Case Study
Patient Demographic: Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)
Mental Status Exam: Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia
Presenting Problem: You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.
Other Contexts: The client comes to this session, sits down, and starts talking about how she met a man and talked to him for about an hour and was frustrated at the end of the conversation because she feels that he is “like everyone I’ve been with before.” The client continues to explain that she knows these men are not good for her and that she wants something different, but she is still talking to him. The client becomes frustrated talking about this and begins crying and breathing heavily, stating that, “I am broken and can’t have a healthy relationship.” You support the client through her strong emotions and provide empathetic listening.  The client inquires about circumstances in which you, as the counselor, are able to disclose information from your sessions with her

Question: The client inquires about circumstances in which you, as the counselor, are able to disclose information from your sessions with her. All of the following are true regarding disclosure of information, EXCEPT:
(A): You may disclose information to the client’s insurance company because they are a payor.
(B): You may disclose information when the client expresses suicidal ideation with a plan and intent.
(C): Even if the client is deceased, you cannot disclose information.
(D): You may disclose information when the client does not show up for a session because you are required to call the emergency contact.

Correct Answer: You may disclose information when the client does not show up for a session because you are required to call the emergency contact.
Explanation: Reaching out to an emergency contact after one missed session is not by itself a sufficient justification for disclosure because you are unsure if the client is at imminent risk of harm. You may disclose information to the insurance company because they are a payor. You can also break confidentiality if the client is at risk of harming themselves or others. Even when the client is deceased, you must maintain confidentiality to the level requested by the client. Therefore, the correct answer is (C)
Competency: professional practice and ethics