Case Study
Patient Demographic: Client Age: 24 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client comes to counseling for help in managing anxiety, workplace dissatisfaction, and a pornography addiction. Diagnosis: Generalized anxiety disorder (F41.1), other problem related to employment (Z56.9), religious or spiritual problems (Z65.8)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appeared hesitant when talking about pornography
Presenting Problem: You are a professional counselor, and the client comes to counseling to work on anxiety, work dissatisfaction, and a pornography addiction. You and the client discuss his anxiety, and he identifies that he experiences anxiety at work, regarding daily tasks, and in social settings. The anxiety is characterized by restlessness, difficulty concentrating, muscle tension, and insomnia. The client states that at work he is often treated poorly by his supervisors, who often point out what he does wrong and do not acknowledge what he does right. He does not feel that he does as much wrong as they claim, and he often finds that their accusations do not accurately reflect his actions, which is frustrating. The client states that he has had many meetings with his supervisors and that they do not appear to try to understand his point of view. The client appears uncomfortable and begins to speak but stops for about a minute before saying that he also has a pornography addiction. The client says that he is a Christian and that he does not feel he should view any pornography, but also that he uses pornography a lot and does not feel like he has control over himself or the frequency at which he uses it. The client asks if you are a Christian, and you decide to disclose with him that you are, knowing this is an important part of the client’s life and perspective. The client states that his work problems and pornography use are his most pressing issues.
Other Contexts: use. Family History: The client has a close relationship with his parents and his older sister. The client has close friends

Question: Which of the following would be an appropriate short-term goal for this client that could be completed in the next month?
(A): Decrease the client’s urges to masturbate.
(B): Learn and implement coping skills for anxiety.
(C): Explore what the client has liked and disliked about his current and past jobs.
(D): Identify and implement assertiveness skills in the workplace.

Correct Answer: Explore what the client has liked and disliked about his current and past jobs.
Explanation: The client wants to focus initially on cessation of pornography use and his unhappiness in the workplace. Exploring what the client has liked and disliked about his current and past employment is an appropriate short-term goal that can open up conversations about possibly changing the employment and identifying what matters to the client when at work. Although decreasing the frequency of masturbation may happen in the first month, you likely will only have a few sessions in this time period, and the skills necessary to manage urges to masturbate will not likely be developed at this point. Assertiveness skills training can be helpful in improving work situations; however, the client has already had several conversations with his supervisors and it does not appear that they have been open to his input thus far. The client does have a generalized anxiety diagnosis; however, he has more immediately pressing issues that he wants to work on, so you likely will not master coping skills for anxiety within the first month. Therefore, the correct answer is (B)
Competency: counseling skills and interventions