone who refuses to conform to the client’s standards is seen as inept and defiant. Black and white thinking, also known as polarization or all or nothing thinking, is exhibited when shades of gray are not acknowledged. There is ridged inflexibility with others. If the wife agrees and conforms to the client’s perfectionistic standards, all is well in the relationship. If the wife dissents and refuses to comply with the client’s perfectionistic standards, she is inept and defiant. Something is either great or terrible; a person is either perfect or a failure. Overgeneralization, personalization, and mind-reading, generally result in self-blame, which is atypical for individuals with OCPD. Overgeneralization occurs when broad implications are based on one or two minor instances (eg, “I let down a friend. Now everyone thinks I’m a total disaster!”). Personalization happens when one assigns themselves blame without solid logistical evidence. As the name implies, mind-reading occurs when one jumps to conclusions or negatively interprets another person’s intentions, feelings, and actions. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis