System in Turmoil 

System in Turmoil

Instructions: Please review the case vignette and respond the questions. Your response should include using your EDM.

Alayah is a cis-gender, biracial (East Asian/White), heterosexual female who has been practicing as a licensed professional counselor with a specialization in clinical mental health counseling for approximately four years (total seven years post MA). She has experience working with a wide range of presenting concerns in a variety of settings, including inpatient, residential, and outpatient 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.

Alayah receives a phone call from a couple, the Johnsons. 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. They describe themselves as a middle-class Black couple who live in the city, both work, and they have not had children but someday hope to. During the phone consultation, Shana Johnson mentions that normally they would not consider counseling as they prefer to handle things privately, but she and her husband Drew 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.

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To prepare, Alayah reviews material from a workshop she attended on the basics of couples therapy. She comes to the session prepared with a plan of action. 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, she senses the discussion going downhill. The couple begin to raise their voices, and Drew appears irate and argumentative, gesturing wildly, as they talked about the Shana’s demanding job and his 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. Alayah is nervous they may not reschedule as she feels like they must know she was in over her head.

System in Turmoil

But they do reschedule and to her surprise, 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 client base.

System in Turmoil

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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 continue working with the couple under the clinical supervision of Rose (who is a licensed professional counselor and marriage and family therapist), Rose and Alayah schedule ongoing supervision. Rose offers to let Alayah borrow some reading materials related to couples therapy. Rose also shares a local group of marriage and family counselors who meet monthly to engage in discussions and learning throughout the year. Alayah is excited to check them out as well.

System in Turmoil

Discussion Board Question: 

1. Should Alayah continue working with the Johnsons? Is her plan to learn more sufficient, or what more should she be doing? Find at least one reputable training program (not a single session event, but a program) she can attend to enhance her competence.
2. Alayah is out one evening, and sees Drew at a restaurant with a woman that is not Shana. What would you do? What steps have you taken during informed consent to guide you and what might you have left out?
3. The couple’s social location differs from Alayah’s. How might this influence Alayah’s work with them including her understanding of their world views, communication style, and life goals.
4. Shortly after starting with the couple, a second couple contact Alayah to request an appointment. They were referred by the Johnsons. Should Alayah schedule them?