Case Study
Patient Demographic: Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined
Mental Status Exam: Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with
Presenting Problem: You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.
Other Contexts: You and the client meet 4 days after the initial intake session due to truancy because she has missed several days of school. For about half of the session, the client seems to be withdrawn. She asks you what you are required to report, and you remind her of the limits of confidentiality. The client says that she understands, and then says she is going to talk about what happened anyway. She says that her volleyball coach asked to meet with her after practice about 7 months ago and when she entered his office, he asked to look at her right thigh following a fall during practice. She continues to state that when she showed him, he started to touch her genital area from the outside of her pants. She states that she ran out of the room and went home. She explains that after this event she quit the team and told her parents that she did not want to play anymore, but recently she has started to experience distressing memories of the sexual abuse; she refuses to go to school because she would see the man daily; she has difficulty feeling happiness; and she is experiencing feelings of shame, insomnia, and difficulty concentrating. You praise the client for disclosing this information and empathize with her about how hard it must have been to share this experience

Question: All of the following are appropriate short-term treatment goals following the new information presented during the session EXCEPT:
(A): Identify situations that could trigger a trauma response in order to reduce the impact of the sexual assault.
(B): Identify and reduce the symptoms and effects of the sexual assault.
(C): The client will process her feelings of shame associated with the sexual assault.
(D): Process thoughts and feelings regarding the investigation process into the sexual assault.

Correct Answer: Identify situations that could trigger a trauma response in order to reduce the impact of the sexual assault.
Explanation: Identifying situations that may trigger a trauma response would likely come later in treatment from processing because the effects of the sexual assault are not fully understood at this point. It is important to begin processing the feeling of shame because this is a feeling the client is experiencing presently. One of the first steps in working through trauma is to process how it affects present functioning; therefore, it would be helpful to assist the client in reducing the sexual assault’s effects on herself. It is also helpful to prepare the client for the investigation because this may be further triggering and occur quickly, and the client would be otherwise unprepared to emotionally manage the situation. Therefore, the correct answer is (D)
Competency: treatment planning