Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3)
Mental Status Exam: Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio
Presenting Problem: You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.
Other Contexts: The client has been on antidepressants for 3 weeks and has shown improvement with depressive symptoms. She has benefited from weekly counseling sessions and attends a psychoeducational group designed to help reduce stigma associated with mental disorders, provide information on medication management, and improve healthcare access and utilization. It has been 18 months since her grandmother’s death, and she has expressed a desire to process feelings of grief and loss

Question: Ethical guidelines for the counseling profession state that counselors must refrain from terminating or referring clients based solely on which of the following conditions?
(A): The client’s failure to pay agreed-upon fees
(B): The determination that the client is no longer benefiting from services
(C): The lack of competence required to provide professional assistance
(D): Adherence to personal values, attitudes, beliefs, and behavior

Correct Answer: Adherence to personal values, attitudes, beliefs, and behavior
Explanation: Counselors are instructed to “refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature” (ACA, 2014). The ACA Code of Ethics specifies that the client’s failure to pay agreed-upon fees justifies appropriate termination. Counselors review policies and procedures associated with nonpayment as part of informed consent. In terms of counselor competence, the ACA Code of Ethics states, “If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship” (ACA, 2014). Lastly, counselors are ethically obligated to end professional counseling relationships when the client no longer benefits from counseling. Therefore, the correct answer is (C)
Competency: professional practice and ethics