Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed
Mental Status Exam: Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc
Presenting Problem: You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.
Other Contexts: The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations

Question: Counselors practicing the ethical use of distance counseling, technology, and social media disclose to clients all of the following EXCEPT:
(A): The lack of visual cues and voice intonations used with electronic communication may affect the counseling process.
(B): The need to identify alternative methods of service delivery may occur, because of the possibility of technology failure.
(C): Informed consent for distance counseling, technology, and social media is no different than the protocol used with face-to-face counseling.
(D): There are some individuals who may have unauthorized access to their electronic health records.

Correct Answer: Informed consent for distance counseling, technology, and social media is no different than the protocol used with face-to-face counseling.
Explanation: According to the ACA Code of Ethics (2014), “In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, [there are] issues, unique to the use of distance counseling, technology, and/or social media, [that] are addressed in the informed consent process” Specifically, counselors must explain that “individuals might have authorized or unauthorized access to such records or transmissions (eg, colleagues, supervisors, employees, information technologists)” (ACA, 2014). Counselors acknowledge that the lack of visual cues and voice intonations used with electronic communication may affect the counseling process. Finally, counselors inform clients that there is a need to identify alternative methods of service delivery because of the possibility of technology failure. Therefore, the correct answer is (C)
Competency: professional practice and ethics