Case Study
Patient Demographic: Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)
Mental Status Exam: Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia
Presenting Problem: You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.
Other Contexts: The client comes into the session, sits down, and immediately begins to talk about one of her roommates in the domestic violence home that has been making her angry because the roommate comes into her room when the client is gone and borrows her personal hygiene items. The client continues to explain that she worries that the roommate might come in while she is sleeping, but that she has not done this yet. You process these feelings with the client and identify that when she was a child, her uncle would come into her room without her permission and sexually abuse her. The client also reported that one of her ex-husbands would enter their bedroom drunk at night and would often hit her while she was asleep. You and the client discuss how to make her environment feel safe and how to engage in cognitive reframing. You empathize with the client and validate her emotions.  You disagree with the client’s evaluation of her situation and want to support her

Question: You disagree with the client’s evaluation of her situation and want to support her. Which of the following would most support the client’s presenting needs?
(A): Empathize with the client’s thoughts and feelings and encourage cognitive reframing.
(B): Validate the client’s feelings and thoughts in order to continue building rapport.
(C): Encourage cognitive reframing in order to guide the client toward your conclusion about her thoughts and beliefs.
(D): Challenge the client’s thoughts and beliefs.

Correct Answer: Empathize with the client’s thoughts and feelings and encourage cognitive reframing.
Explanation: Providing empathy and encouraging cognitive reframing are helpful because these actions validate the client’s experience, even if you do not think that it is rooted in reality, and it provides an opportunity for her to identify other ways to think about the situation. Simply validating the client’s experience does not provide the client with other options about how to feel or think. Challenging beliefs does not validate the client’s experience and may make the client feel unheard or that you do not think she is being rational. Encouraging reframing on its own may put pressure on the client to feel a certain way. Pairing empathy with cognitive reframing is a more holistic approach to supporting the client. Therefore, the correct answer is (B)
Competency: counseling skills and interventions