Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3)
Mental Status Exam: Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam
Presenting Problem: You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”
Other Contexts: The client no-showed for her last session without calling to cancel. She arrives today, appearing disheveled and irritable. The client states that she has not been sleeping well. She explains that she was talking to someone on an online dating site and had planned a face-to-face meeting this past weekend. She says she waited at the bar for more than an hour and finally realized that her date had stood her up. She explained that she was in so much shame after the incident that she engaged in self-harm. The client reveals superficial razor cuts on her thigh and upper arm. She says she feels like she is a failure and undeserving of love.  You ask the client to relax into the present moment and acknowledge thoughts and feelings that may arise without categorizing them as good or bad

Question: You ask the client to relax into the present moment and acknowledge thoughts and feelings that may arise without categorizing them as good or bad. Why are you engaging the client in this exercise?
(A): To teach conflict resolution skills
(B): To encourage a nonjudgmental stance
(C): To identify core beliefs
(D): To assess the client’s capacity for transference

Correct Answer: To encourage a nonjudgmental stance
Explanation: The purpose of this activity is to encourage the client to take a nonjudgmental stance. You are using a component of dialectical behavior therapy, which is an empirically validated approach for BPD. This approach targets black-and-white or all-or-nothing dialects that characterize common thinking patterns among individuals with BPD. Mindfulness-based exercises are used to help the client stay fully aware of the present (ie, here-and-now) moment. In this state of awareness, clients learn to accept and regulate intense emotions in a nonjudgmental fashion. Identifying core beliefs, teaching conflict resolution skills, and exploring transference and countertransference are also interventions for BPD; however, a nonjudgmental stance allows the client to have experiences that are “both-and” rather than “either-or”. Therefore, the correct answer is (D)
Competency: counseling skills and interventions