Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem
Presenting Problem: You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.
Other Contexts: You meet with the client, and she comes and sits down and appears happy because she is smiling and sitting with an open posture. The client’s food log shows improvement in engaging in healthier eating habits and minimal restriction. You and the client review her progress in treatment and agree that she has met all of the treatment goals. The client reports several situations in which she wanted to restrict, purge, and binge, but instead she engaged in cognitive reframing and was able to manage her reaction to the trigger. You praise the client and express that she should be proud of herself for her management of her symptoms. The client reports that she has gained weight and is in a healthy weight range at this point. She continues that her husband has made comments of concern about her weight gain and that the frequency of sex has decreased recently. The client says that she and her husband have been arguing about her eating recently and that she does not feel that he supports her in recovering from her eating disorder. You empathize with the client

Question: Which of the following indicates that this client is ready for termination?
(A): The client reports that no symptoms of the eating disorder or trauma are present, and you also observe no symptoms.
(B): The client states that she is not restricting, bingeing, or purging and that she and her husband are going to start couples counseling.
(C): The client has nothing to talk about in sessions and reports that she does not have anything she needs to work on.
(D): Minimal symptoms of the eating disorder and trauma are present, and the client manages them when they occur.

Correct Answer: Minimal symptoms of the eating disorder and trauma are present, and the client manages them when they occur.
Explanation: It is not always realistic to expect all symptoms to be abated. When minimal symptoms are present and the client is able to manage them and maintain progress, termination is appropriate. Although no symptoms being present is the ideal, this may never be attainable in some clients; therefore, it is appropriate to terminate when the client is able to be autonomous and manage her symptoms by herself. The client having nothing to talk about is not ideal for termination because this may indicate that she is not reporting or not being forthcoming with what she is experiencing. The client’s report regarding eating habits and a plan for couples counseling is good progress, but it does not focus on the client’s autonomy regarding her ability to manage symptoms on her own. Symptoms may be present long after therapy, but one of the most important aspects of counseling is that the client is able to self-regulate and manage what life sends to her. Therefore, the correct answer is (B)
Competency: professional practice and ethics