Case Study
Patient Demographic: Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00)
Mental Status Exam: Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam
Presenting Problem: You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.
Other Contexts:    ily and Work History: The client was married for 15 years before she divorced. She and her ex-husband share custody of their 16-year-old son. The client is an only child and reports that her parents were strict and overbearing when she was growing up. She works as a travel photographer and, until recently, worked for a large national publication. She enjoyed her job but cannot envision a time when she would feel comfortable staying in hotels again. This fear has prevented her from exploring other travel accommodations while on assignment. She states, “There are too many unknowns with travel, and I just don’t think I can do it any longer.”  The client relies on her son when she is too anxious to leave the house, and she describes her parents as overbearing

Question: The client relies on her son when she is too anxious to leave the house, and she describes her parents as overbearing. How might a structural family therapist define the boundaries in the client’s family?
(A): Clear
(B): Disengaged
(C): Diffuse
(D): Flexible

Correct Answer: Diffuse
Explanation: The client’s family boundaries can be described as diffuse. Structural family therapists focus on boundaries among family members. Boundaries are rules or barriers within a family system that dictate the amount of contact that members have with each other and the larger community. Families with diffuse boundaries are also described as enmeshed, which is observed in families who have become overly dependent on one another. Flexible boundaries occur when the boundaries are neither too closed and isolated nor too open and rigid. Flexible boundaries and clear boundaries are synonymous. Structural family therapists view healthy boundaries as those with the flexibility to adapt to stressors, communicate, and adjust limits when needed. Disengaged boundaries are rigid, and family members are isolated from one another. Therefore, the correct answer is (D)
Competency: counseling skills and interventions