Case Study
Patient Demographic: Client Age: Husband, 38; wife, 37 Sex: Husband,male; wife, female Gender: Husband,male; wife, female Sexuality: Husband,heterosexual; wife, bisexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Counseling clinic Type of Counseling: Couples counseling Presenting Problem: The couple is experiencing distress because the wife has had a sexual affair with a woman. Diagnosis: Adjustment disorder, unspecified (F43.20) and relationship distress with spouse or intimate partner (Z63.0)
Mental Status Exam: Mental Status Exam: The couple presents as withdrawn at the start of the session, but they open up as they talk about lighter subjects. Both individuals are oriented to person, place, time, and situa
Presenting Problem: You are a licensed counselor meeting with a couple in your private practice clinic. The couple comes in, and they both sit down at far ends of the couch and do not look at each other. After explaining informed consent and other intake policies, you begin to ask the couple what brought them to counseling, and they both sit silently. You ask the couple if it is hard to start this conversation because of why they came, and they both nod. You ask the couple if it might be easier to start with how they met and why they fell in love with each other, and they both nod in agreement that they can talk about that. The couple appears more comfortable after this and even say a few statements to each other about shared experiences during the conversation. You circle back to the reason why they came to therapy, and the wife says that she assumes that she should talk first. She states that about a week prior she told her husband that she had an affair with a woman a few months before. She continues that, at the time, she was curious and it occurred while she was drunk and insists that it meant nothing. The husband states that he still loves her, but he is not sure how he is going to move past this. He emphasizes that not only did she have an affair, but her action exposed an aspect of her that he did not know about, making him question whether she even finds him attractive.
Other Contexts: Fifth Session, 5 Weeks After the Initial Intake The couple comes into the session and continues to appear more comfortable with each other. Both individuals report that they have been intentional about spending more quality time with one another. The husband says that his wife made sure that he had time to go fishing with his father last weekend, which meant a lot to him. During the session, you discuss events leading up to the affair and both agree that they have spent the majority of the last few years neglecting their relationship. The wife begins to speak but expresses that she knows she is the one who hurt her husband so she should not explain why it happened. You ask the husband if he wants to know how she is feeling and he nods. The wife explains that she felt he was not interested in her anymore, and although she knows what she did was not okay, she felt validated and cared for by the woman. The husband begins to cry. You continue to support the couple’s exploration of this area of their marriage and provide empathetic listening.  While managing this couple’s therapy, you are also supervising an intern at the clinic who is seeing their own clients. You have recently received several complaints regarding this intern that include talking on their phone during sessions, late progress notes, and inconsistent communication with clients. You think the intern is not responding well to feedback and has not tried to make changes. Additionally, several of the intern’s clients have terminated their counseling services

Question: While managing this couple’s therapy, you are also supervising an intern at the clinic who is seeing their own clients. You have recently received several complaints regarding this intern that include talking on their phone during sessions, late progress notes, and inconsistent communication with clients. You think the intern is not responding well to feedback and has not tried to make changes. Additionally, several of the intern’s clients have terminated their counseling services. Which of the following is the most ethical response in this supervisory relationship?
(A): Consider termination of the supervisor/intern relationship.
(B): Provide further coaching to improve their professionalism.
(C): Sit in on a session to observe the intern’s behavior.
(D): Initiate termination of the supervisor/intern relationship.

Correct Answer: Initiate termination of the supervisor/intern relationship.
Explanation: Despite providing coaching, the intern continues the problem behaviors, which has resulted in several clients aborting their sessions. It is apparent, at this point, that the intern is not willing to make changes and is actively harming clients, demonstrated by the client absences. For this reason, termination of the supervisor/intern relationship should be initiated (and not simply considered). If the intern is just starting to demonstrate unethical behavior, providing coaching and considering termination are appropriate actions, but these steps have already been taken. Observing a session would not be helpful because the intern likely would not engage in the problem behaviors during the session that you are watching. Furthermore, observation does not prioritize the best interest of the clients because the intern continues to engage in behavior that is harmful to them. Therefore, the correct answer is (C)
Competency: professional practice and ethics