What would you do in these situations? Are there any negative
consequences to your chosen actions? Other actions you might take
instead, and pros and cons for these? Is there any way you could
have prevented these situations from arising in the first place?
1. You have been seeing a client for several months for chronic suicidality and parasuicidality; it has been increasingly clear that she most likely meets criteria for borderline personality disorder. Your client has not been employed in years, and her husband recently switched jobs. This switch also led to a change in their family’s insurance coverage, as his new job uses a managed care organization in which mental health coverage is fairly restricted. You have spoken with the MCO’s gatekeeper about continuing your treatment with this client, but were informed that your treatment plan is far too long in duration for them to even consider approving this. They have instead approved a crisis management intervention to assist your client in managing her suicidality. You feel very strongly that she will continue to experience episodic crises that will simply escalate if she is not in longer-term treatment to deal with the personality issues, and you have documented the research supporting this view, but the MCO turned down your appeal and you will only be reimbursed for another six sessions of care.
2. You are one of very few practitioners in your town, and you
currently have a completely filled caseload, as does everyone else.
Some of your current clients seem to be generally doing okay, although
they still wish to remain in therapy as they are continuing to learn new
ways of coping and are continuing to increase their satisfaction and their
functioning. Today you received a call from someone who wishes to
begin therapy as soon as possible, as he is completely disabled by a condition
in which you specialize.
3. The parents of a five-year-old boy with developmental disabilities have requested that their child be fully included in the kindergarten at his neighborhood school. Because of the child's unique needs, you and the parents believe he should be in a full-day program. The parents have therefore requested he be in both the morning and afternoon sections of kindergarten. Prior to the child's IEP meeting, the assistant superintendent contacts you. She heard about the request for full-day kindergarten placement, and is concerned because by teacher contract a child with special needs counts as two children in a classroom, and thus this boy would take the space of four children in kindergarten. Because this is a very desirable school in the district, this means that three children will be turned away by the school and assigned to other elementary schools in the district if the boy is granted the fulltime placement. (Adapted from Jacob and Hartshorne, 2003)