Case Study
Patient Demographic: Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client has been engaging in behavior that has gotten him suspended from school several times over the past year, which also causes significant distress for the client’s family at home. Diagnosis: Conduct disorder, childhood-onset type, with limited prosocial emotions, severe (F91.1)
Mental Status Exam: Mental Status Exam: The client was minimally engaged in the session. The client’s behavior was withdrawn, argumentative, and la
Presenting Problem: You are a professional counselor, and you specialize in working with children and adolescents. The client comes to this session with his parents. You review informed consent with the client and his parents and begin to ask the client about what brings him to counseling. The client responds by saying “shut the hell up” and leaves the room to go to the lobby. The client’s father gets up and follows him out, and after a few minutes they return. The client sits down and faces away from you. The client does not engage in the intake session aside from cursing at his parents when they report specific behavioral incidents and he disagrees with them about the facts of the events. The client’s parents say that he has had “bad behavior” over the past 2 years and that his behavior has “gotten worse” over the past 5 months. The parents outline the following behavioral problems that the client engages in, in all settings: bullying, physical fighting, kicking and throwing items at his dog, intentionally breaking others’ property, lying to others to get items or have access to activities, stealing items from others, truancy, and leaving the house at night without permission or supervision.
Other Contexts: Since the fourth session, child protective services investigated the client’s abuse allegations and determined that they were unfounded. You discuss this with the client and he says he was lying because he was mad at his parents that day. You praise the client for being forthright today regarding the allegations and discuss how false allegations can be incredibly harmful to others and can strain his relationship with his parents further. You and the client process several situations similar to this in which he avoided responsibility. You empathize with the client and support his reflection on his behavior.  The client’s parents have not paid for the past three sessions

Question: The client’s parents have not paid for the past three sessions. All of the following are important considerations, EXCEPT:
(A): Inform the client in a timely fashion of your intention to use a collections agency.
(B): Waive the session payments because the client is unable to afford them and you want to preserve the counseling relationship.
(C): Offer the client the opportunity to pay for the past three sessions.
(D): The policy should be covered in your informed consent document, and you should follow the agreed-upon terms.

Correct Answer: Waive the session payments because the client is unable to afford them and you want to preserve the counseling relationship.
Explanation: The client has agreed to certain payment expectations as outlined in the informed consent documents and is not paying as agreed. You are able to refrain from waiving the payments if you would prefer because they have been consented to. Informing the client of intentions to use a collections agency, allowing the opportunity to pay for recent sessions, and including this information in the informed consent are all important ethical considerations in this situation, according to the ACA Code of Ethics. Therefore, the correct answer is (D)
Competency: professional practice and ethics