Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af
Presenting Problem: You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.
Other Contexts: You meet with the client, and he reports that he was able to improve his productivity by organizing his day based on organization techniques that you discussed in therapy. The client says that he really wants to focus on getting into writing stories again and that he also wants to learn to play guitar. He explains that his attempts at learning guitar are disrupted because, when he tries, he becomes frustrated, stops quickly, and often does not revisit playing for weeks. You ask the client about thoughts that he has that are a barrier to writing and playing the guitar, and he identifies that he often anticipates that he will just get frustrated and stop, so there is no point in trying. You support the client in cognitive reframing.  You suspect that the client might have depression

Question: You suspect that the client might have depression. Which one of the following statements is a helpful cognitive reframing of the client’s statement of “I will get frustrated and won’t enjoy playing guitar, so I won’t play at all”?
(A): “I might enjoy playing guitar more than I think I will because if I don’t change what I’m doing, then things will stay the same.”
(B): “I should wait until tomorrow, and I’ll play guitar at 6 pm after dinner.”
(C): “I might enjoy playing guitar; therefore, I’ll try to play for a few minutes.”
(D): “I will play guitar when I’m ready, which is when I feel a bit more motivated.”

Correct Answer: “I might enjoy playing guitar more than I think I will because if I don’t change what I’m doing, then things will stay the same.”
Explanation: When considering depression, activities often seem like they will not be as enjoyable as they are in reality; therefore, it is important to try them anyway. When using cognitive reframing, it is important to consider the notion that if no changes are made, things will remain the same. Encouraging the client to remind himself that he may enjoy the simple process of playing guitar is not as relevant because it does not account for the client’s ability to effect change. The notion that the client should wait until he is “ready to play” allows space for him to find excuses not to play if he is struggling with the impacts of depression and ADHD. Although creating a plan to complete a goal can help the client in goal achievement, it likely will not empower the client to manage his present emotions and thoughts. Therefore, the correct answer is (D)
Competency: counseling skills and interventions