Case Study
Patient Demographic: Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0)
Mental Status Exam: Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th
Presenting Problem: You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.
Other Contexts:    e  The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services

Question: Which statement would best help enhance the client’s motivation to change?
(A): “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you.”
(B): “Your girlfriend declined to have sex with you, but you’ve decided to keep trying.”
(C): “You’re disappointed your girlfriend is not having sex with you, but just like building a building, intimate relationships are constructed one brick at a time.”
(D): “You’re disappointed that your girlfriend doesn’t want to have sex with you. I believe I can help, but the ball is in your court.”

Correct Answer: “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you.”
Explanation: Of all answer options, increasing the client’s motivation to change is best attained by stating, “You were told having a girlfriend in college would lead to sex, and you’re disappointed that’s not happening for you” The statement is an example of an empathetic reflection, a micro skill associated with strengthening the counselor-client relationship. The statement also sets the stage for establishing a discrepancy between the client’s values or expectations and current behaviors. It is a natural lead to discussing what an intimate relationship looks like, the reality of exploring it, and the appropriateness of establishing it. The therapeutic alliance is strongly associated with increased motivation to change. Answer A attempts to engage the client by using his major in architectural design to create an analogy between the building blocks of an intimate relationship and building an actual building. This statement is likely to be misunderstood because individuals on the autism spectrum think concretely and not metaphorically. Telling the client that the ball is in his court is also a statement that, if taken literally, creates a misunderstanding. The statement, “Your girlfriend declined to have sex with you, but you’ve decided to keep trying,” is a paraphrase. A paraphrase reflects the factual aspects of the client’s statements. Paraphrases let clients know that they are being heard, but they are not as powerful as empathetic reflections. Therefore, the correct answer is (B)
Competency: counseling skills and interventions