Case Study
Patient Demographic: Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5)
Mental Status Exam: Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam
Presenting Problem: You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.
Other Contexts: The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client.  While in session with the couple, you state, “You’re telling me that you value your marriage and family, yet you remain unwilling to change behaviors that are causing you to lose them

Question: While in session with the couple, you state, “You’re telling me that you value your marriage and family, yet you remain unwilling to change behaviors that are causing you to lose them.” This is an example of which one of the following?
(A): Confrontation
(B): Reframing
(C): Interpretation
(D): Empathetic attunement

Correct Answer: Confrontation
Explanation: This statement is an example of confrontation. Effective confrontation promotes greater awareness and insight by pointing out discrepancies in clients’ thoughts, words, or actions. The goal of confrontation is to reduce resistance by calling attention to the incongruence between clients’ expressed values and their behaviors. Counselors use interpretation to test a hypothesis or theory about a client’s experiences or inner thoughts and feelings. Reframing is used when counselors rephrase a client’s statement in a way that offers a different perspective or optimistic viewpoint. Counselors express empathetic attunement by becoming in sync with a client’s inner feelings or emotional state. Therefore, the correct answer is (B)
Competency: counseling skills and interventions