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. An ongoing client of yours reveals, after several months of treatment for depression, that her husband regularly beats her. She said she wants help to be able to leave him, but feels strongly she cannot do so at this time as she has no way to support herself and her children. He has never hit the children, nor beat her in their presence, but she is concerned that his anger is increasing and they are becoming more aware of her beatings. You offer her assistance in finding shelters and other services, but she refuses to leave at this time.
1a. Same scenario as above, but in addition to the lack of money to support herself and her children, she is also concerned that if she leaves him, he will find her and kill her, as he has stated this to her on numerous occasions.
1b. Same scenario as above, but instead of wanting to work toward leaving him, she states that she wants therapy to focus on helping her not to anger him.
1c. Same as above, but this time she says she wants to work toward beginning couples therapy so they can repair the relationship.
1d. Same as above, but your client is male, with an abusive wife.
1e. Same as above, but both your client and the partner are the
same gender.
2. A new client comes to you saying he is gay and has read about therapy that can help one become straight. Your understanding of the literature is that sexual reorientation therapy is not effective, and that there is little data to support its use beyond a few case studies. However, he feels quite strongly that this is what he wants to try, because he has strong religious objections to his current sexual orientation.
2a. Same as above, but his concerns are not religiously based; rather, his family has said they will disown him if he does not seek help and become straight.
2b. Same as above, but the client is straight and says he wishes
to become gay, because the majority of his friends are gay and he is uncomfortable
being the only straight person in his crowd.
3. A client comes to you for substance abuse treatment. Your approach to such treatment is to use an abstinence model, wherein the client works toward total abstinence from alcohol; you believe the treatment outcome research supports this goal, and that it is easier to observe when clients fail to meet this goal than when using non-abstinence goals. However, your client refuses to agree to strive for abstinence, stating he has read about other therapies that work toward using alcohol in moderation rather than abusively, but without requiring total abstinence.
3a. Same as above, but the substance being abused is cocaine, not alcohol.
4. Your approach to treating substance abuse is very much based on a behavioral model in which abuse is considered a learned habit. A new client comes to you who has read a great deal about the disease model of alcoholism, and he feels strongly that his abuse must be looked at as a disease rather than as a learned habit. He says he wants you to help him implement the methods he is learning in his 12-step group.
5. You are a therapist specializing in long-term psychoanalysis.
A new client with obsessive-compulsive disorder comes to see you, saying
she wants to get rid of her OCD symptoms. Although you know that
both drugs and intensive behavior therapy have been shown to be effective
in reducing OCD symptoms fairly quickly, you personally believe that long-term
psychoanalysis is more effective in the long run, and that it is important
to get at the underlying root of her problems.
6. You work in a program for autistic children. One of the children in your program has been severely self-injurious, banging his head against the wall to the point that staff fear he may give himself a concussion. Intensive therapy has been used, but he continues to bang his head. His parents request aversive treatment in which he is shocked when he head-bangs, as they have read this can be very effective. Your program has a firm policy against using any form of aversive therapies.
7. You have been seeing a client for several months for depression, and you feel like she has made good progress. She now begins reporting bingeing and purging that have been increasing, and although you have worked well with this client and have considerable experience with treating depression, you have little experience in treating eating disorders. Your client states clearly she trusts you and does not wish to begin a whole new therapy relationship.