Case Study
Patient Demographic: Clients Age: Husband: 45 Wife: 43 Sex: Husband: Male Wife: Female Gender: Husband: Male Wife: Female Sexuality: Heterosexual Ethnicity: Both Individuals Are Caucasian Relationship Status: Married Counseling Setting: Private Practice Counseling Clinic Type of Counseling: Couples Counseling Presenting Problem: Marital Distress Diagnoses: Couple Diagnosis: Adjustment Disorder with Anxiety (F43.22) and Relationship Distress with Spouse or Intimate Partner (Z62.898) Individual Diagnosis (Wife): Generalized Anxiety Disorder (F41.1)
Mental Status Exam: Mental Status Exam: The husband and wife were both oriented to person, place, time, and situation. Both individuals were dressed appropriately for the season and appeared clean. The husband presented as angry, and the wife presented as remors
Presenting Problem: You are a licensed therapist working at a private practice. The couple comes to counseling in order to work on their relationship following an infidelity. The wife has difficulty expressing what happened, and the husband interrupts her and expresses that his wife had an affair with a coworker 3 weeks ago. The couple states that they are currently talking very little aside from conversations that involve their children. The wife states that she is regretful of what she did and that she does want her marriage “to be saved.” The husband explains that he is very hurt by her infidelity and that he is unsure if he can forgive her and continue being married to her. The couple has been married for 25 years and report that they both are in counseling to see if they can continue to be married following the affair. The husband expresses strong anxiety following the revelation of the affair and questions how he can be in a relationship with his wife following the infidelity. The wife is experiencing anxiety regarding her husband leaving her because she reports regretting the sexual interaction with her coworker and does not want to get divorced.
Other Contexts: You meet with the couple for the third session, and they report that they continue to have minimal communication. The couple continues to process feelings regarding the affair and begin to yell and curse at each other. The wife reports that she has tried to engage in quality time with her husband and that he has ignored these attempts. Around 10 minutes into the session, the husband leaves the session and walks out and proceeds to sit in the waiting area of your practice.  You desire to support both individuals

Question: You desire to support both individuals. Which is the most ethical intervention to support the couple?
(A): Meet with the wife and then meet with the husband in a separate, empty office in the practice to maintain confidentiality.
(B): Encourage the wife to come to the lobby to process the situation with the husband because the door is closed to the practice and no one else is present.
(C): Inform the husband of what the wife feels about him leaving because they are both clients and have access to information and no one else is present in the lobby.
(D): Meet with the wife and then meet with the husband in the lobby because the practice door is closed and no one else is present in the practice setting.

Correct Answer: Meet with the wife and then meet with the husband in a separate, empty office in the practice to maintain confidentiality.
Explanation: It would be most ethical to meet with the husband in a separate, empty office in the practice following the meeting with the wife. You want to protect both individuals’ right to confidentiality, and you do not know whether the wife would be listening in on your conversation with the husband in the lobby. Because both individuals are clients, it is important to ensure that they each have a safe space to express themselves. You should provide this safety by using separate spaces for self-expression prior to returning to the joint session. Therefore, the correct answer is (C)
Competency: professional practice and ethics