Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem
Presenting Problem: You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.
Other Contexts: You meet with the client in your office 1 week after the intake session. The client reports that her husband was out of town for half of the past week and she engaged in bingeing and purging. You review the client’s food log with her and can see the difference between when her husband is home and when he is gone based on her documentation. The log included the client’s thoughts following bingeing, purging, and restricting, and you and the client work on creating new scripts for the thoughts that have led to unhealthy eating and compensatory behaviors in the past.  You want to demonstrate congruence with the client when she begins to cry, and you feel the urge to sit beside her and put your hand on her shoulder to comfort her

Question: You want to demonstrate congruence with the client when she begins to cry, and you feel the urge to sit beside her and put your hand on her shoulder to comfort her. Which of the following is the most important consideration?
(A): The appropriateness of this action depends on the sexual orientation and identified gender of you and the client, so as to not send the wrong message to the client.
(B): Physical comfort is a typical human reaction, and this can build therapeutic rapport.
(C): You must first consider if you want to comfort the client physically for your own needs or for the client’s needs.
(D): Handshakes are the only appropriate physical touch with a client.

Correct Answer: You must first consider if you want to comfort the client physically for your own needs or for the client’s needs.
Explanation: It is most important to first consider your own motives for any personal reaction, similar to self-disclosure, because you want to make sure that you are responding for the client’s benefit and not for your own management of emotional response or emotional needs. Although handshakes are generally acceptable, clients may also respond well to other types of physical touch and may benefit from a comforting hand on the shoulder. Sexual orientation and the client’s identified gender are important considerations; however, your motives are the first filter in assessing the benefits of physical touch. Although physical touch is a typical and accepted human response, you should be careful about the impacts of this response. Therefore, the correct answer is (C)
Competency: core counseling attributes