Case Study
Patient Demographic: Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)
Mental Status Exam: Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are
Presenting Problem: You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.
Other Contexts: The client comes to the counseling center during walk-in hours. The client is continuing to experience a manic episode. She reports that she went out to dance with friends the previous evening and ended up buying a gram of cocaine for $100 and reported doing several lines throughout the night. The client says that she has never used any drugs before and that it scared her that she would spend that much money on drugs and that she used drugs at all. You empathize with the client’s frustration with her behavior and provide psychoeducation on impulse control to support her. The client appears tired as evidenced by her affect and slow movements, and she also appears to have poor hygiene because her clothes have visible stains and she has a slight body odor.  As an individual, you value hard work and were focused solely on school when you were in college; you think that the client is not prioritizing what is important for her

Question: As an individual, you value hard work and were focused solely on school when you were in college; you think that the client is not prioritizing what is important for her. How can you balance your own values and support the client in working toward goals without letting your personal values affect treatment in a negative manner?
(A): Self-disclosure can be beneficial, so you choose to share your own tactics in working toward goals.
(B): You support the client’s reflection on how her behavior is keeping her from her goals.
(C): You are honest with the client about where your values lie in order to foster open discussion and create awareness of how personal biases affect the counseling process.
(D): You ignore your own values because they should not have an impact on therapy, and you focus exclusively on the client’s needs.

Correct Answer: You support the client’s reflection on how her behavior is keeping her from her goals.
Explanation: It is important to consider your own views and how they affect the counseling process with the client. With this client, it would benefit the therapeutic process to focus on assisting her with seeing how her behavior is keeping her from reaching her own goals. It may be helpful to share tactics that work for you, but self-disclosure should only be used if it will meaningfully impact the counseling process. Honesty about differences between the therapist and client is important at times, but in this case, it can be helpful for the client to see how her own behavior affects her progress. You should not ignore your own values, because they do impact therapy and the goal is to minimize the impact that they have. Therefore, the correct answer is (B)
Competency: counseling skills and interventions