Case Study
Patient Demographic: Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam
Presenting Problem: You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.
Other Contexts: The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process

Question: To facilitate the client’s progress, which of the following would you use to help access the client’s underlying core beliefs about himself, others, and the world?
(A): The hidden emotion technique
(B): The memory rescripting technique
(C): The scaling technique
(D): The downward arrow technique

Correct Answer: The downward arrow technique
Explanation: The downward arrow technique helps facilitate the client’s progress by uncovering the client’s underlying core beliefs about himself, others, and the world. Core beliefs, generally rooted in childhood experiences, can drive automatic thoughts and lead to distorted thinking. The downward arrow technique identifies the intermediate beliefs impeding progress. The counselor then draws a downward arrow and challenges each rigidly held belief. For example: Client: “I’m destined to fail in all intimate relationships” Counselor: “And what does that mean?” Client: “I’m a failure” Counselor: “If you’re a failure, what does that suggest?” Client: “That I’m unlovable” Once the core belief is uncovered, it can be further explored and tested against sound logic and reason. Memory rescripting, or imagery rescripting, is a technique used with clients experiencing flashbacks originating from trauma. The goal of memory rescripting is to alter the memories leading to shame and self-blame. The hidden emotion technique brings to the forefront anxiety-provoking situations that are avoided or denied. Counselors who practice solution-focused therapy use scaling questions to help clients track their progress on an identified goal. Therefore, the correct answer is (A)
Competency: counseling skills and interventions