Assignment

Client Case Study

Jen ---

University of the Southwest

School of Arts and Sciences

PSY 5803 Mental Health Counseling Internship

August, 2015

Client Identification Data

Name: “Jillian Smith” (Fictitious name for confidentiality) Gender: Female Referral Date: 2/28/15 Date of Birth: 12/17/97 Counselor: Jen Age and Grade: 17 years 8 months, Grade 10 Number of Sessions: 9 School: --- Academy, ---, CT

Referral Source and Reason for Referral

Counseling was requested by Jillian’s parents due to their concerns about her Generalized Anxiety Disorder (GAD) and her adjustment to a recent diagnosis of Autism Spectrum Disorder (ASD). Mr. and Mrs. Smith are concerned about Jillian adjusting to a recent discharge from the wilderness therapy program, Pacific Quest (PQ), and current enrollment in Franklin Academy.

Presenting Problems and Diagnosis

This counselor and Jillian determined the presenting problems are her GAD, rigid thinking, poor self-image, social anxiety, adjusting to her recent diagnosis of ASD, adjustment difficulties to novel situations, and her perceived lack of familial support.

Jillian had previously been diagnosed on the Diagnostic Statistical Manual (DSM-5) with Specific Learning Disorder in Mathematics, Social Pragmatic Disorder (SPD), GAD, Disruptive Mood Dysregulation Disorder (DMDD), Parent-Child Relational Problems, and Acculturation Difficulty. In February of 2015, Jillian was diagnosed with ASD, which replaced the diagnosis of SPD and DMDD.

Treatment Goals

This counselor and Jillian established the following goals, which are to develop emotional awareness and regulation, to develop anxiety management skills, to improve social skills, to increase mental flexibility, to develop a secure sense of self, and to become educated in ASD.

Mental Status Exam (MSE)

During the intake, Jillian appeared about five feet tall and overweight. Her clothes seemed clean. She wore a low cut tight long sleeve black shirt, frayed jeans, black heeled boots, gold hooped earrings, and a gold necklace. Her brown hair was disheveled into a ponytail and she wore makeup. Jillian appeared restless by wringing her hands and continually fidgeting in her chair. Jillian’s speech was rapid, but not pressured. She answered questions spontaneously. Her eye contact was fleeting. Her affect appeared anxious and fatigued. She stated her mood was typically anxious. Jillian’s thought processes were logical, coherent, and ruminative. Her thought content seemed to obsessively focus on her weight and past failings. She did not appear to possess delusions, hallucinations, phobias, paranoia, or suicidal ideation. Jillian’s cognition appeared intact and was oriented to time, place, and person apart from difficulties with concertation and attention. Jillian exhibited partial insight into her emotional difficulties. Her judgment seemed slightly impaired.

Information Sources

Information presented in this case study is based on:

· This counselor’s and Jillian’s counseling sessions, observations, intake, and MSE

· Intake interview with Mr. Smith

· Interview with the Psychiatrist at Franklin Academy

· Behavior Rating Inventory of Executive Functioning (BRIEF) Teacher and Self-Report Forms on April 13, 2015

· Behavior Assessment System for Children 2nd Edition (BASC-2) Teacher and Self-Report Forms on April 13, 2015

· Social Responsiveness Scale Teacher Form on April 13, 2015

· Jillian’s PQ Discharge on February 19, 2015

· Psychoeducational evaluation report on November 1, 2014

· Psychoeducational tests on October 14 and 15 of 2014

· Background Information Form

· BASC-2 Parent and Self-Report Forms

· BRIEF Parent and Self-Report Forms

· Brown ADD Scales Self-Report Form

· Clinical Interview with Mr. Smith and Jillian

· Comprehensive Mathematical Abilities Test (CMAT)

· Conners’ Continuous Performance Test 2nd Edition (CPT-II)

· Delis-Kalan Executive Function System (D-KEFS)

· Motor-Free Perception and Visual Test 3rd Edition (MPVT-3)

· Multidimensional Anxiety Scale for Children 2nd Edition (MASC-2) Parent and Self-Report Forms

· Nelson Denny Reading Test

· Rey-Osterrieth Complex Figure Test (Rey-O)

· Social Language Development Test

· Social Responsiveness Scale 2nd Edition (SRS-2)

· Test of Written Language 4th Edition (TOWL-4)

· Test of Word Reading Efficiency 2nd Edition (WAIS-IV)

· Wechsler Memory Scale 4th Edition (WMS-IV)

· Woodcock-Johnson III (WJ-III): Tests of Academic Achievement and Cognitive Abilities

Family Background Information

According to the intake interviews with Jillian and her father, Mr. Smith, Jillian’s parents are married. Jillian has a younger sister, Kayla, who is 13-years-old. Mrs. Smith is a commercial officer with the United States Department of State. Mr. Smith does not currently work, but has an occupational background in special education and social work. The family has moved several times since Jillian was born in 1997; Mr. Smith reported Jillian has significant adjustment and transition difficulties due to the various moves. She was born in Merrick, New York and lived there for the first three years of her life. The family then moved to France to be closer to Mrs. Smith’s family. When Jillian was 5-years-old, the family moved to Kansas City because Mrs. Smith accepted an attorney position, Jillian’s parents wanted their daughter to attend the American school system, and Mr. Smith’s family lived in Kansas. In July of 2013, the family moved to Australia when Mrs. Smith was assigned her first post with the Department of State. Her current post terminated July of 2015 and the family has relocated to Mexico City for her next post.

Development

Language Development

Jillian’s father reported she began to speak full sentences in English and French by 18 months. According to Jillian, she is still bilingual in French and English.

Socio-Emotional Development

Mr. Smith reported as an infant, Jillian was frequently irritable, exhibited temper tantrums, and had difficulties sleeping. He attributed some of this behavior to her allergy to infant formula.

Mr. Smith stated at the age of 4 Jillian’s younger sister, Kayla, was born. This change in the family dynamics created significant stress and adjustment difficulties for Jillian. Mr. Smith claimed Jillian became jealous and aggressive towards Kayla. When Jillian grew older, she accepted her sister; however she was never willing to share her toys with Kayla.

Mr. Smith recalled in kindergarten, Jillian’s behavioral difficulties increased significantly. She exhibited tantrums, was extremely possessive of her belongings, had difficulties sleeping, continually possessed social challenges, was often inattentive and hyperactive, never played make believe or parallel played, and exhibited aggressive behaviors at home as well as at school.

In second grade when the family moved within the Blue Valley School District, Mr. Smith stated Jillian continued to have academic, emotional, and social difficulties. Mr. Smith and Mrs. Smith decided to seek therapy for Jillian. She was enrolled in the HCBS Waiver Program for Severe and Emotionally Disturbed Children through the Johnson County Mental Health, in which a social worker conducted therapy at their home and taught Jillian life skills. Therapy was discontinued after two years when Jillian met her therapeutic goals.

According to Jillian, in the fourth and fifth grade she was socially isolated, severely bullied, and her grades were poor. She physically fought other students who bullied her. Mr. Smith reported the police were contacted once due to anti-Semitic harassment from her peers, in which swastikas were drawn on Jillian’s school belongings. In fifth grade, Jillian’s parents had her evaluated for ASD by a private specialist. The specialist determined in her report that although Jillian exhibited several developmental issues, she did not meet the criteria for ASD or other special education services. Mr. and Mrs. Smith then enrolled Jillian at Hyman Brand Hebrew Academy from sixth to eighth grade.

In middle school, Jillian stated she experienced a few panic attacks, had difficulties with social skills, and her grades remained poor. She took several Ibuprofens tablets when she experienced a severe Major Depressive Episode. Jillian also reported she was seeking attention from her mother because she was constantly working. After she swallowed the pills, Jillian recounted she immediately told her mother who transported her to the hospital. She was prescribed 5-mg of Abilify for mood disorders. Jillian attended weekly individual therapy and bi-weekly family therapy with a private clinical psychologist. Jillian claimed she has not possessed suicidal ideation since middle school.

Mr. Smith reported in ninth grade, the family reenrolled Jillian into the Blue Valley Public School District. Jillian excelled in chorus, gained a few friendships, and earned average to above average grades. However, Mr. Smith claimed at home Jillian continued to exhibit verbally aggressive behavior and refused to accept responsibility for her actions.

Jillian recalled in June of her ninth grade year, her mother entered the Foreign Service and the family moved to Sydney, Australia in July of 2013. Jillian was enrolled in Redlands Secondary School, halfway through the Australian school year since school begins in late January and ends in December. Jillian had significant difficulties adjusting academically and socially to the Australian school system. Jillian reported she felt frustrated and mentally fatigued in school because she knew she could not perform at the level that her parents expected of her in the International Baccalaureate Program. She claimed her parents stated she was lazy and was not applying herself. Jillian indicated her relationship with her mother was strained because her mother did not understand her learning difficulties. Consequently, Jillian reported her hair fell out due to stress and anxiety. Mr. Smith stated Jillian exhibited rigid thinking, social anxiety, and poor social skills, which contributed to Jillian reporting she felt isolated, excluded, and targeted from her peers. Jillian recounted she was teased for her accent and for being middle class, in which most of her peers were upper class. Her peers stated she was “too loud,” had “too much personality,” and was “too American.” Jillian indicated she had significant difficulties understanding the Australian culture’s sarcastic humor. This contributed to lowering her self-esteem while increasing her anxiety. The school referred Jillian to an outside clinical psychologist for therapy.

Mr. Smith stated the family requested Jillian be evaluated due to longstanding concerns with academic, social, and emotional difficulties. The BASC-2 parent and self-report ratings were completed in October of 2014. Mr. Smith indicated hyperactivity, aggression, anxiety, depression, somatization, adaptability, and daily living activities as clinically significant challenges. Withdrawal, inattention, social skills, and a lack of leadership were moderate. Jillian reported anxiety, sense of inadequacy, and hyperactivity as clinically significant. She indicated locus of control, somatization, inattention, interpersonal relations, self-esteem, and self-reliance as moderate. In April of 2015 Jillian self-reported on the BASC-2, as at risk for inattention and clinically significant for hyperactivity while the teacher reported scale indicated at risk for hyperactivity and average for inattention.

The MASC-2 parent and self-report results in October of 2014 indicated significant anxiety. Mr. Smith reported physical symptoms, social anxiety, separation anxiety/phobias, obsessions/compulsions, and generalized anxiety as clinically significant. Jillian reported physical symptoms, humiliation/rejection, obsessions/compulsions, and general anxiety as clinically significant. She also reported panic, separation anxiety/phobias, and harm avoidance were mild.

The SRS-2 completed by Mr. Smith in October of 2014, indicated Jillian displayed severe levels of social impairment in the areas of social cognition, social communication, social motivation, restricted interests, and repetitive behavior. He reported Jillian had mild problems in social awareness. Mr. Smith reported Jillian almost always showed rigid or inflexible patterns of behavior that appeared odd, did not recognize when others took advantage of her, was literal, misinterpreted communication, was uncoordinated, had adjustment difficulties to changes in her routine, did not comprehend cause and effect, and frequently was teased by her peers.

Jillian was administered the Social Language Development Test in October of 2014. Her overall score was within the Average range. However, Jillian showed significant challenges in interpreting iconic statements, comprehending the speaker’s intention, and using the context clues from the story to interpret irony as well as sarcasm. The test results also indicated mild difficulty in taking the perspective of others, negotiating a solution, and problem solving with peers.

Based on the psychoeducation testing, Jillian was diagnosed on the DSM-5 for Specific Learning Disorder with impairment in mathematics, Social Pragmatic Disorder (SPD), GAD, Disruptive Mood Dysregulation Disorder (DMDD), Parent-Child Relationship Problem, and Acculturation Difficulty.

In November of 2014, Jillian reported she was caught stealing money out of a student’s locker in her Australian school and was expelled. She indicated she was unsure the reason she stole money because her family was financially stable, but she thinks she might have been asking for help for her academic, social, and emotional problems.

Mr. Smith reported Jillian was then enrolled in Pacific Quest (PQ), which is a wilderness therapy program, on December 15, 2014 to February 28, 2015. Jillian reported she attended cognitive behavioral (CBT) individual and group therapy, which she believed was beneficial. According to Jillian’s PQ discharge, on arrival she exhibited rigid and obsessive thinking, social anxiety, GAD, poor social perception and a verbal filter, verbally aggressive and defensive behavior, adjustment difficulties causing hypervigilance of her surroundings, low self-esteem, and poor executive function. Near the conclusion of Jillian’s program, the professionals at PQ concluded that she met the criteria for ASD.

The PQ discharge stated initially Jillian appeared overwhelmed by emotional triggers and rapidly reacted to them, such as separation from family, irritations with peers, family dynamics, fear of the unknown, normal life stresses, and task management. She also struggled to identify healthy coping strategies for emotional regulation and expression. Instead Jillian used unhealthy coping strategies, such as misbehaving, anger, deflection, fabricating, tantrums, and verbal aggression.

The PQ discharge also reported Jillian had challenges comprehending reciprocity in relationships, tracking conversations, understanding and demonstrating empathy, and discerning others’ thoughts as well as emotions. Consequently, Jillian exhibited poor non-verbal communication and reasoning skills, unhealthy boundaries, rigid thinking, selfish tendencies, isolating behaviors, and inappropriate conduct.

After attending Pacific Quest, Jillian stated she recently enrolled at Franklin Academy, which is a supportive therapeutic boarding school for students with ASD and co-occurring disorders. Jillian reported she continues to struggle with significant daily anxiety and rigid thinking. She frequently feels tense and dizzy, possesses headaches, has difficulties falling asleep, and has gastrointestinal problems. She reported she exhibits obsessive-compulsive thoughts and behaviors. She claimed her obsessive behaviors have lessened since she was 12-years-old when her mother intervened with her specific bedtime rituals. Jillian also feels extreme stress and anxiety when she encounters life changes.

Jillian reported she has difficulties interpreting and responding to social cues at Franklin Academy. She also has difficulties with social pragmatic skills, such as conversation turn taking and adjusting as well as editing her speech, which this counselor believes may be caused by an increased influx of ideas as well as an inability to inhibit verbal expression. From observing Jillian, this counselor has noted she has established a few initial, but superficial peer relationships.

The psychiatrist at Franklin Academy reported the Abilify dose was too low for any significant effect and discontinued the medication in May of 2015. The psychiatrist recommended when Jillian returned home for the summer that she schedules a pediatrician appointment to prescribe medication for her GAD. Jillian’s family has a history of mental illness; Mr. Smith has attention deficit disorder and bipolar disorder. Jillian’s paternal grandfather has bipolar disorder, substance abuse disorder, and GAD. Her maternal grandmother has major depressive disorder. Her maternal uncle has schizoaffective disorder. Mr. Smith did not report any familial history of learning disorders.

Physical Development

Mr. Smith reported his wife’s pregnancy and delivery were uncomplicated. Jillian was born 2 ½ weeks early. Mr. Smith could not recall her actual birth weight or height, but he noted it was below average. Jillian walked and climbed out of her crib at 8 months. Jillian has consistently had difficulties with fine motor skills, such as handwriting and tying her shoes. According to Mr. Smith, Jillian has never been evaluated by an occupational therapist.

Mr. Smith reported Jillian has continually been healthy. She has never been hospitalized, nor had any serious illnesses, head injuries, or surgeries. Jillian’s last vision and hearing exams were normal. Mr. Smith reported her only allergy was to infant formula.

According to Mr. Smith, Jillian physically developed early. Jillian reported her peers teased her for her early development and she had sexual relations at the age of 15 with a male student.

Jillian reported she has gained 30 pounds since she has attended Franklin Academy because of poor eating choices, not exercising regularly, and increased symptoms of her GAD. She also stated she has insomnia.

Intellectual Development

Mr. Smith reported Jillian was considered bright and creative beginning in kindergarten. In fourth and fifth grade, her academic record was poor. Mr. and Mrs. Smith had her evaluated for ASD by a private specialist in fifth grade. The specialist in her report determined that although Jillian had some developmental issues, she did not meet the criteria for ASD or other special education services. According to Mr. Smith, Jillian continued to perform poorly academically in middle school at the Hyman Brand Hebrew Academy due to a lack of study skills, low motivation, and a lack of maturity. Mr. Smith stated she was placed in the public school system for ninth grade due to Hebrew Academy not being able to meet Jillian’s needs. In ninth grade, Jillian stated she earned average to above average grades. At the end of ninth grade when her family moved to Australia, her grades were significantly poor. Jillian claimed her new school in Australia was challenging because she was enrolled in the International Baccalaureate Program, which was academically more challenging than the Kansas School System in the United States. She also reported the Australian teaching style differed from the American’s style and she was unfamiliar with Australian History as well as Geography. Jillian stated Franklin Academy’s schoolwork has not been challenging and she has earned passes or high passes.

Neuropsychological testing in October of 2014 found significant variability in Jillian’s abilities. The WAIS-IV reported her overall cognitive functioning fell within the Average range. Jillian’s verbal reasoning skills were in the Superior range while her nonverbal reasoning skills fell in the Lower Average range indicating she met the criteria for ASD. Her working memory and processing speed were in the Average range. Additional testing found sustained attention, cognitive flexibility, response inhibition, and contextual auditory verbal memory were in the Average range. Areas of concern from the testing indicated visual perception, visual-spatial, visual memory, visual-motor integration, verbal fluency, and rote verbal memory.

Executive function deficits in several settings were noted in the neuropsychological testing and the BRIEF parent and self-report in October of 2014 as well as the BRIEF teacher and self-reports in April of 2015. For example, Jillian struggled to monitor her behavior, shift working memory, initiate and complete tasks, organize, plan, maintain effort, and follow sequential steps in various directions and math problems. Jillian stated her room appeared cluttered and filthy at home and at Franklin Academy. This counselor noted research has shown people with ASD may commonly have executive function deficits.

Jillian’s scores on tests of attention and the BASC-2 teacher rating demonstrated average attention abilities; however on the BASC-2 parent and self-reports in October of 2014 and April of 2015 suggested significant attentional difficulties, which may be partly due to her increased symptoms of GAD.

The cognitive testing indicated Jillian was functioning at an overall High Average to Very Superior level in reading and written language skills. In mathematics she scored overall in the Low Range. Her basic math calculation skills and mathematical reasoning were in the Low range and her applied problems skills were in the Low Average range. Her global mathematical ability fell in the Below Average range. It was noted in the testing, Jillian could not solve multiplication, fractions, or long division without the use of a calculator. This counselor believes Jillian’s low mathematic testing scores may partially be the result of visual-spatial difficulties, anxiety, and frustration.

Career Development

According to Mr. Smith, Jillian attended numerous schools. She was enrolled in preschool at the Loving and Learning Educational Child Care in Oceanside, New York. While Jillian was in preschool, the family moved to France. Jillian was enrolled in pre-kindergarten and kindergarten at Ecole du Marie in Venellas, France. When Jillian entered kindergarten, the family moved to Kansas. She attended kindergarten through fifth grade at various schools in the Blue Valley School District in Overland Park, Kansas. According to Jillian, in grades sixth through eighth grade she attended Hyman Hebrew Academy, which is a private Jewish school. In ninth grade she re-enrolled in the public system because Hebrew Academy lacked the academic resources to meet Jillian’s needs. In June of 2013 Jillian’s family moved to Sydney, Australia. Jillian was enrolled in year 10 at Redlands Secondary School in July of 2013. The Australian school year begins in late January and ends in December. Near the end of Jillian’s school year in Australia, she stole money from a student’s locker and was expelled from the school. Mr. Smith reported they enrolled Jillian in Pacific Quest (PQ) due to her overall behavior deterioration and school failure. Jillian proudly reported that she was able to complete the challenging PQ program in three months. In February of 2015, Jillian was enrolled in Franklin Academy. Jillian reported her future aspirations are to attend a four-year college and work in some capacity with the Down’s syndrome population.

Ethical Implications

Since Jillian is a minor, she is unable to provide consent to counseling under the American Counseling Association (ACA) Code of Ethics (2014). This counselor had to obtain her parents’ consent to counseling Jillian, assessing her, and writing of this case study. This counselor also attempted every effort to protect Jillian’s identity in this case study by changing her name to avoid unjustifiable invasion of privacy.

According to the ACA Code of Ethics (2014), this counselor needed to inform Jillian and her parents of this counselor’s status as an intern. This counselor also informed Jillian and her parents the limits of confidentiality due to the supervision relationship.

According to the ACA Code of Ethics (2014), even though Jillian is a minor she has ethical rights to confidentiality. However, her parents have legal rights to information that occurs in the counseling sessions. This counselor informed the parents and Jillian during informed consent about the minor’s and parents’ ethical and legal rights to ensure a collaborative relationship with all parties. Throughout counseling, this counselor reminded Jillian of the limits of confidentiality according to the ACA Code of Ethics (2014), such as information from the counseling sessions may be shared with the interdisciplinary team, which includes this counselor’s supervisor.

This counselor recorded the majority of Jillian’s counseling sessions. According to the ACA Code of Ethics (2014), this counselor needed to obtain parental consent to record the sessions.

This counselor has maintained ethical boundaries with Jillian according to the ACA Code of Ethics (2014).

According to the ACA Code of Ethics (2014), throughout counseling, this counselor reminded Jillian of the pending termination when she no longer needed assistance, the counseling is no longer beneficial, or the conclusion of this counselor’s internship.

Summary of Case Study

Based on testing and the interview intake with Mr. Smith and Jillian, since an infant she has had a history of social, academic, and emotional difficulties. According to Mr. Smith, in fifth grade Jillian’s parents suspected she had ASD; however the school professionals disagreed. After psychoeducational testing in October of 2014, Jillian was diagnosed with SPD. However in February of 2015, the Pacific Quest therapists indicated in the discharge that the SPD diagnosis was misdiagnosed. The therapists reported Jillian experienced obsessive-compulsive thoughts and behaviors as well as inflexible adherence to routines as well as rules, which is indicative of ASD. For example, Jillian moved and changed schools frequently; however she had significant difficulties adjusting to these changes. Jillian reported she was relieved to learn she has ASD because it explained the difficulties she has always experienced. However, she was disappointed that she was unaware of her diagnosis when she was younger because she has learned ineffective coping strategies to compensate for her disability. Jillian also stated she is grateful to attend Franklin Academy where she can continue to adjust to her new diagnosis and share her experiences with students with similar challenges.

Jillian also has a continual history of GAD, which may be contributed to her ASD, history of experiencing bullying, moving and changing schools frequently, often not seeing her mother because of her position at the United States State Department, genetic makeup, negative self-talk, and obsessive thoughts. She is currently pursuing further psychiatric evaluation to address her GAD.

These issues are currently being addressed in individual counseling with this counselor.

Counseling Treatment Plan and Recommendations

This counselor utilized person-centered therapy (PCT), Cognitive Behavioral Therapy (CBT), and brief psychodynamic theory (BPT) with Jillian based on her presenting problems, current functioning, diagnoses, past counseling experiences, and development. This counselor believes PCT is the foundation of counseling. According to Rogers (2013), clients have the capacity for self-healing and personal growth that may lead to self-actualization. This counselor believes Jillian is responsible for improving her life and thus this counselor attempted to empower Jillian to self-explore, examine her strengths, and increase her self-esteem. Through PCT, this counselor provided Jillian with unconditional positive regard, empathy, genuineness, support, and guidance to nurture Jillian to direct her own treatment. This created greater rapport, allowing Jillian to feel comfortable disclosing her thoughts and feelings. This counselor also used Rogers’ basic counseling skills of active listening, such as encouragers, paraphrasing, summarizing, and reflection of feelings, which this counselor believes is the foundation of counseling.

While using PCT’s active listening and relationship skills, this counselor diverged from PCT’s focus on the here-and-now and encouraged Jillian to examine how the past affected the present using BPT (Meyers, 2013). This counselor utilized BPT to explore Jillian’s dreams, defense mechanisms, and patterns of interpersonal relationships, which according to Meyers (2013) are also effective components of this theory. For example, this counselor encouraged Jillian to explore how her past bullying experiences and adjustment difficulties with moving as well as changing schools have contributed to her GAD. This counselor also guided Jillian to notice how these difficulties related to her ASD.

Moreover, at times this counselor frequently took a more directive approach when this counselor utilized CBT while still using PCT’s active listening and relationship skills. According to Beck (2011), CBT is short-term, direct, structured, encourages the client to actively participate, focuses on the here-and-now, and provides psychoeducation on life skills. This counselor believes in CBT’s straightforward premises that people’s thoughts, feelings, and behaviors are intertwined. If clients can identify their negative thought patterns and challenge these irrational thoughts, they can learn new positive methods of thinking that ultimately will alter their feelings and behaviors. This counselor believed Jillian could benefit from CBT since she experienced negative self-talk, rigid thinking, and perseverating thoughts. Jillian also indicated CBT was effective for her at Pacific Quest. Through Beck’s work, this counselor used reframing, role-playing, problem solving, modeling, teaching positive self-talk, and Ellis’ ABC theory with Jillian. According to Beck, A is the activating event, B is the belief about the event, and C is the consequence. This counselor provided Jillian homework, such as thought records, to practice the skills outside of counseling. This counselor collaboratively worked with Jillian to reach agreement about the presenting problems, the therapy goals, and the treatment.

This counselor also encouraged Jillian to participate in an 8 week anxiety counseling group, which enabled Jillian to realize that her peers also experienced anxiety. This counseling group shared their anxiety experiences and their effective coping strategies. The group also learned new coping strategies as well as how to recognize their triggers and symptoms. In the fall of 2015, this counselor recommends Jillian participate in an 8 week social skills counseling group as well.

Conclusions on the Counseling Treatment

This counselor met with Jillian for an hour on a weekly basis for nine sessions. Currently, Franklin Academy is on summer break, but this counselor will continue to meet with Jillian for an hour on a weekly basis during the fall of 2015. Jillian is making slight progress towards her therapeutic goals, which are to develop emotional awareness and regulation, to develop anxiety management skills, to improve social skills, to increase mental flexibility, to develop a secure sense of self, and to become educated in ASD. The theoretical orientations, PCT, BPT, and CBT, have shown to be effective approaches for Jillian; although her preferred method is CBT. In June of 2015, Mr. Smith reported Jillian had a pediatrician appointment to discuss anti-anxiety medication for her GAD. By fall of 2015, this counselor suspects Jillian’s anxiety will lessen if she is on medication, which will assist her to make greater progress towards her therapeutic goals.

Jen

References

American Counseling Association. (2014). 2014 ACA code of ethics: As approved by the ACA governing council. [Electronic version]. Retrieved from http://www.counseling.org/resources/aca-code-of-ethics.pdf

Beck, J.S. (2011). Cognitive behavioral therapy: Basics and beyond (2nd ed.). New York, NY: Guilford Press.

Meyers, K.J. (2013). Counseling theories converge: Person, client, therapist. Counseling today. Retrieved from http://ct.counseling.org/2013/11/counseling-theories-converge-person- client-therapist/

Rogers, C. (2013). Significant aspects of client-centered therapy. Colorado Springs, CO: Createspace Independent Publishing Platform.