Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation
Presenting Problem: You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.
Other Contexts: ship. Family History: The client is close with her parents and her younger brother (28 years old). The client says that she was engaged twice before but that neither engagement progressed to marriage because her two fiancés both felt that she was too clingy and unable to care for herself.  The client is hesitant about sharing her experiences of physical abuse

Question: The client is hesitant about sharing her experiences of physical abuse. How does this inform your course of treatment?
(A): Check in every session to see if the client is ready to talk about the physical abuse, and then strongly encourage it when you think you have a strong therapeutic rapport with her.
(B): Encourage the client to talk about the abuse during the intake session, and remind her that the more you learn about her, the more effective treatment will be.
(C): Allow the client a few sessions to become more comfortable, and then strongly encourage the client to talk about the physical abuse.
(D): Allow the client the space needed to become ready on her own, and bring it up every few sessions to check in and see if she is ready.

Correct Answer: Allow the client the space needed to become ready on her own, and bring it up every few sessions to check in and see if she is ready.
Explanation: When processing any sort of trauma, the counselor should follow the client’s lead regarding their readiness to discuss the trauma (in this case, abuse). There is no obligation for clients to talk about something that they do not want to, or are not ready to, talk about. It would be helpful to check in every few sessions to show this client that you remember that this was an issue she presented and to open up the opportunity to discuss it, should her willingness/readiness to do so change. Asking about the trauma every session or pressuring the client to talk about the trauma could cause more harm than good and could induce more resistance to openly discuss it. Although it is important to talk about the client’s history of physical abuse at some point (because it likely contributes to her presenting issues), the timing must be dictated by the client. Therefore, the correct answer is (C)
Competency: treatment planning