Running head: CLIENT CASE STUDY 1 CLIENT CASE STUDY 20 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 Inf ...

1. Running head: CLIENT CASE STUDY 1
CLIENT CASE STUDY 20
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

2. 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

3. 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

4. · 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

5. 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

6. 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

7. 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

8. 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,

9. 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

10. 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.

11. 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

12. 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

13. 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

14. 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

15. 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,

16. 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

17. 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

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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
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