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: You guide Taylor through the process of identifying her emotional reactions to her stressors, recognizing automatic thoughts, and challenging her underlying irrational belief systems through filling out a Thought Record. What is the end goal of this exercise?
(A): To highlight her negative her core beliefs
(B): To demonstrate how her feelings are irrational
(C): To create a new, healthier thought process
(D): To analyze each cognitive distortion individually

Correct Answer: To create a new, healthier thought process
Explanation: If Taylor concludes that her unhelpful thinking styles are longer-term patterns that have been pervasive over time, this can be useful for her as motivation to change. Helping Taylor learn how her emotions affect her cognitions, which then affect her behaviors, is the purpose of Cognitive Behavioral therapy. The "Thought Record" is intended to support Taylor's cognitive restructuring process with the goal of training her mind to automatically develop healthier thoughts when faced with triggering situations. Within this process, her core beliefs, cognitive distortions, and irrational thoughts might be highlighted; but this is not the end goal. Additionally, feelings should never be presented as "irrational"; all feelings should be validated regardless of its origin of irrational thought. Therefore, the correct answer is (A)
Competency: counseling skills and interventions