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: The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as evidence for reframing his self-talk when he is nervous during sex. The client states, “the fact that she even has to say that means that I am inadequate.” The client’s girlfriend says she can tell that he is tense and “in his head” when they are having sex. She also notes that he appears sad after sex and often isolates himself for a while afterward. She also identifies that she feels tense when she notices that he is tense and that this makes her less likely to initiate sex. You empathize with the couple and provide psychoeducation regarding positive communication surrounding sex.  The client asks to meet via online video for the next session

Question: The client asks to meet via online video for the next session. All of the following are practical and ethical problems with video sessions EXCEPT:
(A): Increased ability for a client to misrepresent themselves
(B): Limitations to confidentiality
(C): Access to nonverbal cues
(D): Provision of interventions for a CBT approach

Correct Answer: Provision of interventions for a CBT approach
Explanation: A CBT approach is still possible via telehealth; therefore, this is not a practical or ethical consideration. Access to nonverbal cues is limited when counseling is provided via telehealth. The client’s ability to misrepresent themselves is heightened when services are accessed via telehealth because the client’s identity can be manipulated in the case of audio-only sessions. Confidentiality is more difficult to guarantee when sessions are virtual because it cannot be guaranteed that the conversation is not being overheard on the client’s end and because general privacy settings may be breached. Therefore, the correct answer is (A)
Competency: professional practice and ethics