Case Study
Patient Demographic: Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate
Mental Status Exam: Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam
Presenting Problem: You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.
Other Contexts: The client displays a blunted affect and remains pleasant and cooperative. He reports that he did apply for a few jobs, but it has been difficult due to his past experiences of workplace harassment and discrimination. He is socializing more frequently, primarily at LGBTQ-friendly bars and clubs. The client states he used to go to the gym daily and has recently started going some on the weekends. He explains that he has felt less depressed but remains poorly motivated. He denies suicidal ideation. The client is unsure how to prioritize goals for treatment.  The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation

Question: The client reports feeling “defective” and carries a significant amount of shame related to his sexual orientation. Using a constructionist approach, how would you assist the client with these feelings?
(A): Construct an authentic sense of self by examining the consequences of overgeneralization.
(B): Improve the client’s sense of self-worth by showing unconditional positive regard.
(C): Create a strengths-based narrative emphasizing affirming community experiences.
(D): Teach new skills by increasing environmental rewards and positive reinforcement to mitigate avoidance and shame.

Correct Answer: Create a strengths-based narrative emphasizing affirming community experiences.
Explanation: A constructionist approach would assist with creating a strengths-based narrative emphasizing affirming community experiences. Constructionists believe that individuals create personal meaning in their lives through social constructs (ie, relationships with others). Theories that use a constructionist approach include object-relations theory, solution-focused therapy, emotionally focused therapy, and narrative therapy. Narrative therapy uses a strengths-based approach to help clients retell their stories and reauthor their lives. The client attests to finding acceptance in the LGBTQ community, which may help guide the client to an affirming sense of self. Showing unconditional positive regard is a person-centered technique rather than a constructivist approach. CBT would emphasize that the client is engaging in overgeneralization, a cognitive distortion used when taking one incident and using it as the only source of evidence for a general conclusion. Finally, behavioral therapists would teach new skills by increasing environmental rewards and positive reinforcement. Therefore, the correct answer is (C)
Competency: counseling skills and interventions