Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Pacific Islander Relationship Status: Single Counseling Setting: Private practice counseling clinic Type of Counseling: Individual counseling Presenting Problem: The client and her boyfriend recently broke up, and she is “tired of being with the wrong guys.” She admits that she will often stay in relationships even if she knows they are wrong for her. Diagnosis: Provisional diagnosis: Dependent personality disorder (F60.7), personal history (past history) of spouse or partner violence, physical (Z69.11), and personal history (past history) of spouse or partner psychological abuse (Z91.411)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. No hallucinations, delusions, or paranoia are reported. The client was anxious at the start of the session, but she was able to calm herself down by easing into the counseling relation
Presenting Problem: You are a professional counselor working in a private practice clinic. The client comes in and sits quietly. The client appears nervous because she avoids eye contact and waits for you to initiate conversation. You ask why she is in counseling, and she responds that she is just tired. You ask more about this, and she says that she is not ready to talk about it yet. You decide to cover demographics and other less intimidating topics and then ask if she is comfortable talking yet. The client says that she feels a little more comfortable. She begins to state that she and her boyfriend broke up the previous week and that she was with him for 2 years. She explains that she has been “in this type of relationship before,” continually finds the “wrong guy,” and that she always goes “all in” with her relationships. Through processing, she identifies the following behaviors and beliefs: difficulty making daily decisions without the input of her partner, doing anything to gain support and affection even if she does not want to do the task or activity, quickly moving on to another relationship when a relationship ends, feeling that she cannot care for herself when she is not with someone else, and acknowledging that she needs others to take responsibility for major areas of her life. The client says that she has experienced physical and psychological abuse from partners, but that she is not ready to discuss this. The client identifies that her most important goal is to not end up in “the same relationship” again or rush into a relationship that is not right for her. Throughout the session, you provide empathetic and active listening. You suspect that the client has dependent personality disorder.
Other Contexts: ship. Family History: The client is close with her parents and her younger brother (28 years old). The client says that she was engaged twice before but that neither engagement progressed to marriage because her two fiancés both felt that she was too clingy and unable to care for herself.  Psychodynamic therapy has proven to be effective in the treatment of dependent personality disorder

Question: Psychodynamic therapy has proven to be effective in the treatment of dependent personality disorder. Which one of the following is a defining principle of psychodynamic therapy?
(A): Childhood experiences and unconscious wishes and fears greatly shape an adult’s personality
(B): Changing the narrative from “I’m a loser” to “my anxiety sometimes makes me think I’m a loser”
(C): Focusing on the present moment using mindfulness techniques to accept thoughts and feelings without judgment
(D): Using free association and dream interpretation to investigate conscious and unconscious thoughts

Correct Answer: Childhood experiences and unconscious wishes and fears greatly shape an adult’s personality
Explanation: The psychodynamic approach involves investigating childhood experiences and underlying wishes and fears because they often affect an adult’s personality and functioning. Focusing on the present and accepting thoughts and feelings are principles of acceptance and commitment therapy. Changing the narrative from “I’m a loser” to “my anxiety sometimes makes me think I’m a loser” is a principle of narrative therapy, which strives to externalize anxiety as not being part of the client. The use of free association and dream interpretation as well as investigating conscious and unconscious thoughts are parts of psychoanalysis. Therefore, the correct answer is (A)
Competency: counseling skills and interventions