Case Study
Patient Demographic: Client Age: 60 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Unemployment; Anxiety; Depressed Mood Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)
Mental Status Exam: Mental Status Exam: The client appears to have a depressed mood as evidenced by his affect, slow speech pattern, and body posture. The client is dressed appropriately for the season and is in clean clothing. The client is oriented to person, place, time, and situa
Presenting Problem: You are a private practice therapist working in an outpatient clinic. Your 60-year-old male client comes into the intake session, sits down, and sighs deeply. You verbally acknowledge that the client looks as though he is carrying a big mental weight, and he nods. The client begins to talk about how he was let go from his job at an assembly plant a month prior due to budget cuts. The client says that he worked there for about 30 years and that he was most recently a plant manager for the past 10 years. The client states that the plant shut down because the automotive company moved their manufacturing to another country. The client expresses anxiety surrounding what he is going to do for work next. The client states that he worries that he does not have much to offer other employers due to the extent of time he spent at his last job and also that his age will make him unemployable. The client says that he has been isolating himself, feels down more often than not, and often worries about making ends meet. The client states that his wife is currently receiving cancer treatment and, because of this, they have significant, regular medical bills.
Other Contexts: The client comes into the session with a similar presentation as last week as he sits down and sighs deeply. You ask the client what he is thinking about, and he recounts an argument earlier in the day that he had with his wife when they were discussing finances. The client expresses frustration that they have had several arguments over the past week regarding finances. You empathize with the client and support him with further processing his anxiety about finances. The client expresses an immediate need to start working soon for financial reasons and because he is having a hard time “doing nothing” every day.  The client wants to work on the conflict that he and his wife are experiencing

Question: The client wants to work on the conflict that he and his wife are experiencing. Which of the following would be the most ethical and clinical decision based on the client’s needs and current situation?
(A): Offer to have the client’s wife in the session one time to focus on how they can support each other through this transition.
(B): Continue individual counseling with the client and include methods on resolving conflicts with his wife during a single session.
(C): Refer the couple to a couples counselor.
(D): Offer to provide couples counseling in addition to continued individual counseling for your client after explaining the risks involved.

Correct Answer: Offer to have the client’s wife in the session one time to focus on how they can support each other through this transition.
Explanation: The ACA Code of Ethics prohibits providing services to the client’s family members because this affects objectivity in the counseling process (2014, p 5). You can provide a counseling session for the client that involves his spouse if it focuses on supporting your client’s well-being and is not an ongoing process because this would be a dual relationship and biases would affect efficacy. The couple should be referred to couples counseling; however, the client has concerns about paying for sessions and currently does not have health insurance, which would make this an untenable option. Therefore, the correct answer is (C)
Competency: professional practice and ethics