Case Study
Patient Demographic: Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th
Presenting Problem: You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.
Other Contexts: The client attends group therapy and is making therapeutic gains. Her overall anxiety has decreased, and she is engaging in more constructive thinking. Today is week 6 out of the 12 scheduled weekly group sessions. The client continues to work on increasing her assertiveness and has become less tentative with self-disclosures. She is pleasant and cooperative but remains eager to please others. Three group participants have formed a subgroup (i\. e., clique) and have excluded others. The client has begun to take social risks, and today she shares about a time when she felt most anxious. You notice the subgroup whispering and laughing after her disclosure. She nervously turns to you to gauge your response

Question: How should you respond to the negative interactions between the client and the members of the subgroup?
(A): Use linking to help the client recognize similar feelings that she experienced in her past.
(B): Evoke universality by asking the client to share how the experience has made her feel.
(C): Impart information by offering your interpretation of the interaction.
(D): Block the negative behavior and reestablish protective norms.

Correct Answer: Block the negative behavior and reestablish protective norms.
Explanation: The best response to the negative interaction is to block the negative behavior and reestablish protective norms. It is important to note that the group is in the storming stage of development. Without group cohesion, the group leader must keep members safe by taking charge and addressing conflict. Reestablishing group norms and rules involves reminders about the group rules, tasks, and purpose. Universality, one of Irvin Yalom’s group therapeutic factors, helps clients feel less alone as they relate to one another’s experiences. This is not achieved by placing pressure on the client to share, particularly as it may relate to experiences of shame. Linking connects group members to foster universality. Groups need to have a here-and-now focus, which would not apply to feelings that the client experienced in the past. Imparting information, also one of Yalom’s therapeutic factors, is not necessarily accomplished by offering your interpretation of the interaction. In doing so, you may risk isolating the client, the subgroup, and other group members. Therefore, the correct answer is (A)
Competency: counseling skills and interventions