Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Bisexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Telehealth Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty focusing on work due to a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and thinks that if he cannot keep up with work, he is going to get fired. Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation (F90.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time and situation. The client is engaged and participates fully in the intake session. The client does not appear anxious. The client has a flat af
Presenting Problem: You are a licensed counselor working in your own private practice and providing telehealth sessions to clients. The client states that he is having trouble keeping up with tasks at work. The client reports that he wakes up and does not want to go to work because he knows he will not get much done. The client is often late to work, and although he is typically the only one in the office, his employer comes to work every now and then, and he worries that he will get caught arriving late. He says that he procrastinates on tasks but, often near the end of the day, finds motivation to complete the tasks and stays late to do so. In addition to his trouble at work, the client says he thinks that he does not do much that makes him happy. He expresses the desire to write stories and play guitar more because these activities used to make him happy, but he has trouble finding motivation to engage in them at the present.
Other Contexts: Following the 10th session, the client has not responded to your attempts to contact him and the only communication from the client has been the cancellation of the 11th session

Question: Which of the following would be the most ethical response to the client’s lack of communication regarding cancellations?
(A): You attempt to reach out several times to provide contact information and referral information.
(B): You continue to attempt to make contact with the client until a response is provided.
(C): You terminate services because the client is participating voluntarily and if he does not want to attend, then he does not have to.
(D): You reach out after the first no-show, and then you wait for the client to make contact to initiate services again.

Correct Answer: You attempt to reach out several times to provide contact information and referral information.
Explanation: If you determine that the client is not going to initiate contact regarding services, then reaching out several times to ensure that he knows how to reconnect with you or another therapist is an appropriate next step. This demonstrates that you have attempted to follow up with the client and that you are not abandoning him. Termination based only on whether the client is voluntary or involuntary does not matter because you want to ensure that the client has the information that he needs and that you make every effort to continue services. Continuing to attempt contact without a cutoff point does not make the best use of your time, and it does not put the responsibility on the client to decide if therapy is important enough for him to participate in. Reaching out once and waiting for a response might be missed by the client and does not demonstrate genuine attempts to support the client. Therefore, the correct answer is (B)
Competency: professional practice and ethics