Case Study
Patient Demographic: Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)
Mental Status Exam: Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.
Presenting Problem: You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”
Other Contexts: The client attends a process-oriented CBT group that is nearing the middle stage of group development. The client presents today with a bright affect and arrives early to converse with two other women in the group. During group activities, she is reticent to share and is sensitive to a conflict between two members that has started to emerge. One member becomes openly critical of the group tasks and their usefulness. Other members start to weigh in and take sides. The conflict quickly escalates between two members, with one shouting at another, “You have monopolized every session with your opinions. You are the most judgmental person I know! This group would be so much better without you.” Other members nod in agreement

Question: As the leader of this process-oriented group, what is your best response to the emerging conflict?
(A): “How might removing a member deprive you of learning from one another?”
(B): “What core beliefs might underlie the strong opinions expressed today?”
(C): “I’d like to pause for a moment and remind everyone of the group rules.”
(D): “Let’s explore ways that we have all responded to difficult people in our lives.”

Correct Answer: “How might removing a member deprive you of learning from one another?”
Explanation: The best response to the group’s conflict is the statement, “How might removing a member deprive you of learning from one another?” This question tests your knowledge of the stages of group development, the need to provide a here-and-now focus, and the leadership skills used to promote group cohesion. The middle stage of group development, also appropriately known as the storming stage (Tuckman, 1984), is characterized by conflict among members, challenges toward group leaders, and the formation of alliances or subgroups. Group leaders are tasked with normalizing conflict and redirecting members to here-and-now interpersonal exchanges rather than labeling certain members as “problematic” or “scapegoats” Core beliefs are schemas rooted in childhood. Although counselors can address core beliefs in process-oriented groups, caution must be used when group leaders interpret conflict as core beliefs, partly because it takes away from the group’s here-and-now focus. Exploring how members respond to difficult people in their lives is incorrect because it refers to other members as “difficult” rather than ascribing the conflict as member’s behaviors. Therefore, the correct answer is (C)
Competency: counseling skills and interventions