Case Study
Patient Demographic: Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1)
Mental Status Exam: Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors
Presenting Problem: You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.
Other Contexts: You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice.  Following this session, the couple decides to stop meeting with you together because they plan to separate. The husband states that he would like to continue working with you

Question: Following this session, the couple decides to stop meeting with you together because they plan to separate. The husband states that he would like to continue working with you. According to the ACA Code of Ethics, which one of the following would be the most ethical decision in this scenario?
(A): Provide a referral to another therapist due to your past counseling relationship with his wife.
(B): You agree to provide individual counseling and explain that if you start to counsel him independently, you cannot provide marital counseling for him and his wife should they decide to stay together.
(C): You agree to provide individual counseling to him and offer to provide marital counseling if they end up wanting to stay together.
(D): You cannot continue seeing him due to having a previous counseling relationship with his wife.

Correct Answer: You agree to provide individual counseling and explain that if you start to counsel him independently, you cannot provide marital counseling for him and his wife should they decide to stay together.
Explanation: The ACA Code of Ethics allows for the counselor to change counseling modalities, but in these cases, the counselor must explain the possible consequences of the change, which may be financial, legal, personal, or therapeutic in nature. If you begin to provide individual counseling to the husband in this case, there is a possibility of becoming biased toward him, which would create a conflict of interest should you resume marital counseling with the couple. If you think the client’s needs are out of your scope of practice, you can refer him to another counselor. Therefore, the correct answer is (D)
Competency: professional practice and ethics