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: The client talks about when he went to see his daughter at a dance recital and how, afterward when he went to say hello to her, she ignored him. He called his ex-wife later that day, and she denied knowing what was wrong, but when he talked to his son, the boy said, “Mommy told us you didn’t want to live with us anymore and that is why you left.” The client expresses frustration and anger with his ex-wife because she chose to leave him, and he thinks that it is not fair that she is telling the children a lie and also that it is affecting his relationship with them. The client states that he wanted to talk to you before he confronted his wife about this. You and the client discuss conflict resolution skills.  The client asks if his ex-wife can come into the next session so they could work on co-parenting skills

Question: The client asks if his ex-wife can come into the next session so they could work on co-parenting skills. Which one of the following is the most ethical course of action?
(A): Explain your role with the client and provide a family therapy or couples counseling referral.
(B): Explain that if you are going to work with the client and his wife, then you would not be able to revert back to individual counseling because you can only work with him in one modality to avoid a conflict of interest.
(C): Explain guidelines for how you can provide individual therapy for him and his family or couples therapy for him and his ex-wife.
(D): Explain that you are unable to meet with both of them because you are his individual counselor.

Correct Answer: Explain your role with the client and provide a family therapy or couples counseling referral.
Explanation: You have had four sessions with this client and would likely already be too engaged, and therefore biased, to provide appropriate therapy to your client and his ex-wife at this point. It would be most ethical to refer the couple to another therapist if they would like to work on coparenting skills. Simply stating your inability to work with the couple without providing proper direction via a referral would not be the most ethical course of action because it does not support your client in seeking the additional help that he is requesting. If you provided individual and couples/family therapy, you would be risking bias toward this client because you work more directly with him and his needs. Therefore, the correct answer is (A)
Competency: professional practice and ethics