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.  You select Aaron Beck’s cognitive model for depression to address the client’s feelings of worthlessness

Question: You select Aaron Beck’s cognitive model for depression to address the client’s feelings of worthlessness. According to Beck, causes of the client’s distorted thinking can be attributed to which of the following?
(A): Feelings of inferiority due to a mistaken style of life
(B): Activating events, beliefs, and consequences
(C): Unresolved unconscious conflicts
(D): View of oneself, the world, and one’s future

Correct Answer: View of oneself, the world, and one’s future
Explanation: Beck would attribute causes of the client’s distorted thinking to their view of themselves, their world, and their future. These cognitive deficiencies are known as the “cognitive triad” Freud attributed maladaptive behavior to unresolved conscious conflicts. Adlerian therapists view maladjustment as the development of a mistaken style of life leading to feelings of inferiority. Known for rational-emotive therapy, Ellis suggests that irrational thinking can be deconstructed by recognizing an activating event, beliefs, and consequences. Therefore, the correct answer is (D)
Competency: counseling skills and interventions