Case Study
Patient Demographic: Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th
Presenting Problem: You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.
Other Contexts:    e  The client’s milestones for walking, talking, and toilet training were all developmentally appropriate. The client is the only child of parents who divorced when the client was 5 years old. She states that she has always been a worrier and remembers seeing the school counselor in kindergarten for separation anxiety. Her father has physical custody of the client, and her mother sees the client at regular visitation intervals. The father is a tennis pro, and her mother works as a fitness trainer. The client describes her parents as “type A” and explains, “They are always pushing me to my limit.” The client’s mother has panic attacks, which the client believes are manageable with medication. Her maternal grandmother was an alcoholic who died when her mother was younger. There are no reported mental health issues on the paternal side of the family

Question: During the initial stages of therapy, which of the following would best enhance the family’s motivation and adherence to treatment?
(A): Providing written information explaining the components of informed consent
(B): Integrating contextualized factors (e.g., cultural, spiritual) into treatment interventions
(C): Offering a selection from a variety of treatment modalities (e.g., individual, group, family)
(D): Coordinating treatment with youth-serving systems (e.g., educational, medical)

Correct Answer: Integrating contextualized factors (e.g., cultural, spiritual) into treatment interventions
Explanation: Integrating contextualized factors in treatment interventions is the best way to enhance the family’s motivation and adherence to treatment. Integrating contextual factors is one method that counselors use to help establish a therapeutic alliance, enhance motivation, and increase treatment adherence. Examples of contextualized elements include race, ethnicity, gender, spirituality, and culture. The client is an African American female with concerns about fitting in with her predominantly white peers. When delivering contextualized treatment interventions, the client’s and counselor’s racial and ethnic identity and positionality (ie, privileged versus marginalized) must also be considered. Offering a selection of treatment modalities during the initial stages of therapy may not be appropriate or desired. Coordinating treatment with youth-serving systems is vital to the client’s care but is not the best way to influence motivation and treatment adherence. Counselors provide written verbal explanations of informed consent and transparent back-and-forth discussions to help foster a clear understanding of all components of informed consent before obtaining an agreement. Therefore, the correct answer is (B)
Competency: core counseling attributes