Case Study
Patient Demographic: Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)
Mental Status Exam: Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa
Presenting Problem: You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.
Other Contexts: The client comes into the session with a similar presentation as last week as he sits down and sighs deeply. You ask the client what he is thinking about, and he recounts an argument earlier in the day that he had with his wife when they were discussing finances. The client expresses frustration that they have had several arguments over the past week regarding finances. You empathize with the client and support him with further processing his anxiety about finances. The client expresses an immediate need to start working soon for financial reasons and because he is having a hard time “doing nothing” every day.  During the session, the client states, “I don’t think I can provide for my family like I need to, so I’m worthless

Question: During the session, the client states, “I don’t think I can provide for my family like I need to, so I’m worthless.” Which one of the following areas needs to be explored following this statement?
(A): Anxiety
(B): Self-esteem
(C): Depression
(D): Work skills

Correct Answer: Self-esteem
Explanation: As evidenced by his frustration with unemployment and feelings of worthlessness, the client’s self-esteem is affected by his current situation. This would be important to investigate further. The client’s depression and depressed mood have already been identified and are therefore not new symptoms. The client has demonstrated that he has work skills, and although it is within your role to support the client in finding new opportunities that match his skill set, the focus should be on the underlying root of the client’s statement. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis