What laws could potentially be involved in this case?

Case 7

Couples Counseling Gone Wrong

Jennifer M. Johnson

Alayah is a licensed professional counselor and national certified counselor who graduated with a specialization in clinical mental health counseling. She has experience working in a variety of settings, including inpatientresidential facilities and nonprofit agencies. Over the past year, Alayah has been building a private practice and has received multiple referrals from clients based on advertising through social media, local newspapers, churches, and nonprofits. Many of her clients are seeking assistance with depression, self-esteem issues, and work-life balance, and Alayah feels confident in utilizing her theoretical orientation to assist these clients.

She receives a phone call from a couple. They are seeking marital counseling, which is unchartered territory for her. The couple was referred by their friend, who was a previous client of Alayah's. The friend spoke highly of Alayah, and the couple is desperate for help. During the phone consultation, the wife mentions that normally they would not consider counseling, but she and her husband are open to it because of the friend's recommendation. As Alayah is starting a new practice, she does not want to turn away any potential clients, so she schedules an appointment with the couple.

To prepare, Alayah reviews material from a workshop she attended on the basics of couples therapy. She comes to the session prepared with assessments and other standard forms for the clients to complete. The session starts off well with Alayah discussing informed consent, confidentiality, and her role as the therapist and obtaining a history of the couples' relationship. However, midway through the session, the discussion goes downhill. The couple become irate and very argumentative as they talk about the wife's demanding job and the husband's infidelity. Alayah feels lost; it seems to her that she is acting more like a "referee" at a shouting contest than a counselor. Eventually, however, she is able to redirect the couple, and she ends the session by scheduling an appointment for the upcoming week. As they are rescheduling, both the husband and wife state that they are grateful for the session and felt "heard for the first time in a long while." Despite this positive feedback, Alayah feels conflicted about her ability and competence working with the couple.

That afternoon, after much reflection, Alayah calls Rose, her former clinical supervisor and mentor, for guidance. They agree to meet the following day. During their meeting, Alayah states that she felt "like a fish out of water" with the couple she saw yesterday. She acknowledges that she has expertise in clinical mental health settings but that she feels "inadequate" with this new client population. She adds that she has always had an interest in working with couples and wants to learn effective techniques. Rose encourages Alayah to elaborate, and Alayah mentions that she "thoroughly enjoyed a graduate course on couples therapy," but she knows she needs more information and tools to be successful. Rose and Alayah also discuss Alayah's motivation behind agreeing to meet with the couple. Alayah admits she felt an "obligation" to help the couple because they were referred by a previous client and were open to seeking therapy because of the friend. Alayah acknowledges that her decision was also selfish because she wants to build her clientbase. She shares that, because she is a licensed professional counselor, she feels ashamed that she might need to refer a client when she "should know how to work with the couple effectively." Rose processes these expectations with Alayah and remarks that professional counselors are constantly learning. Rose also normalizes Alayah's experience by self-disclosing her own ongoing areas of growth.

After speaking with Rose, Alayah feels relieved and optimistic. However, she is still faced with deciding whether to continue working with the couple or refer them to another clinician. After further reflection and another conversation with Rose, Alayah decides to (a) continue working with the couple under the clinical supervision of Rose (who is a licensed professional counselor and marriage and family therapist), (b) not accept any new couples clients at the moment, and (c) audit a graduate-level course on marriage and family counseling. Rose and Alayah schedule ongoing supervision. Rose offers to let Alayah borrow some reading materials related to couples therapy.