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 and reports that he and his wife have been getting along better since the last session following some conversations about what they can do to get through this situation together. The client says that he wants to work on figuring out what he is going to do for work next. You and the client discuss possible options, and he says a friend offered him a job at his restaurant. The client says that he is considering it just for the money but that he has never been a server before and has some reservations. You conduct a career interest assessment and discuss the results.  The client has not been applying to jobs due to anxiety that he will not get a job due to his age

Question: The client has not been applying to jobs due to anxiety that he will not get a job due to his age. Which of the following would be an appropriate intervention to improve his motivation to apply to jobs?
(A): Use of a CBT thought log to process during sessions
(B): Progressive muscle relaxation
(C): Role-playing
(D): Psychoeducation on relaxation techniques

Correct Answer: Use of a CBT thought log to process during sessions
Explanation: CBT thought log can capture unhelpful thinking that is a barrier to applying to jobs and can be used in counseling sessions to process these thoughts in order to improve self-talk. It will be helpful to provide psychoeducation on relaxation techniques, such as progressive muscle relaxation, in order to manage anxiety when he is experiencing it; however, this would not improve motivation because it focuses on symptoms rather than on cognitive barriers. Role-playing might be helpful when it comes to interviewing, but it does not help the client with applying to jobs. Therefore, the correct answer is (C)
Competency: counseling skills and interventions