Case Study
Patient Demographic: Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5)
Mental Status Exam: Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam
Presenting Problem: You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.
Other Contexts:    ily and Work History: The client works as a web designer and developer. He allows you to obtain collateral information from his wife. You reach his wife by phone, who explains that the client has “an explosive temper when I don’t do things exactly how he asks.” The client’s wife states he can be controlling, overly critical, and irrational at times\. This is the client’s first marriage\. The client’s wife wants to participate in couples counseling but says the client is adamant about her not joining

Question: You are use using acceptance and commitment therapy (ACT) with the client, which involves combining behavioral therapy with which one of the following?
(A): Shaping
(B): Developing discrepancy
(C): Mindfulness
(D): Unbalancing

Correct Answer: Mindfulness
Explanation: ACT combines mindfulness and behavioral therapy to assist individuals with accepting distressing thoughts and feelings rather than fighting against them. ACT is an evidence-based practice for OCPD because of its focus on increasing psychological flexibility (ie, reducing rigidity). The practice of mindfulness helps clients stay in the here-and-now and accept each thought and feeling without judgment. Shaping is used in operant conditioning and involves reinforcing successive approximations to a targeted behavior. Unbalancing is associated with structural family therapy and consists of the counselor aligning with a family member or subsystem to create disequilibrium. Developing discrepancy is used with MI to help the client explore the pros and cons of making a change. Therefore, the correct answer is (A)
Competency: counseling skills and interventions