Case Study
Patient Demographic: Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: College Campus Counseling Clinic Type of Counseling: Individual Counseling Presenting Problem: Depression and “Odd Behavior” Diagnosis: Bipolar 1 Disorder, Current Episode Manic Without Psychotic Features, Moderate (F31.12)
Mental Status Exam: Mental Status Exam: The client states that she slept for 4 hours the night before, which was the most she has slept in one night in the past week and that she now feels tired for the first time. The client had dark circles around her eyes and was wearing sweatpants and a t-shirt with stains on it. The client is oriented to person, place, time, and situation. The client’s affect and speech are
Presenting Problem: You are a licensed therapist working on a college campus in the counseling center. A 20-year-old female client comes to counseling following 8 days of experiencing the following symptoms: little to no sleep most nights with the longest stretch of sleep being 2 hours, several middle-of-the-night shopping sprees, and distractibility. She reports that some of her college professors have called on her to stop talking during class and that she has not been doing very well in school this semester. The client identifies that she has felt this way before over the past 2 years and that this last time scared her because she was more aware of the negative impact it is having on her schooling. The client continues to relate that she also experiences depression at times and that she does not understand where it comes from but that it happens for a few weeks at a time every few months. When in a depressive episode, the client experiences a depressed mood more often than not, decreased enjoyment of activities, hypersomnia, fatigue, and a significant decrease in appetite.
Other Contexts:     flat. Family History: The client says that she and her family moved to the United States from Kenya when she was 5 years old. The client is the first member of her family to go to college, and she reports significant pressure from her parents to succeed. She feels that she has a good relationship with both of her parents. Her sister is 2 years younger than her, and they talk on the phone on a daily basis. The client identifies no other close family members because most are still living in Kenya

Question: Following the intake session, you determine that you have the experience and education to provide counseling, but because this is not your specialty, what would be an appropriate next step?
(A): Refer to a psychiatrist for medication management and continued observation by another professional.
(B): Seek continuing education regarding treatment of bipolar disorder.
(C): Refer to a therapist that specializes in bipolar disorder.
(D): Continue to provide counseling, but seek peer supervision/consultation to ensure your interventions are clinically appropriate, and refer to a psychiatrist for medication management.

Correct Answer: Continue to provide counseling, but seek peer supervision/consultation to ensure your interventions are clinically appropriate, and refer to a psychiatrist for medication management.
Explanation: You have the experience and education for treatment of bipolar disorder; therefore, clinical supervision or consultation would be beneficial in ensuring that you are providing appropriate treatment. Therapists should seek supervision in areas of new specializations per the ACA Code of Ethics in order to ensure that the service provision is appropriate (2014, p 8). That said, because evidence-based practice in the treatment of bipolar disorder supports the combination of counseling and medication management, a referral to psychiatry to oversee the medication management is also required because this is outside the scope of the counselor. A referral to another therapist would not be necessary because your education and experience are appropriate for effective treatment. It is always beneficial to seek ongoing education as a therapist, but if the client came to counseling and you did not already have the education in the area required to appropriately support her, you would refer her to another therapist. Therefore, the correct answer is (C)
Competency: treatment planning