Case Study
Patient Demographic: Client Age: Client 1: Age 18 Client 2: Age 21 Client 3: Age 22 Client 4: Age 19 Client 5: Age 18 Sex: Male and female Gender: Male and female Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: All members are single Counseling Setting: Counseling clinicType of Counseling: Group and individual counseling Presenting Problem: All individuals are seeking support for struggles related to borderline personality disorder. Diagnosis: Borderline personality disorder (F60.3)
Mental Status Exam: Mental Status Exam: All clients appear to be oriented to time, situation, location, and person. The clients are all dressed appropriately for the weather. No clients appear to experience any visual or auditory hallucinations. Most of the clients are presenting as friendly but gua
Presenting Problem: You are a licensed therapist running a dialectical behavior therapy (DBT) group for young adults. You also provide a weekly individual counseling session for each group member, which is common practice for DBT group therapy. During the first session, you provide psychoeducation on DBT and the group process. Most of the members seem closed off and sometimes aggressive in response to being asked to speak during the first session, which can be consistent with borderline personality disorder. Client 3 becomes upset about halfway through the session, stating that he does not need to participate because the group will eventually end, so he does not need to build relationships with the group members. You end the session by planning individual therapy sessions with each group member.
Other Contexts: You meet with the group and continue DBT psychoeducation regarding distress tolerance. About halfway through the group, you notice that client 4 has not shared much, and you ask her about this. The client states that every time she wants to talk, she cannot find a way into the conversation because others are talking. This group is in the working stage of group therapy, they are actively engaged in the session, and they are all also actively engaged in individual therapy.  During this session, client 1, who is a quieter member of the group, begins to cry and client 5 tries to rescue him by immediately providing comfort

Question: During this session, client 1, who is a quieter member of the group, begins to cry and client 5 tries to rescue him by immediately providing comfort. Which of the following demonstrates the counselor’s most therapeutic rescuing response?
(A): Support client 1 in engaging in coping skills to manage his strong emotions.
(B): Encourage client 5 to allow client 1 to experience his pain.
(C): Directly engage with client 1 using the skill of immediacy.
(D): Allow client 5 to ease client 1’s pain because this builds group cohesion and helps client 1.

Correct Answer: Encourage client 5 to allow client 1 to experience his pain.
Explanation: When dealing with rescuing in the group setting, you want to encourage members to experience the emotion that they are feeling. It would be most helpful to encourage client 5 to allow client 1 to experience his pain because he has not been participating as openly in the group process, and this demonstrates a breakthrough. If client 1 had engaged more prior to display of emotions, it may be helpful to allow client 5 to ease his pain, but currently you want client 1 to experience his feelings. Engaging with immediacy and providing coping skills can be helpful, but in this case, prioritizing the client’s experience of his feelings is essential because he is just starting to participate meaningfully. Therefore, the correct answer is (B)
Competency: counseling skills and interventions