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: After the client has responded affirmatively to your last statement, which of the following would be the most appropriate to ask?
(A): Is there a way that you can send your parents money and still have time to make your choices?
(B): What scares you the most about not sending your parents money right now?
(C): Is this something you would like to talk about together?
(D): I wonder if it would help if we talked about some ways that you can work through this.

Correct Answer: Is this something you would like to talk about together?
Explanation: Asking the client if this is something that she wants to talk about with you is the most appropriate question. The counselor must demonstrate respect for the client and her culture. Cultural beliefs about discussing family matters with strangers vary. This client's original intent for counseling was to seek career help, not discuss family issues. It would be necessary for the counselor to allow the client to determine what topics will be discussed in sessions. Asking the client what scares her most makes the assumption that she wishes to discuss her family dilemma more deeply (as noted above) and that she feels scared. It is important for counselors to allow clients to identify their emotions rather than have the counselor assign emotions based on the counselor's own feelings. Asking the client if she can both send money and have time to choose a career demonstrates the counselor's countertransference and need to fix the client's problem, rather than allowing the client to choose her own solutions. Response d is less obtrusive but still does not take the client's culture into account nor allows the client to decide if this will be a topic of counseling. As well, the statement demonstrates the counselor's lack of awareness of her own need to fix the problem. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis