Case Study
Patient Demographic: Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng
Presenting Problem: You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.
Other Contexts: You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services.  You are supervising a counseling resident, and their established client has canceled several sessions in a row

Question: You are supervising a counseling resident, and their established client has canceled several sessions in a row. Which of the following would you encourage the counselor to do?
(A): Contact the client to encourage them to trust the therapeutic process and continue to have sessions.
(B): Support the client by providing an option to have a referral if they think that counseling is not working.
(C): Follow up with the client to ascertain the reason for their cancellations.
(D): Cancel ongoing sessions until the client can commit to regular sessions.

Correct Answer: Follow up with the client to ascertain the reason for their cancellations.
Explanation: Determining the reason for the cancellations is most important because this can open up a dialogue for getting back on track in the counseling relationship. It may be helpful to cancel future sessions if the client will receive cancellation fees, but this does not get to the bottom of what is happening with the client. It can also be helpful to encourage the client to trust the process, but this does not open up dialogue about what they are experiencing. If the client would like a referral, you should support them. However, it is more helpful to process what is causing the cancellations because it may be related to why the client is in treatment, and if unresolved, they may continue to have this issue with the next therapist. Therefore, the correct answer is (A)
Competency: professional practice and ethics