Case Study
Patient Demographic: Client Age: 15 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: African American Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Anxiety Diagnosis: Generalized Anxiety Disorder (GAD) 300.02 (F41.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is neat in appearance. She is cooperative and, at times, overly compliant with the interview questions, which is exemplified by apologizing unnecessarily for “not answering questions in the right way.” Her eye contact is poor, but she is engaged in the interview process. The client is restless and fidgety, and her tone of voice is soft. She states that she gets between 5 and 6 hours of sleep each night, which makes her irritable at times. Her affect is anxious, and she reports poor concentration. Her excessive worry has resulted in exhaustion and feeling like she is “always playing catch-up” with sleep and schoolwork. She denies any suicidal or homicidal ideations. The client also denies drug or alcohol use. Family History and History of th
Presenting Problem: You are a counselor working in a child and family outpatient mental health center. Your client is a 15-year-old African American female enrolled in the 10th grade at a predominately white private high school. She presents today with her father, who says she “has not been herself lately.” The client reports that she is under an enormous amount of pressure to excel academically and athletically. She is the number-one ranked player on the varsity tennis team and is in the school’s honors program. The client states that she perseverates the night before a tennis match and worries that her performance will be subpar. She reports excessively practicing her serves and backhands in her spare time because she is constantly dissatisfied with her less-than-perfect performance. The client says that she feels like she doesn’t fit in with her peers, which she attributes to being the only person of color on her tennis team, and one of few in the student body.
Other Contexts: The client is responding well to your therapeutic interventions. School has ended, and her summertime athletic and academic commitments have lessened. The client reports that she is happy to be out of school and spoke again about not fitting in with her peers. She states that there are limited opportunities for sustaining friendships and worries that she will never find a romantic interest. She reports that her mother has suspended her social media account because the client was overly consumed by the number of “likes” that she received for her online posts. You explain that you will be starting a 12-week group of diverse teens who also experience anxiety and would like her to join. She agrees and is eager to participate.  You are concerned about the client’s online activity. You search and find her social media account, view the content, and find evidence of cyberbullying

Question: You are concerned about the client’s online activity. You search and find her social media account, view the content, and find evidence of cyberbullying. You and your supervisor use an ethical decision-making model to appropriately determine which of the following?
(A): You must respect the client’s privacy unless she permits you to view her social media account.
(B): You must breach confidentiality and inform the client’s parents.
(C): You must respect the client’s privacy but report the cyberbullying peers.
(D): You must disclose the findings to the client and assess for safety.

Correct Answer: You must respect the client’s privacy unless she permits you to view her social media account.
Explanation: You and your supervisor appropriately determine that you must respect the client’s privacy unless she permits you to view her social media account. The ACA Code of Ethics addresses this issue in Section H6c, entitled “Client Virtual Presence” In this scenario, you searched for the client’s social media account without prior permission. You appropriately discuss the ethical dilemma with your supervisor. Per the ACA Code of Ethics, counselors “are expected to engage in a carefully considered ethical decision-making process” This process generally involves determining the scope of the problem, applying the code of ethics, consulting supervisors and other appropriate professionals, and determining the best course of action. You not only viewed a private account without permission but did not have grounds for suspicion. The client stated that she felt like she didn’t fit in with her peers and equated her number of likes with her worth as a person; this did not include allegations of cyberbullying or other safety-related concerns. Therefore, the correct answer is (C)
Competency: professional practice and ethics