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 arrives with his wife for his scheduled individual session today. You have yet to meet his wife in person. Before you can obtain an accurate appraisal of the situation, you find yourself mediating a conflict that has quickly intensified. The wife has given the client an ultimatum—to either stop the “endless manipulation, control, and sharp criticism” or she will take their daughter and go live with her mother, who resides in another state. The wife states that she has shown up today in a last-ditch effort to save their marriage. The client expresses a desire to remain with his wife and daughter

Question: How would a client with OCPD most likely approach termination?
(A): Have a measured external reaction, is self-congratulatory, is indifferent toward the counselor
(B): Feel threatened, experience symptom regression, and become emotionally dysregulated in the counselor’s presence
(C): Terminate too early, deny emotional reactions, and act dismissively toward the counselor
(D): Attempt to delay termination and desperately cling to the counselor

Correct Answer: Terminate too early, deny emotional reactions, and act dismissively toward the counselor
Explanation: Individuals with OCDP experience pathological personality traits marked by avoidance and detachment. Individuals with avoidant attachment styles would react to termination in the same way they react to close romantic partners or interpersonal relationships, which is to remain emotionally detached. Individuals with disorganized attachment styles feel threatened, experience symptom regression, and become emotionally dysregulated in the counselor’s presence. Individuals with ambivalent attachment styles attempt to delay termination and desperately cling to the counselor. Lastly, individuals with varied attachment styles, particularly those associated with narcissistic personality disorder, are self-congratulatory and detached. Therefore, the correct answer is (D)
Competency: professional practice and ethics