There may be times when a client may not want to use their real name. If they are not paying through insurance, this should be accommodated. A client should not be forced to use their legal name. In this instance the client is concerned because they are not documented. It would be misleading to tell client to not worry and that nothing would happen to them. Asking about payment is not addressing the client's question and is insensitive to what the client is expressing.

Counselors must discuss payment during the informed consent process, as well as payment modalities and inform clients that they may change at any time, if applicable. When establishing fees, there are many things for the counselor to consider such as location and financial status of clients. If the counselor realizes that payment is causing a hardship, appropriate steps must be taken such as referring out or lowering fees. Counselors also ensure that they give back in providing services pro bono to the community, trainings for future counselors, or reducing fees.

It is evident that Li is distressed enough to come to counseling even though she believes she is putting herself at risk and maybe cannot afford it. Starting with the source of her anxiety is important. This may lead to discussion about the other areas which would all be discussed during a comprehensive intake. However, the source of Li's anxiety should be addressed first.

Li is in an exploitive situation, and it must be addressed that this is not safe or appropriate. Choices a. and b. minimize what Li is experiencing and disregards her safety and well-being. Choice c. is assuming that Li had a worse experience where she came from and also minimizes what she is currently going through.

Li is a victim of human trafficking and exploitation, and the police should be involved. The counselor should encourage Li to go to the police. If she does not, the counselor must consider the level of risk there is. Ethical Code B.2.a. Serious and Foreseeable Harm and Legal Requirements states that "The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception." A referral to a shelter, would be beneficial after the authorities are contacted. Telling Li she needs to find another place to live would not be the appropriate choice. Although this must be done, simply stating that without calling the authorities or giving her resources would not be appropriate. Li will also have to find another job eventually but the priority is keeping her safe and reporting what happened to authorities.

Cultural awareness is understanding that someone's cultural experiences and views are unique and may differ from your own. Curiosity is being inquisitive about a different culture. Empathy is trying to put yourself in the shoes of another and inclusion is providing equal access or opportunities to others who may be marginalized.

What Li described meets the criteria for a panic attack. It does not yet meet the criteria for Panic Disorder which consists of repeated attacks. Hyperventilation is rapid or deep breathing often caused by panic. A Paroxysmal episode can mimic a seizure and may include loss of consciousness.

All of the above would be helpful for Li. Being part of a group for human trafficking survivors can provide support for Li while helping her to see that she is not alone. An employment counselor can help her target a job congruent with her skills and interests. A care manager can help Li to coordinate her services.

Benzodiazepines have been shown effective for anxiety. Corticosteroids treat conditions such as asthma, allergies, arthritis and bronchitis. They have also been shown to make people anxious. Cardiovascular exercises are not proven to help prevent panic attack. Cognitive behavioral therapy can be used to target irrational thought which may trigger anxiety.

Panic Disorder is characterized by recurrent panic attack with symptoms such as sweating, trembling, nausea, dizziness or derealization. Persistent worry about panic attacks and or maladaptive changes must be present for at least a month. If panic attacks are caused by separation from home or attachment figures, this would be separation anxiety disorder. Additionally, if symptoms are only precipitated by social situations, this is indicative of social anxiety disorder.

This definition describes a facet of autism spectrum disorder; answers a) through c) all correctly fall underneath the symptoms of attention-deficit hyperactivity disorder.

The CPTRS measures the presence and severity of behaviors related to ADHD exploring inattention, hyperactivity, learning problems and social skills, filled out by parents and teachers. It also helps point out where further testing may be needed or monitor how well medication is working for children already diagnosed with ADHD, as is the case with Avery. The VABS measures how a child's daily living skills compare to those of other kids his age, helpful for screening diagnoses of autism spectrum disorder, Asperger's syndrome, and developmental delays. This instrument would be more helpful for use with Avery's brother in this case, but no evidence suggests Avery is having developmental issues. The SCARED is a child and parent self-report instrument used to screen childhood anxiety disorders ages 8-18 years old and could be used to identify anxiety issues, however the question asks about Avery's already diagnosed conditions. The CBAI helps identify young children at risk of behavioral problems in community settings, which is not the most appropriate choice for this case study.

Avery was referred for counseling to address symptoms resulting from his primary diagnosis of ADHD and both of his parents are requesting help with dysregulation related to this issue only. Neither parent has expressed concern or problematic behavior resulting from gender identity confusion, merely it was mentioned as a remark that was made. While gender dysphoria can very well be a legitimate concern for a child his age, begin the treatment planning process focusing on presenting problems related to the diagnosis. Should Avery or his parents bring up gender confusion later in counseling, the issue can certainly be addressed and explored at that time. While the counselor may have a personal theory of its connection to Avery's behavioral problems, it is best practice to first rule out known existing conditions. Referrals to support groups or other referrals, should only be made when the counselor deems it appropriate outside of clinical counseling, once the problem and need have been thoroughly assessed.

Working with the parents on developing and maintaining consistent boundaries at home is an important factor in the effectiveness of your treatment of Avery and would be considered a longer-term goal as it will involve several objectives and interventions delivered over the length of your counseling relationship. Answer a) is a short-term objective that would be paramount in this treatment plan for Avery. Answer b) is an intervention underneath the banner of a short-term objective, and answer d) is also a short-term objective, however it is better conducted by a psychologist.

Parent behavior management training is an evidence-based treatment teaching parents how to manage difficult childhood behaviors (defiance, outbursts, noncompliance). Validating and encouraging a parent like in answer a) is positive, a positive attitude to have however dismissing the behavior or the parent's role in reinforcing the behavior is not clinically best practice when you are responsible for treating the child conducting those behaviors. Answer b) is an aggressive response to a parent who is actively seeking advice and support, however the need for stricter boundaries may be something the parent should consider. Negative reinforcement and CBT (cognitive behavioral therapy) techniques are also appropriate to teach the parent, but this response assumes the parent understands these terms. It is also best practice to collaborate with the parent on what interventions they have already tried already, and work towards empowering them to select their own options as this approach tends to be the most effective.

Verbal reinforcement is the best way to help Avery remember how it feels to reflect positively on himself as it signals an immediate praise-based reward each time he uses a positive affirmation on his own. Making a list is a great way to remember his positive traits however assigning him to read on his own might only exacerbate his frustrations with reading and cause aversion towards the content since reading is what is making him feel bad. Use of prizes may cause immediate compliance and increased alertness with activities in session however is only reinforcing extrinsic or external motivation to do so and will not provide lasting change. Videos with engaging content are helpful tools to use occasionally, however this is not an optimal choice with this child's low attention span and hyperactivity.

Answers b) through d) are all appropriate ways to better understand Avery's journey with mental health medications and addressing each of these items can support the parents in their decision making going forward. While you can view the records of other providers with parental consent of your minor client (whether the parents provide them to you, or you submit a release of information and request them from the provider directly) it is not necessary for your treatment planning considerations.

Emotion regulation and distress tolerance are taught facets from the school of Dialectical Behavioral Therapy (DBT) which would be helpful for Avery in learning how to manage his emotions, tolerate frustration and regulate his affect. This is especially a good choice for a client who has little insight into their problem (either from a maturity standpoint, age, cognitive ability, or to help with personality disorder) and needs help controlling their bodily reactions immediately without necessarily understanding the underlying reasons why they react the way they do. Cognitive behavioral therapy (CBT) approaches will also be useful for Avery but focus on identifying and changing negative beliefs and thought patterns that contribute to maladaptive behaviors, which is critical for long term change. Applied Behavior Analysis (ABA) is the preferred intervention for autism, and holistic therapies can be considered to provide additional support but are not all clinically evidence-based and do not directly apply to the interventions listed in the question.

This is an example of showing empathy by validating a client's feelings and reinforcing the therapeutic relationship by reminding them of your commitment to give your clinical resources to help alleviate their distress. Answer a) is a fabricated counseling skill. All clinical services should be provided from a non-judgmental position, offering unconditional positive regard as best practice. Developing resolution to their conflicts is at times a collaborative process along with the client, as well as it is a teaching process, that will continue throughout the course of their treatment. If the response were to include strategies, there would be instructions and SMART goals involved. This response was merely using core counseling attributes as a skill to enhance the client's trust and comfort their apparent frustrations.

It is best practice to offer or assess each client on your own prior to agreeing to or denying services. To better understand Marc's needs, conducting an assessment can help you to rule out which conditions you can or cannot support. You should also prepare your clients to know that external support from other specialists might be an option you provide depending on the client's needs that may be outside of your scope of practice. It is not unethical to treat more than one member of the same family depending on the circumstances and situation, specifically when it comes to child siblings; often the parents of children in counseling will prefer the same counselor to meet with their different children and resolve family dynamics issues and provide insight to the parent. The situation must be screened for boundary issues and unethical dual relationships or roles. Answer d) sounds supportive and encouraging but could be giving a family false hope if agreeing to provide services without properly screening through initial assessments.