Case Study
Patient Demographic: Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng
Presenting Problem: You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.
Other Contexts: The client enters the room and appears distracted when she sits down because she has a furrowed brow and is looking off to the side of the room. You ask her what is on her mind, and she reports that this morning she had a panic attack that led to her throwing up. You ask her to talk through the moments when she noticed it starting and how the panic attack progressed. She says that she woke up and was worried that she might have a panic attack because she typically has one on school days, and this turned into worry that she might be late for class, which compounded into worry about how it might affect her grades and eventually into certainty that she would fail. The client then experienced an increased heart rate, chest tightness, difficulty breathing, a feeling of impending doom, shaking, and finally vomiting. You empathize with the client and provide psychoeducation on the management of panic attacks.  You had an argument with your roommate prior to the session and are distracted

Question: You had an argument with your roommate prior to the session and are distracted. Which of the following would be the most appropriate decision with regard to your client’s well-being as it is impacted by your distraction?
(A): Start the session a little late so you can resolve the argument in order to be more focused.
(B): Reschedule the session with the client.
(C): Talk with the client about how you might impact the session and get refocused.
(D): Be aware of how your personal life is impacting the session and refocus as needed.

Correct Answer: Be aware of how your personal life is impacting the session and refocus as needed.
Explanation: It is most ethical and appropriate to continue your session as scheduled, while maintaining awareness of how your personal life is affecting the counseling session because you want to support the client and prevent as much personal impact as possible. Rescheduling may be appropriate if the impact of your personal life is unavoidable; however, it is your responsibility as a therapist to ensure that you are minimizing your own personal life’s impact on the client. Occasionally, you may need to directly address emotions or thoughts that you are having during sessions; however, this topic may distract from the client and reduce their confidence in your focus this session. You want to be consistent and be on time to respect your client’s time and to show your investment in the client. Therefore, the correct answer is (B)
Competency: professional practice and ethics