Case Study
Patient Demographic: 7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual
Mental Status Exam: Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone
Presenting Problem: Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.
Other Contexts: llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.

Question: How will showing Millie unconditional positive regard help her clinically?
(A): Being genuinely nice to Millie will guarantee she will continue to see you.
(B): Millie will experience paradoxical intention and develop insight into her behaviors.
(C): Millie will more likely engage therapeutically over time if she feels accepted.
(D): Approval of Millie's behavior will make her feel better about her decisions.

Correct Answer: Millie will more likely engage therapeutically over time if she feels accepted.
Explanation: Unconditional positive regard (UPR), credited by the humanist psychologist Carl Rogers, is demonstrating unconditional love, acceptance and affection for your client while not necessarily approving of their behaviors, as in answer b. Through UPR, a therapist offers compassion and puts their value in the person over their choices. Use of this core counseling attribute will not guarantee a client will continue in therapy as in answer c but will increase the chances they will feel willing to engage and participate. Paradoxical intention as in answer d is the cognitive technique of persuading a patient to engage in their most feared or conflicted behavior and is therefore not applicable. Therefore, the correct answer is (A)
Competency: core counseling attributes