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:    tion. Family History: The client has been married for 25 years. He has three children, a 23-year-old son, a 21-year-old son, and an 18-year-old daughter. The client reports a strong relationship with his wife and children and states that they regularly spend quality time together.  The client does not currently have health insurance and says he will have difficulty continuing to pay for sessions at the current rate

Question: The client does not currently have health insurance and says he will have difficulty continuing to pay for sessions at the current rate. Which of the following would be the most ethical method for determining your payment arrangement with this client?
(A): You consider the client’s financial hardships and adjust your self-pay rate for the client.
(B): You maintain the self-pay rate with the client because it is important to be compensated for the service you are providing.
(C): You and the client set up a verbal agreement to trade the client’s garden produce and woodworking in exchange for counseling services.
(D): You refer the client to another therapist who is willing to provide pro bono services.

Correct Answer: You consider the client’s financial hardships and adjust your self-pay rate for the client.
Explanation: Based on the ACA Code of Ethics, the most ethical method in dealing with this dilemma is to consider the possible hardships imposed on the client and adjust your rate for the client (ACA Governing Council, 2014). Bartering for services is appropriate, but it requires a written contract that both parties agree on (ACA Governing Council, 2014). Maintaining the self-pay rate does not consider possible hardships for the client and would not be the most ethical consideration. Providing a referral might be appropriate, but it is most ethical to first consider an adjustment in the fee prior to referring him to another therapist. Therefore, the correct answer is (C)
Competency: professional practice and ethics