Counseling Case Study: Adjustment Disorder & Divorce Stress

Client Presentation and Presenting Problem

Client T.C. is a 40-year-old Black male who self-identifies as male and was born and raised in Miami. He holds a four-year degree in consumer family science from New Mexico State University and is currently employed as a special education program director, a position he reached through consistent promotions. He reports no religious or spiritual affiliation. There are no current legal problems, with the exception that he is pursuing a legal divorce from his wife. He has no prior history of counseling.

The client is seeking counseling due to serious family problems and concerns about obtaining a divorce. His difficulties became acute approximately three months ago, when his wife discovered that he had been having an affair for the previous six months. Since being caught, his wife has become suspicious and monitors his whereabouts constantly. The client reports ongoing financial pressure, attributing it in part to his wife's controlling attitude toward money. His symptoms remain mild but are expressed through irritability, anger, shouting, and loud outbursts. The client's primary goal is to achieve peace of mind, which he believes can be attained by pursuing a divorce and relieving himself of continuous stress.

The client's family of origin reflects his Black ethnic background. Research has shown that Black Americans tend to experience greater psychological distress, with the effects of racial identity manifesting in lower life satisfaction and elevated rates of depression and anxiety (Williams, 2018). The client's significant current relationships are his wife and two sons. He has been married for five years; the boys are aged 13 and 10. Because the marriage has lasted only five years and the children are 10 and 13, it can be inferred that the sons are his wife's children from a prior relationship, which may itself be an additional source of stress. The client's current living arrangement consists of himself, his wife, and the two children.

There are no reported major losses or traumas, no family mental health history, no family substance abuse history, and no family history of violence. Developmental challenges are nonetheless present: the client's angry outbursts directed at the children — who are not the source of his problems — are concerning given their adolescent ages. His wife is already distressed by his infidelity and is further upset by his treatment of her children. These behavioral patterns risk creating lasting social difficulties; if his mood remains persistently hostile, his capacity for constructive interpersonal interaction could be significantly impaired.

Family Structure and Background

As noted, the client identifies as Black. He has no current religious or spiritual affiliation. He reports no ability limitations or physical impairments. His sexual orientation can be inferred as heterosexual based on the nature of his extramarital affair. He does not identify as transgender. At age 40, he belongs to the Millennial generation. He holds a middle-class socioeconomic status, has never experienced homelessness, and continues to advance professionally.

There is no military background, gang involvement, drug culture, or criminal justice contact. The client was born and raised in Miami, and English is his preferred language. While geographic region has been associated with racial discrimination and related psychological stress among older Black adults (Kim et al., 2016), the client's current distress appears to stem primarily from family stressors rather than from geographic or racial marginalization. His consistent professional advancement suggests that racial discrimination has not constituted a significant barrier in his life. His psychological symptoms remain mild and have not escalated to a serious clinical stage.

The client is experiencing significant stress that has begun to manifest behaviorally. Notably, he endorses physical discipline of his children as a form of behavioral management — itself an indicator of impulsive and harsh conduct. Given that both children are in adolescence, a developmental stage during which rebellion tends to increase regardless of social class (Luthar & Ansary, 2005), the client's reactive and punitive approach is particularly ill-suited to their needs. His marital relationship has deteriorated substantially since his wife discovered his infidelity roughly three months ago, and the stress from that discovery can be considered acute in duration.

Contributing factors include his wife's persistent suspicion and her management of household finances in ways the client perceives as selfish. Recurring stressors include her repeated phone calls to check on him, her financial demands, and an additional unexpected expense when her car required repair. The client's primary identified strength is the support of his mother. Beyond that, no other protective factors or resilience indicators are apparent at this time.

Multicultural Considerations

Based on the clinical picture, a DSM-5 diagnosis of adjustment disorder is most appropriate. Adjustment disorder is characterized by a prolonged emotional or behavioral reaction to an identifiable stressor that causes marked distress and functional impairment (Mayo Clinic, 2017). The diagnostic rationale is supported by the fact that the client's stress-related behavioral symptoms emerged within three months of a discrete stressor — being discovered having an affair — which aligns with DSM-5 criteria for this diagnosis (Mayo Clinic, 2017).

Two alternative diagnoses were considered: acute stress disorder and unspecified stressor-related disorder (Virginia Commission on Youth, 2017). These diagnoses share symptomatic overlap with the client's presentation but were not selected because the client's symptoms remain mild and do not meet the full threshold for either alternative. Among the six subtypes of adjustment disorder, the client's presentation most closely corresponds to the subtype involving disturbance of conduct, given that his primary manifestation is behavioral — specifically, his aggressive and reckless treatment of his children (Mayo Clinic, 2017).

Clinicians should note that standardized mental health assessments often struggle to differentiate adjustment disorder from major depressive disorder. Screening instruments such as the Zung Depression Scale, the One-Question Interview, and the Hospital Anxiety and Depression Scale may be useful in clarifying the diagnosis and monitoring treatment response, though their interpretation requires clinical expertise (Casey & Doherty, 2013).

Various psychological theories originally developed to explain PTSD have been extended to adjustment disorder and offer useful frameworks for understanding the client's behavior. One prominent contemporary model, emotional processing theory, proposes that traumatic events and their associated symptoms become linked in memory, producing ongoing emotional instability that disrupts daily functioning (Brewin & Holmes, 2003, p. 352). Applied to this case, the client's reckless behavior toward his children and his desire to exit the marriage can be understood as attempts to eliminate the negative schemas that are undermining his emotional regulation and mental peace.

Narrative Summary and DSM-5 Diagnosis

The preferred therapeutic orientation supports positive change by reducing the reinforcement of those negative schemas. As these schemas lose their hold, the client's fear responses are expected to diminish, resulting in lower anxiety, reduced avoidance behavior, and a decreased preoccupation with stress-inducing memories (Brewin & Holmes, 2003, p. 353).

A second theoretical lens, the anxious apprehension model, addresses PTSD-related panic responses and traumatic flashbacks (Brewin & Holmes, 2003, p. 351). While originally developed for PTSD, it offers some explanatory value here: the client's desire to remove his wife from his life can be interpreted as an effort to eliminate the primary alarm trigger generating his stress. His hyperarousal — expressed as harsh behavior toward his children — reflects a generalized threat response connected to the original stressor of being discovered in infidelity.

Drawing on person-centered theory and the emotional processing framework described above, the short-term SMART goal is the reduction and eventual elimination of the client's acute stress symptoms. This is to be achieved through structured therapeutic sessions over a six-month period (Comprehensive Rehab, 2019). Interventions for this phase include a comprehensive clinical assessment covering problem onset, duration, specific symptoms, family history, any prior medication use, and substance use screening. The client will also be educated about the nature of the therapeutic process, and psychotherapy sessions will be evaluated on an ongoing basis (Wiley, n.d.).

The mid-range SMART goal focuses on mood stabilization and the alleviation of stress-related symptoms. Because the client's irritability and outbursts put his social relationships at risk, restoring emotional regulation is a clinical priority at this stage. Recommended strategies include regular diaphragmatic breathing exercises, yoga, physical activity, a nutritious diet, and engagement with social support networks. These activities are intended to build coping capacity and reduce the frequency of angry outbursts.

The long-term SMART goal is the restoration of a stable and satisfying marital relationship or, if divorce proceeds, the establishment of a healthy post-divorce family dynamic. Couples counseling is recommended as a component of this phase. The wife may benefit from recognizing that behavioral changes in her husband represent genuine progress and that continued punishment may undermine recovery. She may also need support in understanding how her financial behavior contributes to household stress and ultimately affects the wellbeing of the children.

Because the client's treatment is primarily psychotherapeutic, standard ethical principles in counseling apply throughout. These include protecting client confidentiality, honoring the client's right to self-disclosure, maintaining appropriate professional boundaries, and carefully managing any sharing of information with third parties (Sage Pub, n.d.).

Personal barriers to ethical practice may include an inadequate assessment of the client's cultural background and a failure to exercise independent clinical judgment (Akfert, 2012, p. 1809). To address these proactively, the therapist should develop familiarity with Black cultural contexts and use open-ended questioning to invite the client to share any race-related concerns. Institutional support for clinical autonomy should also be sought so that treatment decisions are made on professional grounds rather than organizational or political pressures.