Case Study
Patient Demographic: Client Age: 38 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual Presenting Problem: Marital Difficulties Diagnosis: Obsessive-Compulsive Personality Disorder 301.4 (F 60.5)
Mental Status Exam: Mental Status Exam: The client is meticulously dressed and immaculately groomed. He frequently checks his watch and states he has owned his watch since adolescence and it “still works like new.” His speech is even, and his affect is blunted. At times, he is defensive and attempts to talk over you. He exhibits poor insight into his marital problems and is excessively preoccupied with perfectionism, structure, and order. Fam
Presenting Problem: You are a counselor working in private practice and meeting your client for the first time today. The client is here at his wife’s insistence, who has threatened divorce if he does not seek and comply with therapy. The client explains that he is swamped at work and has already lost an hour of productivity traveling to your office. He discloses that he has been married just over four years and has a daughter who is 3½. The couple dated briefly and married when the client’s wife discovered she was pregnant. The client believes that if he didn’t leave his wife a schedule and checklist, “things would never get done.” He states that they would be in “so much debt” if it weren’t for his detailed household budget. In his estimation, conflict occurs each time his wife tried to do things “her way” because “it is never the right way.” You paraphrase and clarify the client’s concerns.
Other Contexts: The client states that his wife now refuses to follow the client’s to-do lists, and he is growing more frustrated with her defiance. Their daughter turned four this past week, and he felt like he made it clear to his wife that throwing a party for a four-year-old was costly and unnecessary. After working all weekend, he returned home and found that his wife had thrown a party anyway. He stated he “hit the roof” and expressed feeling disrespected despite all the effort he makes towards establishing a detailed budget “with no room for error.” The conversation turns to his upbringing, and he discloses that he was placed in therapeutic foster care in early childhood and remained there until he turned 18. You discuss the implications of early childhood attachment with the client

Question: What are you trying to accomplish by discussing the implications of early childhood attachment with the client?
(A): Demonstrate the connection between biopsychosocial factors and symptom severity.
(B): Illustrate the relationship between temperament and unrelenting standards.
(C): Show the association between unmet childhood needs and maladaptive schemas.
(D): Establish the connection between adverse childhood experiences and risk level for perpetration.

Correct Answer: Show the association between unmet childhood needs and maladaptive schemas.
Explanation: The goal of discussing attachment with the client is to determine the association between unmet childhood needs and maladaptive schemas. Schema therapy is an integrative approach used to treat individuals with personality disorders. The theory integrates elements of attachment theory, cognitive-behavioral therapy, and object relations to address maladaptive schemas. A schema is an influential belief system acquired about oneself, others, and society at large. Maladaptive schemas originate from early childhood experiences and create emotional, cognitive, and behavioral impairments. Since there are no indications that the client’s child is at risk for victimization, determining the client’s risk level for perpetration is unnecessary. Temperament is inborn rather than environmental. While determining the role temperament plays in social and relational interactions is essential, the client’s upbringing in foster care provides more insight into attachment and object relations. A biopsychosocial assessment uses a holistic approach to determine biological, social, and psychological influences on a client’s presenting problem. The connection would need to be made between biopsychosocial factors and attachment rather than symptom severity. Therefore, the correct answer is (A)
Competency: counseling skills and interventions