Case Study
Patient Demographic: Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)
Mental Status Exam: Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c
Presenting Problem: You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.
Other Contexts: The client is now attending family therapy with his parents and has made progress. His last four drug screens have been negative, and the client is beginning to show insight into his problem. The parents have improved with limit setting and are learning how to help the client achieve a healthy sense of identity. The parents are becoming better acclimated to the United States and have developed stronger connections within their church and community.  The client has met his treatment plan goals, is pleased with his progress, and is ready to end therapy. The client and his parents have also made therapeutic gains in family therapy; however, his parents are not prepared to end treatment and would like to keep seeing you without the client

Question: The client has met his treatment plan goals, is pleased with his progress, and is ready to end therapy. The client and his parents have also made therapeutic gains in family therapy; however, his parents are not prepared to end treatment and would like to keep seeing you without the client. After providing pretermination counseling, how should you proceed?
(A): Encourage the client to continue therapy and continue working with all parties.
(B): Terminate with all parties after referring the parents to another provider.
(C): Terminate with all parties.
(D): Terminate with the client and continue working with the parents.

Correct Answer: Terminate with all parties.
Explanation: After providing pretermination counseling, you should terminate with all parties. Per the ACA Code of Ethics (2014), “Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling” Termination with clients is an ongoing process that begins with informed consent at the outset of treatment. Since the client has met his treatment goals, he no longer needs assistance. Regarding multiple roles, the ACA Code of Ethics (2014) states, “When a counselor agrees to provide counseling services to two or more persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person. If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from roles appropriately. […] Counselors provide pretermination counseling and recommend other service providers when necessary” Since the identified client’s goals have been met, the counselor should continue with pretermination counseling and go forward with the planned termination. The parents would not require an outside referral because treatment plan goals have been met. Church and community connections also serve as ongoing support for the family. Therefore, the correct answer is (A)
Competency: professional practice and ethics