Case Study
Patient Demographic: Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)
Mental Status Exam: Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa
Presenting Problem: You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.
Other Contexts: The client comes into the session with a similar presentation as last week as he sits down and sighs deeply. You ask the client what he is thinking about, and he recounts an argument earlier in the day that he had with his wife when they were discussing finances. The client expresses frustration that they have had several arguments over the past week regarding finances. You empathize with the client and support him with further processing his anxiety about finances. The client expresses an immediate need to start working soon for financial reasons and because he is having a hard time “doing nothing” every day

Question: Which of the following would be an example of reflection skills when the client is talking about the need to start working soon because he feels like he is doing nothing every day?
(A): “In addition to being frustrated and anxious about finances, it sounds like you might also feel bored and unengaged.”
(B): “It sounds like we need to focus very intently on figuring out what you are going to do for work because this is causing you a lot of distress.”
(C): “It sounds like most days have been hard because you feel you are not doing much.”
(D): “I can see how hard it must be feeling the pressure of finding a new job and dealing with conflict at home.”

Correct Answer: “In addition to being frustrated and anxious about finances, it sounds like you might also feel bored and unengaged.”
Explanation: Reflection is about identifying the underlying feelings that the client is experiencing based on what he says. Identifying that the client’s statement about “doing nothing” every day might mean that he feels bored and unengaged identifies an unspoken feeling behind the statement and would be considered reflection. Stating that the client’s days are hard because he is not doing much is a paraphrase because it restates the client’s words in a different manner. Stating the difficulty of the pressure that the client is facing is an empathetic statement. Although it is important to focus on the client finding meaningful employment, this is not reflection. Paraphrasing, reflecting, empathizing, and defining goals all show the client that you are listening and are attuned with him. Therefore, the correct answer is (A)
Competency: counseling skills and interventions