Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3)
Mental Status Exam: Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio
Presenting Problem: You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.
Other Contexts: The client has been on antidepressants for 3 weeks and has shown improvement with depressive symptoms. She has benefited from weekly counseling sessions and attends a psychoeducational group designed to help reduce stigma associated with mental disorders, provide information on medication management, and improve healthcare access and utilization. It has been 18 months since her grandmother’s death, and she has expressed a desire to process feelings of grief and loss.  The client’s religious beliefs and core cultural values are inconsistent with your own worldview

Question: The client’s religious beliefs and core cultural values are inconsistent with your own worldview. Which theoretical orientation would best provide you with a basis for sound ethical practice?
(A): Behavior therapy
(B): Rational-emotive behavioral therapy
(C): Conversion therapy
(D): Person-centered therapy

Correct Answer: Person-centered therapy
Explanation: Although all theoretical orientations can be adapted for use with culturally diverse populations, the core elements of person-centered therapy would best enable you to uphold professional ethical principles. According to the ACA Code of Ethics, “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients … 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” The Association for Spiritual, Ethical, and Religious Values in Counseling provides a more thorough overview of ethical competencies aligned with the ACA Code of Ethics. Person-centered therapy is nondirective and uses the facilitative conditions of unconditional positive regard, empathetic understanding, and genuineness to guide the client toward self-actualization. Person-centered therapists respect diverse values, attitudes, and beliefs and refrain from taking the “expert role” in clients’ lives. In general, behavior therapy does not consider the client’s sociocultural background but instead views specific behaviors as a series of “maladaptive responses” Illegal in most states, conversion therapy is supported by conservative religious organizations that view same-sex attraction as pathological. Rational-emotive therapy is less likely to uphold ethical principles primarily because of the techniques “forcefully disputing” irrational thoughts in efforts to change “maladaptive behaviors” Unless adapted for diverse populations, rational-emotive behavior therapy (REBT) does little to consider the sociocultural and political influences on an individual’s thoughts and behaviors. Therefore, the correct answer is (B)
Competency: counseling skills and interventions