Case Study
Patient Demographic: Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th
Presenting Problem: You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.
Other Contexts: The couple acknowledge some improvement with communication, but they continue to feel significant levels of relationship distress. The client has been asking for what she needs, mainly when she is in pain and functionally limited, but she reports that the husband continues to do little to support her. The husband reiterates that he has a demanding job that depletes his energy and that he has little to give when he gets home at night. The husband’s child has been verbally abusive to the client, and her husband minimizes her concern. The client feels “stuck in the middle” when determining her stepson’s schedule and activities. The client states that her husband’s bitter ex-wife makes her new role as stepparent “nearly impossible.” To help with the postdivorce adjustment and lessen conflict, you provide information on local support groups, parent education programs through family court, and additional educational resources.  The imago intentional dialogue technique with couples consists of three steps

Question: The imago intentional dialogue technique with couples consists of three steps. In step 2, you encourage the message receiver to respond by stating, “You make sense because …” or “I can see where …” This is an example of which of the following?
(A): Empathizing
(B): Attending
(C): Validating
(D): Summarizing

Correct Answer: Validating
Explanation: This is an example of validating. Imago relationship therapy, developed by Dr Harville Hendrix and Dr Helen LaKelly Hunt, uses imago dialogue, or an imago intentional dialogue, which is a technique used with couples to facilitate meaningful dialogue rather than unproductive discussions that fuel criticism, judgment, and contempt. There are three steps to an imago dialogue: (1) mirroring (ie, “what I hear you say is …”), in which the sender’s message is reflected by using methods such as paraphrasing, summarizing, and clarification; (2) validating (ie, “you make sense because …”), which conveys to the sender that the receiver has accurately understood the message and conveys how it made sense to them; and (3) empathizing, (ie, “I imagine this feels …”), which involves processing the message sender’s underlying feelings. Attending is a listening skill used throughout the process. Couples demonstrate attending using eye contact, facing their partner, and remaining focused. Therefore, the correct answer is (D)
Competency: counseling skills and interventions