Case Study
Patient Demographic: Client Age: 20 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: College counseling clinic Type of Counseling: Individual counseling Presenting Problem: Panic attacks Diagnosis: Provisional diagnosis: panic disorder (F41.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear anxious or depressed and was friendly and eng
Presenting Problem: You are a counselor working in a college counseling department. The client comes in after being late to class several times over the last month due to reported “freak-outs” in the morning. The client experiences the following panic symptoms: accelerated heart rate, sweating, shaking, shortness of breath, and a feeling of impending doom. The client reports a feeling of impending doom when she wakes up on days when she has classes, and this anxiety tends to escalate into fear of having a panic attack on a daily basis, often making her late to her first class. The client is worried that she will have panic attacks every day for the rest of her life. She says that her parents have put a lot of pressure on her to get a high grade point average at college. The client is worried about how this pressure and the panic attacks are going to affect her doing well at college and engaging socially.
Other Contexts: You are meeting with the client for the termination session. You review the treatment goals and the client’s progress. The client is no longer experiencing panic attacks, and she reports that she has felt panic attacks coming on but that she intervenes early and often to prevent them from occurring. You and the client have prepared for this date during the last few sessions in order to prepare the client for transitioning to independence from therapy. You and the client discuss her use of coping skills and natural supports to continue to manage panic symptoms. You also inform the client of how to reconnect if she needs to receive therapeutic support again and then terminate services.  The client asks you if she could return to work with you after the termination session if panic symptoms were to worsen or return

Question: The client asks you if she could return to work with you after the termination session if panic symptoms were to worsen or return. Which one of the following is the most ethical response?
(A): There is nothing ethically wrong with working with this client again
(B): Encourage her to continue to use coping skills learned in sessions, and assure her that you would be able to work with her should she have the clinical need for therapy
(C): The client should find a new therapist because you would be affected by bias if you reestablished the counseling relationship. But you can counsel her until she begins meeting with her new therapist.
(D): You would not be able to provide counseling services without bias and should refer the client to another therapist if she needed to reinitiate counseling

Correct Answer: Encourage her to continue to use coping skills learned in sessions, and assure her that you would be able to work with her should she have the clinical need for therapy
Explanation: There is nothing ethically wrong with working with a past client again, unless you think their current needs are outside of your scope of practice. Should symptoms worsen, your counseling would likely be very helpful for the client due to your already established rapport and familiarity with her issues. That said, it is important to encourage a client upon termination to recall the skills that were learned during your sessions as a means of preparing her for functioning and dealing with her symptoms independently. For that reason, the most appropriate response would be to first encourage her to use the learned coping skills should symptoms return, but to also reassure her that she will have access to you should those skills be insufficient. Bias is not a concern when a former client returns to counseling; rather, it would be an issue to consider should that former client request your counsel in the context of a family or a relationship, in which case you would have bias toward her over the rest of the group members. Therefore, the correct answer is (A)
Competency: professional practice and ethics