Macy is 20 years old and has been in therapy with Sidney for over a year. She has developed respect and fondness for her therapist, whom she sees as a father figure. She tells him that she is thinking of discontinuing therapy because she has lost her job and simply has no way of paying for the sessions. She is obviously upset over the prospect of ending the relationship, but she sees no alternative. Sidney informs her that he is willing to continue her therapy even if she is unable to pay. He suggests that as an exchange of services she can become the babysitter for his three children. She gratefully accepts this offer. After a few months, however, Macy finds that the situation is becoming difficult for her. Eventually she writes a note to Sidney telling him that she cannot handle her reactions to his wife and their children. It makes her think of all the things she missed in her own family. She writes that she has found this subject difficult to bring up in her sessions, so she is planning to quit both her services and her therapy.
How would you have dealt with this situation?
It is ethically appropriate that the counselor chose to refer Client B to another mental health professional who is more competent to deal with the problems of Client B. The counselor of Client B has a restricted number of sessions with one client as the counselor works in the community setup. Moreover, the problem of Client B may need long-term therapy as the severity of the problem is high. The community counselor of Client B does not have alternatives other than referring the client to a trained professional. Although Client B is not willing to shift to a new counselor because of the client's comfort with the counselor, it is unethical for the counselor to continue seeing the client even after realizing the incompetence and boundaries of the counselor to handle the case. In the case of the counselor, the counselor has a good understanding and perception of the case of Client B as well as the competency level of oneself, which enabled the counselor to offer the client a referral to another therapist for the welfare of the client. However, the therapist is likely to have less focused on the informed consent process. That is, if the therapist had explained to the client during the initial session about the restricted number of sessions [six sessions], the client might have been prepared to terminate the therapy by the sixth session.
The alternatives in the case of Client B are as follows:
Mental health professionals need to have a clear image of one's competency level. That is, a therapist or counselor may need to know about their skills, knowledge, theoretical orientation, their interested areas of cases, and the types of cases they can and cannot handle. It helps the therapist to choose the cases that they can offer the best services to the client within their potential.
When clients come for therapy, the therapists are supposed to collect informed consent from the clients. For that, they need to be briefed about the therapist's credentials, qualifications, experience, therapeutic approaches, the process of therapy, the role of clients, and the role of therapists. By explaining this, the client may have a better understanding of the therapist and their suitability to handle the case. Moreover, the informed consent process may allow the therapist to understand the suitability of the case to their competency level.
In the case of Client B, who is suffering from severe depression, the therapist decides to refer the client because of the therapist's realizations that the case is beyond their competence. Whereas, the client perceives the therapist as good and does not feel comfortable going ahead with a referral to meet a new therapist.
The following are the alternative options that could have been implemented in the case of Client B: