Case Study
Patient Demographic: Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.
Presenting Problem: You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.
Other Contexts: Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.

Question: The referring attorney offers to pay your counseling fees once the case is litigated, which may be up to a year from now. Which of the following is the best choice for responding to the attorney's offer for payment?
(A): Offer to work with the client regarding payments and suggest the client and attorney make their own financial arrangements.
(B): Offer to work with the client and have the attorney's office make regular, monthly payments for counseling services.
(C): Suggest that the attorney find a different therapist for this client so that you will not need to wait for payment.
(D): Offer to bill the attorney's office after each appointment with the expectation of payment within 30 days.

Correct Answer: Offer to work with the client regarding payments and suggest the client and attorney make their own financial arrangements.
Explanation: Arranging payments between the counselor and the client provides greater autonomy for the client in choosing how often they will participate in therapy and minimizes ethical concerns related to who the counselor is working for - the client or the attorney. Counselors may receive payment from attorneys; however, this situation can impact the therapeutic relationship between client and counselor. Therefore, the correct answer is (B)
Competency: professional practice and ethics