Case Study
Patient Demographic: Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00)
Mental Status Exam: Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam
Presenting Problem: You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.
Other Contexts: The client’s son accompanies her to her appointment today. Since the initial intake, COVID-19 has become a global pandemic and has greatly impacted the client’s anxiety and fear. The client was visibly trembling when she spoke and requested that her son remain nearby. She explained that complying with the statewide mask mandate has been difficult, stating, “Wearing this mask makes me feel like I can’t breathe. It’s the same feeling I get when I’m walking up stairs or taking the elevator.” The client’s internist prescribes alprazolam (Xanax), which she has been taking for years. However, she thinks that it is no longer effective and asks if you can help her discontinue the medication. Given the COVID-19 outbreak, you discuss providing distance counseling to the client

Question: The American Counseling Association (ACA) Code of Ethics (2014) guidelines for distance counseling, technology, and social media includes which of the following standards?
(A): Counselors acknowledge the differences between synchronous and asynchronous communication and use synchronous communication whenever possible to avoid missed verbal and nonverbal cues.
(B): Counselors take reasonable precautions to ensure the confidentiality of information transmitted through technology-based communication.
(C): Counselors inform clients that only authorized individuals have access to confidential information.
(D): Counselors verify their identity and the identity of the client (e.g., through the use of code words, numbers) each session.

Correct Answer: Counselors take reasonable precautions to ensure the confidentiality of information transmitted through technology-based communication.
Explanation: Counselors adhering to the ACA Code of Ethics “take reasonable precautions to ensure the confidentiality of information transmitted through any electronic means” Section H3 states that counselors should take steps to verify the identity of the client, rather than their own identity and the client’s identity. This should occur “at the beginning and throughout the therapeutic process” Section H2b states that “Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (eg, colleagues, supervisors, employees, information technologists)” Finally, Section H4f states, “Counselors consider the differences between face-to-face and electronic communication (nonverbal and verbal cues) and how these may affect the counseling process. Counselors educate clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations when communicating electronically”. Therefore, the correct answer is (B)
Competency: professional practice and ethics