Case Study
Patient Demographic:  Initial Intake: Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: The client appears her stated age and is dressed appropriately for the circumstances. She identifies her mood as “somewhat anxious” and her affect is labile and congruent. She is noted to rub her hands together at times and she appears uncomfortable at times as she talks about herself. She demonstrates good insight, appropriate judgment, memory, and orientation. She reports no history of trauma, suicidal thoughts, or harm towards others.
Presenting Problem: You are a non-Hispanic counselor in a private practice setting.  Your client is a 42 year old female who reports that she has been working for the same accounting firm for 10 years and was recently laid off due to a downturn in the economy. She tells you that prior to this firm, she worked in a company doing managerial accounting that she joined right after college. She says that she has liked the people that she has worked with but over the past several years she has enjoyed her work less and less. She reports that she is upset to have lost her job but, in some ways, she sees it as an opportunity to find something else she is more passionate about, but she has no idea where to start. She does say that she wants a job and work environment that is a better fit for her personality. She also tells you that she is afraid that she is too old to begin again or that she doesn’t have “what it takes” to begin a new career.
Other Contexts: Family History:
The client reports no significant family history related to mental health issues or relationship problems. The client tells you that she chose accounting in college because she grew up in a small town and her parents told her that she needed a skill that would help her support herself. Additionally, she states that she has been married for 19 years and has a good relationship with her spouse. She tells you that he is supportive of her exploring new careers but that her income is helpful for the family and it is important that she works.

Question: Based on the information given, which would be the most effective intervention with this client at this time?
(A): Reframing
(B): Self-disclosure
(C): Highlighting here-and-now interactions
(D): Reflection and paraphrases

Correct Answer: Reflection and paraphrases
Explanation: Based on the client's cultural information provided, reflection and paraphrases are the most effective intervention because they allow the client freedom to choose what is or is not discussed, let the client know that the counselor is listening, and provides the opportunity for the counselor to share with the client the thoughts and emotions that the client has been expressing. These techniques are non-directive and allow the client to feel listened to and valued. Reframing with this client is not likely to be effective at this time as she wrestles with cultural expectations. Reframing allows the counselor to provide a different perspective of a problem, but when culture is involved, the counselor is more likely to offer a perspective that may not take culture into account. Self-disclosure is one of the least used interventions because counselors must weigh whether the self-disclosure is more for the counselor's benefit or the client's. With this client, self-disclosure would not be appropriate, particularly if the counselor and client do not share the same culture, as any comparisons would not be similar due to differing cultural beliefs. Here-and-now interactions are useful when working on process versus content as they focus on metacommunication. In this case, the counselor must be careful not to make assumptions about what is said or not said because of the cultural differences between the client and the counselor. Therefore, the correct answer is (A)
Competency: counseling skills and interventions