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: The client comes into the session smiling and says that he is excited to share his log this week. The client shares that he masturbated an average of one to two times daily and that he even went a day without masturbating. You express your excitement for the client achieving his goals. Through processing, the client identifies that he refrained from masturbating most often by leaving his bedroom and finding something to structure his time late at night. The client says that he had difficulty refraining from masturbating mostly when he came home from a difficult day at work, or when he struggled to sleep. You and the client discuss calming techniques to use when he is stressed after work. You also recommend approaches to address difficulty sleeping. On days when the client masturbates, he explains that he often decides that since he already messed up, he can do it again. The client says that he is happy at his new place of employment and that it is just a hard job. You support the client in challenging his past cognitive distortion that his future employment experiences will be the same as his past experiences.  You are reviewing this case with a counseling resident, and she does not think that the client is doing anything wrong by masturbating because it is a typical part of human functioning

Question: You are reviewing this case with a counseling resident, and she does not think that the client is doing anything wrong by masturbating because it is a typical part of human functioning. You encourage your resident to remember all of the following in regard to this client, EXCEPT:
(A): The importance of supporting the diversity of clients
(B): That although you can encourage different viewpoints, you cannot impose them
(C): That the client is not causing himself any harm by refraining from masturbation
(D): Refraining from imposing your own values and beliefs on clients

Correct Answer: The importance of supporting the diversity of clients
Explanation: The counselor should always support the diversity of their clients’ beliefs despite their own value system. It can be helpful to remember that although the resident may not agree with the client’s interpretation of his actions, there is no harm to the client in his goal to refrain from masturbation. Client-centered therapy aligns counseling goals with the client’s goals, which in this case involve removing the urges for and eventually the act of masturbation in his life. With this client, it likely would not be helpful to encourage or impose other viewpoints because they would oppose his religious beliefs, and this may also make the client feel unsupported. Therefore, the correct answer is (A)
Competency: counseling skills and interventions