Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed
Mental Status Exam: Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc
Presenting Problem: You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.
Other Contexts:    ence. Family History: The client is married and has a 10-year-old daughter from a previous marriage. The client explains that her father was “distant and quiet unless he was drinking.” She remembers hearing that her paternal grandfather declared bankruptcy “at least once” due to gambling losses. The client’s mother has been diagnosed with bipolar disorder, with acute episodes requiring hospitalization. The client indicates that a former therapist also diagnosed her with bipolar disorder, but she rejects the diagnosis stating her symptoms are “nothing like my mother’s

Question: How would you engage the client during the initial phase of treatment?
(A): Encourage her to keep a thought log to track maladaptive cognitions.
(B): Explore factors she believes maintains her depression.
(C): Tell her about your theoretical orientation and experience.
(D): Determine the expectations she has regarding the length of time in treatment.

Correct Answer: Determine the expectations she has regarding the length of time in treatment.
Explanation: The best way to engage the client during the initial phase of counseling is to determine her expectations regarding the length of treatment. Strengthening the therapeutic alliance helps engage clients in therapy. The therapeutic alliance is enhanced when the client and therapist work collaboratively to determine agreed-upon tasks and treatment plan goals. The length of time in treatment is a part of informed consent and is documented on the client’s treatment plan. Telling the client about your theoretical orientation and experience is incorrect because it does not actively engage the client. Counselors adopting a strengths-based approach are more likely to engage and motivate clients. Answers B and D are incorrect because the focus is on the problem rather than the solution. Therefore, the correct answer is (C)
Competency: treatment planning