Case Study
Patient Demographic: Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)
Mental Status Exam: Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.
Presenting Problem: You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”
Other Contexts: The client participates in her last group therapy session today. You and the client review her treatment plan goals, and she reports an overall decrease in anxiety and says that she possesses a greater awareness of social anxiety disorder and the associated interventions. She has recently completed a job interview after previously scheduling and canceling two interviews. She plans to stay in touch with two group members. The client is ready to begin termination but is anxious about ending counseling. You and the client review the psychoeducation material reviewed in the group, including factors associated with social anxiety disorder and learned coping strategies.  The client recognizes gains that she has made but fears that she will fail after discharge

Question: The client recognizes gains that she has made but fears that she will fail after discharge. Which humanistic technique would you use to best respond to this discrepancy?
(A): Self-disclosure
(B): Constructive confrontation
(C): Amplified reflection
(D): Attending

Correct Answer: Constructive confrontation
Explanation: Constructive confrontation is designed to help clients achieve congruence. Humanistic therapists assert that incongruence occurs when there is a discrepancy between clients’ perceptions of themselves and reality. Therapists use constructive confrontation when pointing out discrepancies among the client’s actions, thoughts, behaviors, perception, or nonverbal communication. An amplified reflection is a motivational interviewing skill used to state the client’s original statement and overemphasize their point or intent. Amplified reflections address ambivalence to change, making this answer option incorrect. Attending is the counselor’s way of showing interest. The interest can be verbal (eg, by saying “Go on”) or nonverbal (eg, nodding the head). Finally, counselors use self-disclosure when sharing personal aspects of themselves. Self-disclosure can take many forms and may be appropriate or inappropriate, depending on the counselor’s motives (ie, self-serving versus benefiting the client and/or the therapeutic relationship). Therefore, the correct answer is (A)
Competency: counseling skills and interventions