Case Study
Patient Demographic: Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)
Mental Status Exam: Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la
Presenting Problem: You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.
Other Contexts: Since the fourth session, child protective services investigated the client’s abuse allegations and determined that they were unfounded. You discuss this with the client and he says he was lying because he was mad at his parents that day. You praise the client for being forthright today regarding the allegations and discuss how false allegations can be incredibly harmful to others and can strain his relationship with his parents further. You and the client process several situations similar to this in which he avoided responsibility. You empathize with the client and support his reflection on his behavior

Question: Which of the following cognitive distortions is often associated with anger?
(A): Catastrophizing
(B): Personalization
(C): “Should” statements
(D): Disqualifying the positive

Correct Answer: “Should” statements
Explanation: “Should” statements occur when your expectations for how something should be is incongruent with what actually happened. This often incites anger because you expect someone to act a certain way, such as being kind to you, and variations on that expectation are disruptive. Personalization is when an individual thinks that they are responsible for things outside of their control, and this usually leads to the individual thinking that they can make things better even when they are likely not able to. Disqualifying the positive occurs when the client ignores all positives and focuses only on negative events. Catastrophizing is when the client sees only the worst possible outcome even when it is not the most likely outcome. Although anger may result from personalization, disqualification, and catastrophizing, these are more likely to result in disappointment, shame, anxiety, and/or negativity. Therefore, the correct answer is (B)
Competency: counseling skills and interventions