Case Study
Patient Demographic: Client Age: 8 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Hispanic Relationship Status: Single Counseling Setting: Home Health Outpatient Therapy Type of Counseling: Individual with Family Involvement Presenting Problem: Behavioral Issues Diagnosis: Oppositional Defiant Disorder, Severe (F91.3)
Mental Status Exam: Mental Status Exam: The client was argumentative and did not engage in the entire intake session. The client was oriented to person, place, situation, and time. He was dressed appropriately for the weather and appeared well groomed. The client appeared clean and had appropriate hyg
Presenting Problem: You are a home health outpatient therapist working with an 8-year-old male in the home setting. The client’s parents will be actively involved in counseling due to the client’s age. The client was referred to receive counseling by his school social worker. He has been having behavioral issues in school that have led to difficulty staying in the classroom and is resultantly falling behind in academics. During the first session, the client refuses to engage and leaves the room. The client’s parents prompt him to return, and he calls them “jackasses” and leaves the room again. The parents finish the intake session with you and provide you with a report on their observations in the home and reports from the school social worker. The client reportedly often loses his temper and is generally easily annoyed or angered. The client has trouble taking direction from his teachers and parents. The client’s parents also state that he often blames his younger sister for things that he does and often tries to annoy her. The parents have trouble identifying any of the client’s friends and state that he does not get along with his peers.
Other Contexts: The client appears to be more comfortable with you as he greets you at the door and starts talking with you about his favorite TV show as you walk back to the office. The client talks about how his parents give different consequences to him than his younger sister and that they also give her more attention than they give him. You empathize with the client about this because it must be frustrating being treated differently. You assist the client with processing further, and he identifies feeling like he is “bad.” But because he gets attention, he continues to push back against their authority. During this session, the client curses at his parents and they punish him by removing access to video games for the next week.  The client’s parents have offered you dinner every week since you have started therapy with the client

Question: The client’s parents have offered you dinner every week since you have started therapy with the client. All of the following are ethical considerations regarding gifts EXCEPT:
(A): The reason the parents are offering the meal.
(B): Accepting the meal may count as compensation to the clinician for services rendered.
(C): Declining a meal might be offensive due to the client’s culture.
(D): The monetary impact of accepting the meal.

Correct Answer: Accepting the meal may count as compensation to the clinician for services rendered.
Explanation: Compensation for services would fall under the ACA Code of Ethics section on bartering rather than ethical considerations for gifts (ACA, 2104). Bartering would involve further consideration and planning to include a written contract and is not being demonstrated in the offering of a meal. It is important to consider the cultural implications of declining a gift if it negatively affects the counseling relationship. Monetary impact is important because you would not want to regularly accept meals if it puts a financial strain on your client’s family. It is also important to consider the motive for giving the gift because the parents may have expectations for a gift in return, which may complicate or strain the counseling relationship. Therefore, the correct answer is (A)
Competency: professional practice and ethics