Case Study
Patient Demographic: Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate
Mental Status Exam: Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent
Presenting Problem: You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”
Other Contexts: The client reports that she started her week doing well but had a setback a few days ago, causing her to lose confidence in her ability to change. Despite her progress in reducing binge-eating episodes, the client remarks, “I’ll never control my eating.” She says she is frustrated and feels hopeless and unmotivated. You address her ambivalence to change, as well as obstacles she has experienced in the past. When discussing exercise, the client states, “You don’t understand! I’ve tried exercise, and it never works.” You provide the client with self-monitoring sheets to record the following in real-time: daily food intake, maladaptive eating patterns, and thoughts and feelings that accompany binge eating. She is hesitant but agrees to give it a try for one week

Question: Using motivational interviewing to respond to the client’s attitude towards exercise, which statement represents an amplified reflection?
(A): “You’re done with taking suggestions; there are no options left for you.”
(B): “You’ve tried exercise and don’t think it will ever work for you.”
(C): “You feel like nothing works, but you remain persistent. Making this change must be really important to you.”
(D): “You’re frustrated at my suggestion, so much so that it seems like you’ve reached a boiling point.”

Correct Answer: “You’re done with taking suggestions; there are no options left for you.”
Explanation: The counselor’s response representing an amplified reflection is: “You’re done taking suggestions; it feels like there are no options left for you” Amplified reflections use the client’s original statement and over-emphasize their point or intent. The purpose is to push the client past ambivalence and toward change. A simple reflection is represented in answer A: “You’ve tried exercise and don’t think it will work” A simple reflection validates what the client has said and shows that you are listening to her concerns. Stating that it seems like the client may have reached a boiling point is not entirely accurate and illustrates a communication error, specifically a depth error. This occurs when the therapist reads too much into the client’s statements. Answer B, which states: “You feel like nothing works, but you remain persistent. Making this change must be really important to you,” is an example of reframing. Reframing is used to help the client see the problem from a different and generally more positive perspective. Therefore, the correct answer is (C)
Competency: counseling skills and interventions