Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client is engaging in restrictive eating daily. The client engages in bingeing when her husband is away for business trips and engages in exercise as compensatory behavior. Diagnosis: Anorexia nervosa, binge eating/purging type, moderate (F50.02)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. She reports no hallucinations or paranoia. The client was engaged in the session, but she had trouble accepting that her weight and self-talk were problem
Presenting Problem: You are a licensed counselor working in your own private practice, and you specialize in eating disorders. The client comes to counseling after her primary care physician (PCP) provided a referral to counseling due to restrictive eating that has led to a low body mass index of 16.5. The client says that she has lost about 30 pounds over the past 6 months and that she still feels that she is overweight. The client says that she usually consumes about 500 calories each day and that she fears that if she eats more, she will gain weight. The client’s mother, who was overweight, passed away at age 46 due to an aneurysm, which has contributed to the client’s perception that her mother’s death was weight related. The client expresses that she also has a fear that if she gains weight, then her husband will not love her. She describes experiencing anxiety resulting from the belief that she is currently overweight and is therefore already at risk of both her husband not loving her and of dying. The client says that she generally restricts eating when her husband is home, but when he is on business trips she binges and then forces herself to throw up.
Other Contexts:    atic. Family History: The client has two siblings: a younger brother (29) and an older sister (32). The client says that her older sister is obese and she is worried that her body would deal with food similarly, causing her to gain weight easily if she ate more. The client has been married for about 1 month at this point and has lived with her husband for about 6 months total. She says that she feels pressure from her husband to be thin, and although he places this expectation on her, she says that she has felt this way prior to meeting him, but has lost more weight since they have been living together.  You are focusing on building a therapeutic relationship with the client

Question: You are focusing on building a therapeutic relationship with the client. Which of the following terms focuses on viewing the client as the expert of herself and responding warmly with acceptance of where the client is in her life?
(A): Congruence
(B): Mutuality
(C): Identification and internalization
(D): Unconditional positive regard

Correct Answer: Unconditional positive regard
Explanation: This approach to building rapport is called unconditional positive regard. This is used to demonstrate to the client that you accept her as she is and are genuinely interested in understanding what she is experiencing. Congruence is about being a genuine honest person and matching your external expressions to how you internally feel. It is not related to the concept of recognizing the client as the expert of herself. Congruence provides the client with the insight that the therapist is also a human and requires the management of counselor and client boundaries because self-disclosure and being openly emotional may cause the client to want to support the counselor. Mutuality involves sharing decision making, treatment planning, and power, while the therapist and client are both learning as they go. The identification and internalization process is about modeling behaviors or skills and internalizing them. Therefore, the correct answer is (B)
Competency: counseling skills and interventions