Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3)
Mental Status Exam: Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam
Presenting Problem: You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”
Other Contexts: You and the client develop a clear and explicit treatment contract to provide a foundation for informed consent. Through this collaborative process, you establish an agreement outlining treatment roles, responsibilities, and expectations for you and the client. The client agrees with your suggested goals but does not want to include safety issues as part of her treatment plan. You provide psychoeducation on BPD, and she relates to experiences of abandonment. She would like to learn how to navigate romantic relationships and requests interventions targeting this area

Question: Which ethical principle would best guide your response to the client’s request to exclude safety issues from her treatment plan?
(A): Veracity
(B): Autonomy
(C): Beneficence
(D): Justice

Correct Answer: Autonomy
Explanation: The ethical principle that would best guide your response to the client’s request to exclude safety issues from her treatment plan is autonomy. The ACA Code of Ethics includes ethical principles fundamental to ethical decision making. Autonomy is defined as “fostering the right to control the direction of one’s life” (ACA, 2014). In this situation, it is appropriate to consider the client’s autonomy by deciding which items go on her treatment plan. Clients have a right to accept or deny treatment. This does not mean that you do not assess and document the client’s safety issues each session. It would be unethical not to assess the client’s safety and provide safety-related interventions as needed. This topic can also be revisited in future sessions after trust has been established. Veracity is an ethical principle that calls for counselors to be truthful in their professional communication. Justice is honored when counselors stand up for equality and promote equity. Lastly, beneficence is achieved when counselors work for the well-being of clients and society at large. Therefore, the correct answer is (C)
Competency: professional practice and ethics