Case Study
Patient Demographic: Client Age: 12 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private Practice Type of Counseling: Individual Counseling Presenting Problem: Withdrawn and Avoidant Behavior Diagnosis: Undetermined
Mental Status Exam: Mental Status Exam: The client appears oriented to person, place, time, and situation. The client is dressed appropriately for the weather and appears to be maintaining appropriate hygiene. The client was withdrawn for most of the session but was able to open up slightly about what was going on with
Presenting Problem: You are a licensed therapist working in private practice. A 12-year-old female client comes into your office for the intake session and is accompanied by her parents. The client’s parents report that their daughter has been withdrawn and has refused to return to school for the past 6 school days. The client is avoiding eye contact with anyone and is slouching with her arms crossed. You try to engage the client in open questions to initiate the intake session with her, and she does not answer you or look at you. You ask her if privacy would make her more comfortable, and she nods, so you ask her parents if they would mind waiting in the lobby, and they agree. The client continues to refuse to talk about school, but she does engage in conversation with you about other topics.
Other Contexts: You and the client meet 4 days after the initial intake session due to truancy because she has missed several days of school. For about half of the session, the client seems to be withdrawn. She asks you what you are required to report, and you remind her of the limits of confidentiality. The client says that she understands, and then says she is going to talk about what happened anyway. She says that her volleyball coach asked to meet with her after practice about 7 months ago and when she entered his office, he asked to look at her right thigh following a fall during practice. She continues to state that when she showed him, he started to touch her genital area from the outside of her pants. She states that she ran out of the room and went home. She explains that after this event she quit the team and told her parents that she did not want to play anymore, but recently she has started to experience distressing memories of the sexual abuse; she refuses to go to school because she would see the man daily; she has difficulty feeling happiness; and she is experiencing feelings of shame, insomnia, and difficulty concentrating. You praise the client for disclosing this information and empathize with her about how hard it must have been to share this experience

Question: Which of the following would be the most appropriate next step due to the information provided during this session?
(A): Invite the parents into the session to discuss the information provided, and report the information to the appropriate local government agency.
(B): Invite the parents into the session to discuss the information provided.
(C): You are a mandated reporter and will report this to the appropriate local government agency.
(D): Invite the parents back into the session to discuss the information that was provided, and receive a release of PHI to report this to the school.

Correct Answer: Invite the parents into the session to discuss the information provided, and report the information to the appropriate local government agency.
Explanation: As a therapist, you are a mandated reporter and must report all incidents of abuse or neglect to the local government agency that investigates those reports, such as the local child protective services office. It is also important to make the parents aware of what happened, and, although the client does not need to consent to this, you already know that she is okay with this because she said so earlier in the session. The client does not need to consent, but it is beneficial to the counseling relationship that she has consented to you breaking confidentiality. A release of PHI to talk with the school may be helpful but is not required to ensure the client’s safety. It may be helpful to create a safety plan with the family to ensure that the client is not in a position to be sexually abused by this individual again at school. Reporting the incident to the local government agency and collaborating with the parents are the minimal steps needed at this point in therapy. Therefore, the correct answer is (D)
Competency: professional practice and ethics