Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Counseling Setting: Community Mental Health Agency Type of Counseling: Individual Presenting Problem: Depressed Mood Diagnosis: Bipolar II 296.89 (F31.81), current episode depressed
Mental Status Exam: Mental Status Exam: The client is dressed casually and is somewhat disheveled. She avoids eye contact and displays a flat affect. The client admits to having suicidal thoughts in the past but currently denies both suicidal and homicidal ideations. Her speech is soft in volume and tone. She tends to provide one-word responses but is cooperative when asked to elaborate. The client denies audio-visual hallucinations, and her thought content is coherent. The client’s mood is depressed, and her affect is flat. She appears tired and reports she has insomnia at night and is sleeping most of the day. The client has experienced depression off-and-on, beginning in late adolesc
Presenting Problem: You work at a community mental health agency providing outpatient services to adults. Today, you are meeting with a 32-year-old female who presents with her husband for an initial intake session. The client’s husband is concerned about his wife’s depressive symptoms. She is experiencing sadness, decreased appetite, and hypersomnolence. The client also expresses hopelessness and has lost interest in doing the things she once enjoyed. Until recently, the client worked at an art gallery. When employed, she reports that she, “just couldn’t get out of bed” and was eventually let go due to excessive absences. After her employment ended, her depressive symptoms worsened. The client was able to recall a time nearly one year ago when she felt “almost the opposite” of how she feels now. During this time, she experienced increased energy and felt more inspired and creative. The client explains that she and her husband used to travel selling their art at juried art exhibitions most weekends, but it has been awhile since she has joined him.
Other Contexts: The client reports that she has been feeling less depressed. Her affect is full-range and appropriate to the situation. She continues to have sleeping difficulties that seem to worsen when experiencing unexpected stressors. The client explains that she has been arguing with her daughter’s father about financial matters, which developed after the client lost her job. The client believes her depressive symptoms are exacerbated after spending significant periods of time on social media. The client remarks, “My husband’s patience with me is growing thin. I don’t think I can ever live up to his expectations.”  After your discussion with the client about her social media use, she sends you a Facebook friend request

Question: After your discussion with the client about her social media use, she sends you a Facebook friend request. What is your ethical obligation regarding the use of social media, distance counseling, and other related technology?
(A): To have written procedures in place and reviewed before or during the client’s initial session
(B): To recognize the potential harm and benefits of developing an informal virtual relationship with clients, former clients, and their families and personal friends
(C): To disclose that you maintain a professional and personal online presence, and it may be difficult for the client to distinguish between the two
(D): To include in the client’s record all electronic communication, except clerical information (e.g., appointment scheduling)

Correct Answer: To have written procedures in place and reviewed before or during the client’s initial session
Explanation: Your ethical obligation is to have written procedures in place and reviewed before or during the client’s initial session. Answer B is incorrect. According to the NBCC Code of Ethics (2016), “NCCs shall include all electronic communications exchanged with clients and supervisees, including those through digital technology and social media methods, as a part of the record, even when strictly related to clerical issues such as change of contact information or scheduling appointments” Answer C is incorrect because it includes benefits and harms rather than only specifying harms. The NBCC Code of Ethics states, “NCCs shall recognize the potential harm of informal uses of social media and other related technology with clients, former clients and their families and personal friends” Lastly, the ethical guideline for an online virtual presence included in the ACA Code of Ethics (2014) states, “separate professional and personal web pages and profiles are created to clearly distinguish between the two kinds of virtual presence (ACA, 2014)”. Therefore, the correct answer is (A)
Competency: professional practice and ethics