Case Study
Patient Demographic: Initial Intake: Age: 29 Gender: Female Sexual Orientation: Heterosexual              Ethnicity: Caucasian Relationship Status: In a relationship Counseling Setting: Private practice Type of Counseling: Individual
Mental Status Exam: Taylor presents as well groomed, has good eye contact, and movements are within normal limits. Taylor appears anxious with tense affect and is occasionally tearful. Taylor has no history of suicidal thoughts or behaviors, no reported trauma history and has never been in counseling.
Presenting Problem: Diagnosis: Adjustment disorder with anxiety (F43.22)
 

You are a counseling intern working in a private practice with your supervisor and several other interns. Taylor is a 29-year-old college student who was referred to you by her university’s resource center for mental health counseling. Taylor went to them requesting someone to talk to about her family stress. Taylor’s 18-year-old brother has autism and is preparing to go to college in another state, and Taylor is feeling anxious about the transition since he will be leaving home for the first time and their family will not be around to help him. Taylor has been manifesting her anxiety in ways that are causing her difficulty in school and in her relationship, such as trouble concentrating, completing assignments, and lashing out with aggressive reactions towards her parents or her boyfriend whenever they bring up the topic of her brother’s college. She has even yelled at her brother once out of frustration. Taylor is hoping to find ways to cope with her stress and manage her emotions over her family’s decisions.
Other Contexts: Family History:
Taylor lives at home with her parents and her brother, and commutes to University for her Bachelor studies. She stayed at home since graduating high school to help her parents with her brother with autism. Her parents had separated on and off for several years because of an affair her mother had, so the house has had tension and instability making Taylor feel responsible to keep her brother on a stable routine. Taylor comments that her brother’s challenges have always “taken up all her time” and that she used to complain about them, but now that he is going to be on his own, she is very upset she will not be able to be there for him. She complains her parents are “flaking out” on her and feels left out of their decision making but does not know what to do about it.

Question: Given the level of information Taylor has shared in her e-mail, what is the appropriate response?
(A): Inform that e-mail is for scheduling purposes only and that it is unethical to see her brother.
(B): Do not respond and discuss virtual safety and protocols in the next session.
(C): Send new client documentation for her brother to sign prior to the next session.
(D): E-mail a detailed itinerary of your next session's goals and activities for both siblings.

Correct Answer: Inform that e-mail is for scheduling purposes only and that it is unethical to see her brother.
Explanation: You must make mention of the inappropriate use of e-mail. E-mail communications regarding symptoms (or in Taylor's case her mention of crying spells and driving emotionally) increase the safety risk of your client and could end up causing a liability issue. Answer a is not best practice as it neglects to set boundaries, which could complicate the next session if she decides to have her brother present. Answer b only further encourages this type of communication for clinical discussion and unless you have worked out an arrangement where assignments will be delivered via e-mail, inclusive of a signed Telemedicine consent form outlining these details, it is not best practice. Answer c neglects to address any of these aforementioned factors and focuses solely on getting legal permission to see Taylor's brother next session. It is furthermore unethical to be her brother's counselor, especially since Taylor's presenting problems for counseling involved her complex feelings about her brother. Therefore, the correct answer is (D)
Competency: professional practice and ethics