Case Study
Patient Demographic: Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)
Mental Status Exam: Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c
Presenting Problem: You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.
Other Contexts:    age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement

Question: What is the primary ethical risk of allowing the client to interpret for his family?
(A): It might cause the client to experience secondary trauma when discussing his parent’s torture.
(B): It might violate the principles of self-determination and autonomy inherent in informed consent.
(C): It might reinforce unhealthy boundaries and contribute to parental inadequacy.
(D): There is the potential for misdiagnosis if the client chooses to interpret selectively.

Correct Answer: It might violate the principles of self-determination and autonomy inherent in informed consent.
Explanation: The primary risk for allowing the client to interpret for his family is that it calls into question the validity of informed consent. The principles of self-determination and autonomy govern informed consent. While the adolescent is the identified client, he does not have the legal right to provide consent for treatment. According to the ACA Code of Ethics (2014), “Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. […] Counselors communicate information in ways that are both developmentally and culturally appropriate. When clients have difficulty understanding the language that counselors use, counselors provide necessary services (eg, arranging for a qualified interpreter or translator) to ensure comprehension by clients” If counselors do not have immediate access to interpreters, remote options are available via phone or video. In certain instances, in some states, using nonprofessional interpreters is against the law. Experiencing secondary trauma is unlikely because there is an increased probability that the client is already aware of the torture or that the parents do not discuss it with anyone. Additional considerations include perpetuating the client’s role as chief decision-maker, selective messaging, and intentional or unintentional miscommunication; however, these issues do not supersede the need to adhere to the principles of self-determination and autonomy. Therefore, the correct answer is (D)
Competency: professional practice and ethics