Case Study
Patient Demographic: Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam
Presenting Problem: You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.
Other Contexts: The client has responded well to identifying automatic thoughts and distorted thinking. Although some depressive symptoms have decreased, he reports continued distress stemming from the breakup with his girlfriend. He believes that he is “unworthy of love” and is destined to fail in his intimate relationships. Despite his progress in identifying cognitive distortions, the client reports feeling stuck. You and the client discuss your theoretical orientation, the therapeutic relationship, and the treatment plan goals and objectives. The client says that he values your collaborative approach, believes that the two of you have a strong working relationship, and agrees with the overall therapy goals. Despite slight improvement with his depressive symptoms, he is committed to therapy and trusts the process

Question: Once a core belief is identified, which cognitive restructuring technique would you select to help reduce psychological distress?
(A): Role reversion
(B): Identify the “three basic musts”
(C): Shame-attacking exercises
(D): Ask exception questions

Correct Answer: Role reversion
Explanation: Cognitive therapists use role reversion to challenge negative cognitions, therefore reducing psychological distress. Role reversion works by instructing clients to switch roles with the counselor and argue against the client’s hypothesis associated with distorted thinking. Shame-attacking exercises are REBT techniques designed to be performed in public to reduce the need for others’ approval. The theory behind shame-attacking exercises is that by reducing the need for approval, there is also a reduction in catastrophic thinking that fosters feelings of inadequacy. Identifying the three basic musts, or irrational beliefs, is an REBT technique. The three basic musts include (1) believing one must perform in a manner that others affirm or else one is void of self-worth, (2) believing one must be treated in a manner that the client finds affirming or else one is labeled “no good,” and (3) believing that one must get what they think they are entitled to or that one’s life is unacceptable. Exception questions are a solution-focused technique used to explore times in the client’s life when the problem did not exist, thus creating optimism, hope, and the potential for recreating those experiences. Therefore, the correct answer is (C)
Competency: counseling skills and interventions