Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af
Presenting Problem: You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.
Other Contexts: You meet with the client, and he reports that he was able to improve his productivity by organizing his day based on organization techniques that you discussed in therapy. The client says that he really wants to focus on getting into writing stories again and that he also wants to learn to play guitar. He explains that his attempts at learning guitar are disrupted because, when he tries, he becomes frustrated, stops quickly, and often does not revisit playing for weeks. You ask the client about thoughts that he has that are a barrier to writing and playing the guitar, and he identifies that he often anticipates that he will just get frustrated and stop, so there is no point in trying. You support the client in cognitive reframing.  Some of the client’s sessions are being provided via telehealth

Question: Some of the client’s sessions are being provided via telehealth. All of the following are unique considerations for telehealth sessions that are different than in-person sessions, EXCEPT:
(A): Body language
(B): Orientation to person, place, time, and situation
(C): Confidentiality
(D): Cost

Correct Answer: Orientation to person, place, time, and situation
Explanation: Orientation to person, place, time, and situation can be observed and assessed regardless of the session being provided via telehealth. Body language is a unique consideration in telehealth, and you might have more difficulty assessing the client’s body language, such as hand gestures, bouncing legs, shaking hands, etc. The counselor’s body language and the counseling room environment are not as important or impactful, aside from what the client sees behind you on his or her computer screen. Costs for telehealth sessions can be cheaper at times than in-person sessions. An additional cost for the counselor might be a HIPAA-compliant telehealth medium. Confidentiality remains the same in that sessions should remain confidential; however, you cannot guarantee that no one is listening in or is in the room in the client’s location. Therefore, the correct answer is (C)
Competency: professional practice and ethics