Case Study
Patient Demographic: Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0)
Mental Status Exam: Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th
Presenting Problem: You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.
Other Contexts:    e  The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services.  You discuss the case with your supervisor, who encourages you to use a structural family therapy approach to examine the relationship between the client and his mother

Question: You discuss the case with your supervisor, who encourages you to use a structural family therapy approach to examine the relationship between the client and his mother. Which statement best reflects this approach?
(A): The client and the mother’s maladaptive behavior is the result of misunderstandings and a lack of loyalty and trust.
(B): The client and the mother belong to an enmeshed family subsystem.
(C): The client and the mother’s dysfunctional communication is the result of a reinforced circular feedback loop.
(D): The client and the mother are highly emotionally fused and undifferentiated.

Correct Answer: The client and the mother belong to an enmeshed family subsystem.
Explanation: Developed by Salvador Minuchin, structural family therapy is based on the premise that family subsystems and boundaries are either disengaged or enmeshed. The mother and the client are an enmeshed subsystem due to being overly dependent and close. Multigenerational (Extended) Family Systems therapists use the termundifferentiated family ego massto describe individuals in families with high levels of emotional fusion and low levels of differentiation. Contextual family therapists view maladaptive behavior as an imbalance in loyalty, trust, and mutual understanding. Strategic family therapists view maladaptive behavior as the result of circular communication. Circular communication occurs when a behaviorally reinforced feedback loop maintains the family’s homeostasis and dysfunction. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis