Case Study
Patient Demographic: Client Age: 32 Gender: Female Sexuality: Bisexual Ethnicity: Caucasian Counseling Setting: Agency Type of Counseling: Individual Presenting Problem: Binge-eating Diagnosis: Binge-Eating Disorder 307.51 (F50.8), Moderate
Mental Status Exam: Mental Status Exam: The client presents as polite and cooperative. She was well-groomed and dressed appropriately for the situation. Her affect is blunted, and she is tearful when discussing episodes of binge eating. The client has poor eye contact and periodically bites her fingernails. Her thought content is clear. She does not endorse audiovisual hallucinations, and she is oriented to person, place, time, and situation. The client denies suicidal and homicidal ideations. She denies previous suicidal attempts but states that she used to engage in cutting when she was an adolescent
Presenting Problem: You are working at an agency serving clients from the metropolitan area. Your client is a 32-year-old bisexual female presenting with feelings of sadness, frustration, and shame due to increased episodes of binge eating. The client explains that she has tried unsuccessfully to manage her weight and control her eating. She states she is secretive when bingeing and feels “disgusted” afterward but “completely unable” to stop the compulsion. The client reports binge eating six times per week, with episodes worsening in the last two years. She identifies as bisexual and reports her binge eating increased after coming out to her family. She continues to struggle with depressive symptoms, including feelings of hopelessness, depressed mood, and anhedonia. The client’s weight places her in the category of obese, and she has recently been diagnosed with borderline diabetes. Towards the end of the session, the client states, “This is starting to affect my health. If I could change anything in my life, it would be to stop binge eating.”
Other Contexts:    . Family and History: The client is an only child and has never been married. She describes her relationship with her parents as “close until recently.”She and her family belong to a Christian evangelical church, and her family does not accept the client’s sexual orientation\. Her father is an accountant without any known mental illness. The client’s mother has been diagnosed with depression and anxiety. When growing up, the client states her parents placed a strong emphasis on how things looked on the outside. She feels she has failed her parents and carries shame and guilt over her body weight and sexual orientation.  You consider yourself evangelical and uphold values consistent with church teachings

Question: You consider yourself evangelical and uphold values consistent with church teachings. How should you handle your opposing values?
(A): Speak to your supervisor about referring the client.
(B): Seek guidance and consultation from the client.
(C): Tell your supervisor about the issue and agree to follow-up if it becomes problematic.
(D): Seek professional training in that area and continue to work with the client.

Correct Answer: Seek professional training in that area and continue to work with the client.
Explanation: The best way to handle your opposing values is to seek professional training in that area and continue to work with the client. Seeking professional training and supervision is designed to honor ethical counseling principles, specifically justice, nonmaleficence, and beneficence, and to preserve a safe counseling environment. According to the ACA Code of Ethics (2014), counselors avoid imposing “their own values, attitudes, beliefs, and behaviors” and “seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature” The primary focus of treatment must always be the client’s goals and desired outcome. When opposing values are brought into the counseling process, the counselor is no longer impartial, and there is a danger of harming the client. Seeking guidance and consultation from the client is incorrect because of the power differential and the counselor’s responsibility to obtain professional guidance. Referring the client to another provider is incorrect because “Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors (ACA, 2014)”. Therefore, the correct answer is (B)
Competency: professional practice and ethics