Case Study
Patient Demographic: Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng
Presenting Problem: You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.
Other Contexts: You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services.  Some clients may need to be referred to another counselor

Question: Some clients may need to be referred to another counselor. All of the following are appropriate reasons to make a referral, EXCEPT:
(A): The client would benefit more from a psychiatrist or a medical specialist.
(B): The client and you have very different political affiliations, and their presenting problems relate to political events.
(C): You fail to connect with the client due to personality differences.
(D): You do not specialize in the disorder experienced by the client.

Correct Answer: The client and you have very different political affiliations, and their presenting problems relate to political events.
Explanation: Political affiliations should not affect the counseling process. You must support the client’s values and beliefs even when trying to reframe what you perceive as illogical thoughts. A failed connection due to personality differences is a valid reason for referral if a connection cannot be made. Personality differences are important to consider because the therapeutic relationship relies on a real interpersonal connection between two people. If the client’s needs are outside of your competency, or if the issue at hand is a medical issue or would benefit more from psychiatric intervention, then a referral is also appropriate. Therefore, the correct answer is (D)
Competency: professional practice and ethics