Case Study
Patient Demographic: Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual
Mental Status Exam: Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.
Presenting Problem: Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.
Other Contexts: Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.

Question: Taylor realizes after several CBT exercises that she is not reacting to facts, but to her feelings. She doesn't understand where the feelings are coming from and asks what she can do to figure them out. Which of the following should be suggested based on her treatment plan?
(A): Add a Trauma goal and conduct EMDR to get to the bottom of the feelings.
(B): Include journaling, narrative therapy, and empty chair exercises under communication skills.
(C): Explain that it's normal to not always understand your feelings and not to worry.
(D): Teach thought stopping and refocusing techniques for emotional management.

Correct Answer: Include journaling, narrative therapy, and empty chair exercises under communication skills.
Explanation: The activities of journaling, narrative therapy or timeline therapy and Gestalt theory-based exercises such as the Empty Chair technique are all effective and evidence-based methods of improving communication skills and increasing self-discovery at a client-led pace. Answer b) does not validate the client's desire to better understand herself. Neglecting to offer interventions that lead her to change but instead placating with sentiments of comfort is unhelpful and irresponsible. Thought stopping and refocusing strategies are useful for clients who suffer intrusive thoughts, traumatic memories, or struggle with ruminations and are not the best match for a client who desires to intentionally think more about her feelings with the goal of modifying her thought processes. Adding a trauma goal when the client has expressed that she has no trauma is also not necessary unless cognitive behavioral strategies and other interventions have been exhausted, or if in the future a traumatic event is recalled because of these other interventions. Therefore, the correct answer is (A)
Competency: treatment planning