Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express
Presenting Problem: You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.
Other Contexts:  Diagnosis: Premature Ejaculation, Acquired, Generalized, Mild (F52.4)   ions. Family History: The client reports that he has been in a relationship with his girlfriend for 3 years. The client says that he is close with his parents and his younger brother.  You are supervising an intern, and he is also your employee. Your intern reports that he recently experienced a breakup with a significant other, and this has made him late to several sessions; in turn, several clients have canceled upcoming sessions due to his unreliability

Question: You are supervising an intern, and he is also your employee. Your intern reports that he recently experienced a breakup with a significant other, and this has made him late to several sessions; in turn, several clients have canceled upcoming sessions due to his unreliability. According to the ACA Code of Ethics, which of the following would be the best course of action as a clinical supervisor/manager in order to prevent harm to clients?
(A): The intern is causing harm to clients; therefore, employment consequences must be enforced to remove the source of harm.
(B): Consider either reducing the intern’s caseload or putting him on a short-term leave in order to reduce harm to clients.
(C): Support your intern through the breakup in order to prevent harm to current clients.
(D): Sit in sessions with the intern and his clients to provide accountability.

Correct Answer: Consider either reducing the intern’s caseload or putting him on a short-term leave in order to reduce harm to clients.
Explanation: The ACA Code of Ethics notes that if services to clients are impaired due to physical, mental, or emotional issues, then the termination of supervisory efforts may be considered. The code also states that the intern should seek assistance with these kinds of problems in order to prevent harm to clients. Therefore, a combination of supporting the intern (by reducing his caseload) combined with the consideration of employment or supervision consequences (such as a short-term leave) is the most appropriate course of action. Simply terminating supervision would not be indicated at this time because an effort needs to be made to support the intern. Sitting in the sessions might provide accountability for the intern to be on time; however, it does not address the root of his issues. Therefore, the correct answer is (D)
Competency: professional practice and ethics