Case Study
Patient Demographic: Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)
Mental Status Exam: Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.
Presenting Problem: You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”
Other Contexts: The client attends a process-oriented CBT group that is nearing the middle stage of group development. The client presents today with a bright affect and arrives early to converse with two other women in the group. During group activities, she is reticent to share and is sensitive to a conflict between two members that has started to emerge. One member becomes openly critical of the group tasks and their usefulness. Other members start to weigh in and take sides. The conflict quickly escalates between two members, with one shouting at another, “You have monopolized every session with your opinions. You are the most judgmental person I know! This group would be so much better without you.” Other members nod in agreement

Question: After processing the conflict, what technique could you use to help group members recognize significant themes and patterns?
(A): Genuineness
(B): Summarization
(C): Empathetic reflection
(D): Unconditional positive regard

Correct Answer: Summarization
Explanation: Counselors use summarization to tie together certain concepts and themes. Summarization is particularly useful in the middle stages of group development, with special care being taken to emphasize positive growth or therapeutic progress. Genuineness, or congruence, occurs when the counselor’s responses are consistent with what the client is expressing. Counselors also use genuineness to show nonjudgmental acceptance, reflect empathetic attunement, and keep the focus on here-and-now interactions. Counselors express unconditional positive regard by showing nonjudgmental acceptance and care for clients. Counselors use empathetic reflection to respond to the client’s underlying feelings accurately. Empathetic reflections lead to empathetic responding, which consists of perceiving, understanding, and experiencing what the client is communicating. Therefore, the correct answer is (D)
Competency: counseling skills and interventions