Case Study
Patient Demographic: Client Age: 35 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Hispanic Relationship Status: Divorced Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Anxiety; Depressed Mood, Difficulty with Changing Relationship Roles Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)
Mental Status Exam: Mental Status Exam: The client presents as oriented to person, place, time, and situation. The client appears anxious because he avoids eye contact often and expresses that he has never been in counseling and is ner
Presenting Problem: You are a licensed counselor in Texas in a private practice. A 35-year-old male client comes to counseling for support during a recent divorce. The client says that he and his wife separated a year ago and had to wait a year for divorce per state law; therefore, they finalized the divorce recently. The client says that his wife decided she married him because she was lonely and that, after 8 years of being married, she wanted to find someone she loved. The client states that he still loves his ex-wife and that he has a hard time with his new relationship with her because he shares custody of his children and still has to communicate with her regularly. He continues saying that his wife often calls him for emotional support and he does not know how to respond when this happens because he loves her and wants to support her, but this is confusing for him. The client says that he knows he “shouldn’t be with someone who doesn’t want to be with him and that things won’t go back to how they were.” The client identifies that anxious and depressive symptoms are present and that they affect his ability to engage socially, engage with his children, and perform at work. The client wants to work on navigating his new relationship with his ex-wife, his relationship with his children, and being single again.
Other Contexts:    vous. Family History: The client was married for 8 years, has been separated for a year, and was divorced within the past month. The client reports a good relationship with his family of origin and with his ex-wife’s family. He has two children, a 5-year-old son and a 6-year-old daughter. The client’s children stay at his house every other week.  The client requests to have a session with his children to support their continued transition to being children of divorced parents. The client’s children live across state lines

Question: The client requests to have a session with his children to support their continued transition to being children of divorced parents. The client’s children live across state lines. Considering the location of the children, which of the following is the most ethical clinical decision?
(A): Your main client, the father, is in your state; therefore, it is okay to have a family session.
(B): You consult with the state boards of both states and follow their recommendations.
(C): You cannot provide counseling to the children while also counseling their father, so you provide referrals to a counselor licensed in both states.
(D): You cannot provide a therapy session to the client’s children because they are in a state in which you are not licensed.

Correct Answer: You consult with the state boards of both states and follow their recommendations.
Explanation: Different states have varying rules for providing across-state counseling services. It is always important to consider state regulations regarding cross-border counseling services prior to providing counseling. Simply providing referrals may meet the family’s needs; however, it would be more helpful to the client to find out more about the states’ regulations. You cannot move forward with providing a session just because the father lives in the state you are licensed in. Therefore, the correct answer is (D)
Competency: professional practice and ethics