Case Study
Patient Demographic: Client Age: 22 Sex: Male Gender: Male Sexuality: Homosexual Ethnicity: Latino American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depression Diagnosis: Major Depressive Disorder, Moderate
Mental Status Exam: Mental Status Exam: The client is pleasant and dressed in age-appropriate attire. He is tearful when discussing his family and states this has been difficult for him. The client has had no previous suicide attempts. He is observed biting his nails. He describes feeling sad daily and states he sleeps during the day because he cannot sleep at night. He is slightly underweight but denied any difficulties with appetite. The client’s speech is coherent and clear. He denies suicidal ideation but often questions his worth and purpose. Fam
Presenting Problem: You are providing counseling services at a Community Mental Health Center. A 22-year-old Latino male, accompanied by his aunt, presents with symptoms of depression. The aunt is concerned about the client’s social isolation, feelings of hopelessness, and excessive daytime sleeping. Four months ago, the client’s parents kicked him out of their home after discovering a suggestive social media post of him with another male. He is close with his aunt and uncle, who have allowed him to stay in their basement. The client’s father refuses to speak to him and has told him he is “less than a man” and an embarrassment to the family. The client’s symptoms worsened last month when he was laid off from his job as a server.
Other Contexts: The client displays a blunted affect and remains pleasant and cooperative. He reports that he did apply for a few jobs, but it has been difficult due to his past experiences of workplace harassment and discrimination. He is socializing more frequently, primarily at LGBTQ-friendly bars and clubs. The client states he used to go to the gym daily and has recently started going some on the weekends. He explains that he has felt less depressed but remains poorly motivated. He denies suicidal ideation. The client is unsure how to prioritize goals for treatment.  The client states he is tired of the obstacles he faces due to his sexual orientation. He no longer wants to be attracted to men and believes being gay is a sin. He has heard of conversion/reparative therapy and would like to pursue this treatment option

Question: The client states he is tired of the obstacles he faces due to his sexual orientation. He no longer wants to be attracted to men and believes being gay is a sin. He has heard of conversion/reparative therapy and would like to pursue this treatment option. How do you respond?
(A): Discuss the benefits and harms and refer the client to a therapist who provides this treatment.
(B): Encourage the client to seek religious guidance and continue to treat the client.
(C): Discuss the harms of this treatment and continue to treat the client.
(D): Consult a therapist who provides this treatment prior to determining whether a referral is appropriate.

Correct Answer: Discuss the harms of this treatment and continue to treat the client.
Explanation: The American Counseling Association (ACA) and several other professional organizations have determined that conversion therapy causes harm to patients, and since counselors have an ethical obligation to “do no harm,” they should actively advise clients against it. Despite this, conversion therapy is still legal in most states. The ACA Code of Ethics (2014) requires that “counselors recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others” Referring the client to someone who provides this treatment would be considered unethical in all circumstances, and therefore consulting that therapist to determine referral opportunities would also be inappropriate. Since conversion therapy is a religious-based practice the ACA would hold that encouraging the client to seek religious guidance is a vague suggestion and includes an element of risk. The best option is therefore answer choice D. Therefore, the correct answer is (D)
Competency: treatment planning