Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express
Presenting Problem: You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.
Other Contexts: The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as evidence for reframing his self-talk when he is nervous during sex. The client states, “the fact that she even has to say that means that I am inadequate.” The client’s girlfriend says she can tell that he is tense and “in his head” when they are having sex. She also notes that he appears sad after sex and often isolates himself for a while afterward. She also identifies that she feels tense when she notices that he is tense and that this makes her less likely to initiate sex. You empathize with the couple and provide psychoeducation regarding positive communication surrounding sex.  You have provided support for your counseling intern, and he continues to be late for and miss client sessions

Question: You have provided support for your counseling intern, and he continues to be late for and miss client sessions. Which of the following would meet ACA criteria for ethical considerations at this point?
(A): You see this as an opportunity to support the intern in balancing his personal life and his professional life.
(B): You seek consultation and document your decision to terminate your supervisory relationship with the intern.
(C): You encourage the intern to seek counseling in order to work through what he is going through.
(D): You provide a corrective action plan to the intern in order to prevent further issues with his clients.

Correct Answer: You seek consultation and document your decision to terminate your supervisory relationship with the intern.
Explanation: At this point, documenting the consultation and terminating the relationship would be indicated because the intern is continuing to harm clients (ACA, 2014, p 13). You have already tried to support the intern, and it was not helpful in preventing client harm or changing his behavior. At this point, a corrective action plan may not be helpful because the intern has not shown that he is willing to change. It may be helpful to encourage the intern to seek counseling; however, this does not address the potential for further client harm. Therefore, the correct answer is (A)
Competency: professional practice and ethics