Case Study
Patient Demographic:  Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual
Mental Status Exam: Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.
Presenting Problem: Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.
Other Contexts: Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.

Question: Taylor asks if anyone in your family has autism. What is the best response?
(A): Offer a warm smile and respond asking "How would it help you to know if I did or not?"
(B): None of these options are appropriate.
(C): Gently point out that personal details about the counselor are not important.
(D): Share about those whom you know with autism to create a therapeutic bond.

Correct Answer: Offer a warm smile and respond asking "How would it help you to know if I did or not?"
Explanation: Clients are often looking to bond with their counselor to share similar experiences or seeking support from their counselor through advice based on personal experience. While neither is necessary to offer valid clinical feedback, understanding why a client wants to know can be more helpful in therapy than building rapport through sharing a commonality. Self-disclosure is always at the discretion of the counselor but answer a maintains the focus on the client's feelings. Answer b alters the professional relationship by switching focus to the counselor, which again is at the counselor's discretion but is not the best response. Pointing out that details about yourself are not important when a client has specifically asked them of you can be invalidating if you are unaware of the client's reasons for asking. Therefore, the correct answer is (A)
Competency: counseling skills and interventions