Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Counseling Clinic Type of Counseling: Individual Presenting Problem: Depression and Suicidal Ideation Diagnosis: Major Depressive Disorder, Recurrent, Mild (F33.0)
Mental Status Exam: Mental Status Exam: The client appears to not have bathed recently because his hair is greasy and unkempt. The client has food stains on his clothing; however, he is dressed appropriately for the season. His motor movements are within normal limits. He is engaged in therapy, but he appears anxious as evidenced by hesitating before speaking and by his hand wringing. The client reports suicidal ideation with no plan or intent. The client reports a depressed mood more often than not and difficulty enjoying most activities. The client is oriented to person, place, time, and situation. The client reports that his appetite has increased lately and that he is experiencing hyperso
Presenting Problem: You are a resident in counseling practicing in a private practice agency. During the initial counseling session, the 25-year-old single male client reports feeling depressed and hopeless. He has difficulty enjoying activities that he has enjoyed in the past and feels unsatisfied with most areas of his life. The client identifies that he is not happy at work and wants to make a career change. The client verbalizes feeling sad more often than not, and that this has been going on for about 2 years. The client decided to start counseling when he began experiencing suicidal thoughts. The client reports no plan or intent to attempt suicide but is concerned about his own well-being.
Other Contexts:    mnia. Family History: The client reports that he has two younger brothers who are 19 and 22 years old. His parents divorced when he was 10 years old, and he grew up living with his mother but maintained a strong consistent relationship with his father. The client reports no history of trauma, neglect, physical abuse, sexual abuse, or emotional abuse. The client denies drug or alcohol use, although he reports that his father previously was an active alcoholic.  Due to your observation of anxious behavior, you prompt the client to identify and rate his feelings at the start and end of the session

Question: Due to your observation of anxious behavior, you prompt the client to identify and rate his feelings at the start and end of the session. What would be the main purpose of this therapeutic intervention in the first session?
(A): To facilitate the client’s awareness of his anxious behavior
(B): To determine the client’s level of comfort
(C): To determine if the counselor can meet the needs of the client
(D): To facilitate discussion regarding goals for anxiety management

Correct Answer: To determine the client’s level of comfort
Explanation: The client’s level of comfort is assessed using this therapeutic intervention. This intervention involves the use of the counseling skill called “immediacy” Immediacy addresses emotional responses that are present in the counseling session and can facilitate deeper processing of emotions and building therapeutic rapport. Although the client’s hesitation before speaking and him wringing his hands may indicate anxiety, it is common for clients to be nervous during their first therapy session. Creating awareness of anxious behavior alone may make the client feel judgment, which may make him more uncomfortable. This intervention will not, on its own, determine if the counselor is a good fit for the client. Therefore, the correct answer is (B)
Competency: professional practice and ethics