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 continues to benefit from counseling and presents today with a euthymic mood. She has met her treatment plan goals related to depressive symptoms and reports a better understanding of her illness. The client has begun painting again and accompanied her husband to an art show this past weekend. She expresses gratitude for your work together and is especially thankful that you have helped her get back into doing what she likes to do. At the end of the session, she gives you an original painting as a token of appreciation. She explains that the abstract painting conveys the emotional transformation she has experienced in counseling. You let the client know you would be joining a private practice in a few weeks. You explain you would be happy to see her again if needed and gave her your new business card with the address and contact information for the practice

Question: How would you navigate gift giving with the client?
(A): You decline the gift because to do so would not be culturally offensive to this client.
(B): You decline the gift because she is a talented artist and the painting is high in monetary value.
(C): You accept the gift but explain that agency policy prohibits you from reciprocating.
(D): You accept the gift because rejecting the gift would hurt the client.

Correct Answer: You accept the gift because rejecting the gift would hurt the client.
Explanation: You accept the gift because rejecting the gift would hurt the client. In weighing beneficence and malfeasance, it can be reasonably determined that rejecting the gift does more harm than accepting it. The gift represents the culmination of hard work and the return to enjoying things she loves. She credits the counselor for helping her through that journey. Therapy is coming to a close, and she has worked hard to achieve personal success. The ACA Code of Ethics (2014) states, “Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and gratitude. When determining whether to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, the client’s motivation for giving the gift, and the counselor’s motivation for wanting to accept or decline the gift” For this client, the gift’s monetary value is of lesser significance than what it represents. The client’s culture does not recognize small gifts as a token of respect and gratitude. Lastly, the policy for reciprocating is not necessarily a stipulation for receiving the client’s gift. Therefore, the correct answer is (D)
Competency: professional practice and ethics