Documente Academic
Documente Profesional
Documente Cultură
MAQE
Amr E. Abdelkireem
Adler School
Spring 2014
MAQE 2
MAQE
Identifying Information
Mr. A is a 37-year-old, single, heterosexual, Caucasian male who was referred to our
agency by Kane County Drug Rehabilitation Court for a substance abuse evaluation. Mr. A defines
himself as Italian American man. He notes that he does not believe in God and considers himself
to be an atheist. He is the oldest child of two and his sister is 9 years his younger. He states that he
grew up with his mother and stepfather and that he does not know anything about his biological
father. Mr. A is currently not working and he relates that he is looking for employment; however,
he is not willing to work for a minimum wage. He currently lives in his own apartment with his
girlfriend who moved to the United States from Italy only five months ago. Mr. A has a history of
Presentation/Behavioral Observations
The client appears to be his stated age. He is a balding man, underweight, and he usually
dresses Black Metal T-shirt. Client has several tattoos on his arms, legs, neck, and even on the
inside of his ear. He is alert and oriented to all three spheres (e.g., time, place, and person), with no
evidence of formal thought disturbance. Eye contact is usually good. His speech is logical,
coherent, and relevant. Affect is appropriate to content and mood varies from euthymic to slightly
depressed. Suicidal and homicidal ideations are denied at present. Client appears aware of his
opioid dependency, however, he lacks insight about the causes and the impact of his dependency
on his life.
The client was referred to our agency by the Drug Rehabilitation Court (DRC) for
MAQE 3
substance abuse evaluation. Client suffers from opioid and sedative dependency. He was released
from prison in 2012 and he is currently on probation. Client is currently unemployed and he states
that he is looking for work. Client reports that he has one 18-year-old daughter who also suffers
from heroin addiction. He reports that he wishes he would have never went to prison in order to
have a better relationship with his daughter. He reports that his daughter refuses to have any
relationship with him, and she blames him for her problems.
Client reports that he began using cocaine between ages 17 and 18. He states using about
‘once a month’ and to using ‘a few lines’. Client reports his date of last use to be in 2012. He also
relates beginning using crack around age 18. Client reports to using once a month and using ‘a
couple bags’. He reports he has not used crack for 10 years. Client notes that he began using heroin
between the ages of 17 and 18. He reports to using a couple bags per day. He states that 2 weeks
prior to the assessment, he had a ‘slip’ and used heroin again after a year and half of sobriety.
Client states that besides this slip, the last time he had used heroin was in July 2012. Client reports
to beginning his use of PCP around age 14. He notes that he used daily and states he would use ‘a
lot’. He reports that he discontinued his use of PCP in 1999. Client states that he was sexually
Psychosocial History
Client denies any history of mental health hospitalization. He reports attending counseling
while he was in middle school due to having some fights at school. Client denies being on
psychiatric medications. He also denies any family members obtaining mental health services.
Client denies any other mental health symptoms or issues. He denies any current or history of
suicidal and homicidal ideations. Client identifies himself as Italian American. He describes his
stepfather to be associated with high status criminal and to be regarded as one. Client states that he
MAQE 4
began stealing at age 12. He reports that his stepfather gave him a sense of approval regarding
stealing. Client reports that he was transferred to behavioral disorder school at age 12, where he
learned from order children more about the life of crime. Client states that he was sexually abused
from the age of 6 to the age of 12 by a family friends’ son, who was 19-year-old when the sexual
abuse started. Client relates that he holds some resentment toward his parents because of his sexual
abuse experience. Client reports that he did disclose to his parents about the sexual abuse about 5
years ago. He states that they were chocked and that his parents confronted the abuser’s mother,
however, there were no legal procedures in this regard. Client reports that he does not believe in
God and that he considered himself atheist. Client reports that he has been arrested over 20 times
during his life, and his legal charges consist of possession of heroin and residential burglary.
Client does not talk much about his relationship with his family, however, he reports that
his sister is very successful career woman who works as a lawyer and lives in Las Vegas. He states
that as a child he got what he wanted by just asking for it. Client notes that he has a good
relationship with his mother, stepfather, and his sister. However, when asked about those
Mr. A, age thirty-seven, is the older of two and his sister, minus nine. Mr. A describes
himself as an Italian American, who comes from prestigious criminal family. Mr. A grew up living
with his mother and stepfather, and he did not know anything about his biological father. He was
the only child for nine years before his sister was born. Mr. A describes his parents as permissive,
disengaged, and indulgent who did not enforce any rules, and he learned to make his own
decisions at early age. Mr. A states that he started stealing at early age and his stepfather gave him
a sense of approval. He sees himself as a convict who does not have much chance in reentering the
MAQE 5
community in a useful way. Mr. A’s inferiority feelings stem from the feelings of inadequacy,
weakness, and guilt, which started in his childhood experience of sexual abuse and exacerbated by
his heroin dependency. These feelings of inferiority can also be conceptualized as a “result of
incongruence between convections in the style of life” (Mosak & Maniacci, 1999, p. 57). Mr. A
seems to interact with the world and others in a safeguarding and superior stance. One can
observe his safeguarding tendency in his social isolation and substance dependency, and his
superior stance in his grandiosity and over-ambition (Clark & Butler, 2012). He seems to be
preoccupied with himself by keeping distance from his family. Mr. A holds anger and resentment
toward his parents; however, he refuses to express his anger, which reinforces and excuses his
distance. Mr. A seems to carry shame and guilt and he appears to use these symptoms to block
method of understanding the client’s fictional goal (Oberst & Stewart, 2003). However, when
asked to report about his early recollections, Mr. A said, “All I can remember before the age of 9
or 10 is all sexual abuse.” Mr. A has experienced sexual abuse from the age of 6 throughout the
age of 12, which highly affected the development of his lifestyle and social interest (Cash & Snow,
2001). Mr. A seems to hold traditional masculine norms, which include prescriptions for how men
should look and act and the kind of attitude men should have (Easton, Coohey, Rhodes, &
Moorthy, 2013). These masculine norms exacerbated Mr. A’s feelings of shame and guilt
Mr. A reports that he was transferred to behavioral disordered school at age 12 as a result
of his misbehavior at school. After the transferring to the behavioral disordered school, Mr. A
reported that he began to interact with and learn from older children about substance abuse and
criminal activities. He began to get in more serious troubles with the legal system and he started to
MAQE 6
use drugs regularly. It appears that Mr. A views himself as different and inadequate. He says, “I
am a different kind of addict.” By viewing himself as a different kind of addict and construing his
situation as unique, he holds a pessimistic view of himself that prevent him to take action. Hence,
he does not need to try or to be involved in narcotic anonymous or recovery in general; there is no
use.
From Adlerian lens, Mr. A is making excuses to follow his private logic and act as if this
private logic is common sense (Mosak & Maniacci, 1999). He excuses and justifies himself with
his perception of himself as: “I’m so bad and I will always fail anyway. Why even try?” (Slavik,
Carlson, & Sperry, 1995). Life for Mr. A has no meaning; he portrays it as just for enjoyment and
having fun, work is for fools. He feels that he cannot count on others, since his own parents failed
to protect him as a child. The world for Mr. A is perceived as a jungle where one should strive to
get what one needs and wants. People for Mr. A are seen as not worthy of trust but they may be
persuaded to provide for him. In order to have a place for Mr. A, he should manipulate others and
achieve high prestige. Mr. A has unrealistically high ambition, while he lacks the willingness to
work for it. Mr. A appears to be striving for superiority out of self-interest. For example, Mr. A
says he needs to find a job, but he also says, “I won’t work for a minimum wage; I get used to
making easy money.” Mr. A’s lifestyle allows him to behave in a familiar way to maintain a sense
of security, rather than taking risk and try new behaviors (Slavik, 1995).
Adlerians pay close attention to understanding of the purpose of the person’s behavior
holistically. Unlike Freudians who see present behavior to be influenced by past experiences,
Adlerians see present behavior to be influenced by one’s view of the future (Feist & Feist, 2009).
For Adler, humans are not pushed by causes but pulled by their self-created goals and dynamic
striving (Millar, 2013). Hence, from an Adlerian lens, the therapist will look at Mr. A’s childhood
MAQE 7
sexual abuse holistically in term of his lifestyle. The therapist would not perceive Mr. A’s
substance dependency and criminal behavior as a result of his childhood history of sexual abuse
(Slavik et al., 1995). Adler (as cited in Millar, 2013; Slavik et al) stated, “It is not the child’s
experiences which dictate his actions; it is the conclusions which he draws from his experiences”
(p. 203). Hence, the therapist may look at Mr. A’s misguided action in term of purposive
behavior. For example, Mr. A seems to be what Adler called a getting type. When Mr. A fails to
get from others, he may use his symptoms (i.e., being a victim) to manipulate others to serve his
needs. In other words, the problem is not the childhood sexual abuse; the problem is his
interpretation of his abuse and of life in general. The therapist is focusing on and exploring current
Mr. A seems to use more than his symptoms as sideshows to distract his attention away
from meeting the tasks of life (Mosak & Maniacci, 1999). Making excuses and seeking distance
are other sideshows in which Mr. A displays. Mr. A views his felony as a barrier for employment,
he says, “No one will hire a convict felon.” Mr. A is standing still in his movement by acting as if
he is still an adolescent who parties too much, avoids taking responsibility, and not meeting the
tasks of life in general. He also creates sideshows by engaging in mob storytelling to avoid
Adlerians identify the individual’s level of social interest in six life tasks.
Work Task: Mr. A does not have a long history of employment. He has worked as a painter
but not for a steady period of time. Currently, he is looking for employment but looking for
the perfect easy job. Mr. A got used to making easy money by dealing drugs and engaging
in other criminal activities. Hence, he is having difficulties accepting working hard for less
money. He states that he used to work with his uncle at his bond shop and that he wants to
MAQE 8
Social Life: Mr. A was affiliated with gang activities from the age of 12 till the age of 34.
He has not been cooperating with the community in a useful way and he lacks a sense of
belonging due to his alienation and isolation. He distances himself from others by moving
backward and standing still due to his feelings of inadequacy and inferiority.
The Sexual Task: Mr. A has never been married; however, he describes himself to be a sex
addict who cannot have enough sex. He is currently in a relationship with an Italian woman
who migrated recently to the United States four months ago. Being a sex addict and
choosing an Italian woman to be his partner are congruent with Mr. A’s style of life. Being
complex (i.e., childhood sexual abuse), and choosing an Italian partner perhaps out of
masculine protest perception. That is, Mr. A overvaluing masculinity and perceives it to be
superior. Thus, he chooses a woman from the farms of Italy (as he noted) who probably
The Self Task: Mr. A sees himself as inferior to others and he act and wants to be perceived
as someone else. He thinks others will not like or accept him if they knew his real self. Mr.
A is not sure of his identity; however, he acts out of his self-ideal that is being Italian
gangster.
The Spiritual Task: Mr. A considers himself an atheist. He does not believe in afterlife or
of the existence of heaven and hell. Mr. A avoids discussing spirituality in general, which
is a challenge to his treatment. Regardless of his belief or lack of it, he needs to have a
meaning for his life in order to overcome his addiction and to have a better quality of life.
The parenting and Family Task: Mr. A has an 18-year-old daughter who refuses to have a
relationship with him and sees him as the reason for her problems and for her heroin
MAQE 9
addiction. Mr. A states that he has a good relationship with his mother and stepfather;
however, he holds resentment toward them for failing to protect him as a child. Mr. A
reported that when he relapsed he called his stepfather and told him about the relapse
incident. The therapist perceives this act as a way of making his parents feeling bad for him
and put the blame on them for his failure. It could be that Mr. A unconsciously wanting to
show his parents what a terrible human being they have created by being neglectful and not
protecting him. It could also be that Mr. A wants to get attention from his family and
There are four phases of Adlerian psychotherapy, which are: establishing the therapeutic
relationship, assessing and understanding the life style, encouraging self-understanding and
From an Adlerian perspective, the most important goal of the treatment of the adult who
has experienced childhood sexual abuse is to encourage his or her sense of belonging, to find
meaning in life, and to restore faith in human kind (Slavik, Carlson, & Sperry, 1993). When the
person feels a sense of belonging as an equal, he or she will probably use social interest and will
find ways to contribute usefully to the common welfare of others (Millar, 2013). There is a
positive relationship between the sense of belonging and social interest; the more sense of
belonging one feels, the more social interest he or she will develop and the minimal feelings of
inferiority he or she will display (Mosak & Maniacci, 1999). In the case of Mr. A, the treatment
focus is on overcoming his discouragement, pessimism, and over-ambition striving, which is the
result of his perception of his childhood sexual abuse (Slavik et al.). Mr. A’s prognosis is good
since he is involved in the treatment process and open to insight and self-understanding.
MAQE 10
Phase 1: Establishing the Therapeutic Relationship: from the beginning of the therapy
process, the therapist works collaboratively with Mr. A by listening attentively, showing empathy
and caring, and by developing a relationship based on mutual respect between equals. Giving the
history of Mr. A’s child sexual abuse, it is crucial not to move toward processing this experience
until establishing the proper trusting relationship. In addition, the therapist needs to help Mr. A see
his assets and strengths, not just focusing on his deficits and problems. Adlerians emphasize
focusing on strengths and warn against processing the traumatic experience (i.e., childhood sexual
abuse) before the safety is established (Millar, 2013; Slavik et al., 1993). The therapist should not
treat the sexual abuse experience as a crisis (Slavik, et al.). Creating an egalitarian relationship
between the therapist and Mr. A is also a focus of the first phase of Adlerian psychotherapy. The
therapist should not pamper Mr. A or treats him as fragile. The therapist should show faith in Mr.
In this first phase of therapy, it is also important for the therapist and Mr. A to agree on and
align the goals of treatment in order for the therapeutic relationship to be beneficial (Oberst &
Stewart, 2005). Given that Mr. A is mandated by the court system to attend therapy, it will be
necessary to align the court system’s goals with the treatment goals.
Phase 2: Assessing and Understanding the Life Style: During this phase, Adlerians proceed
by gathering data that reveal client’s attitude, behavior, and ways of coping with life demands
(Oberst & Stewart, 2005). In Mr. A’s case, the therapist assesses his family constellation, birth
order, early childhood history and recollections. Mr. A comes from Italian heritage and he wants to
be seen as a tough Italian gangster as a way of overcompensating. Mr. A strives for superiority
complex are derived from his perception of childhood sexual abuse. While assessing Mr. A’s
lifestyle, the therapist should not tackle early traumatic memories before the client is stable enough
MAQE 11
to do so (Millar, 2013). The therapist should be cautious while encouraging the client to recall his
Phase 3: Encouraging Self-Understanding and Insight: in this phase, the therapist will work
with Mr. A to remove feelings of guilt and to minimize giving excuses. Mr. A needs to see himself
as a survivor not a victim, and in turn, he will respond to life in a more responsible way. Mr. A
also will start setting realistic goals, seek realistic jobs, and begin to focus on his assets and
strengths. The therapist in this phase should confront Mr. A with his safeguarding tendencies and
discrepancy between his speech and behavior. For example, Mr. A says, “I cannot control my drug
use” and “I am different than other addicts.” Mr. A focuses on the differences between himself and
other addicts not on the similarities. Mr. A justifies not going to an inpatient program by his need
of taking care of his girlfriend; however, he does not have a job and does not bring any money
home, while still using drugs. The therapist confronts Mr. A by pointing out to all of these
Phase 4: Reorientation and Reeducation: at this stage, the therapist will start working with
Mr. A on committing to changing his style of life and fulfilling the life tasks in a healthier way.
There is a metaphor used by recovering alcoholics and addicts regarding change, which is, “The
only thing the newcomer—or the individual who is seeking recovery—needs to change is
everything.” Mr. A admitted to this writer that he needs help to stay sober and that he needs to go
to inpatient treatment. He added, “ I cannot live like this anymore.” Form a 12-step fellowship
perspective, Mr. A admitting defeat and being powerless, which is the first part of the first step.
Although Mr. A is still at the very beginning of the recovery process, admitting defeat is a crucial
gain in the therapy process. Hopefully, after Mr. A finishes the inpatient treatment the therapist
will work with him to maintain recovery. The therapist will be focusing on helping Mr. A change
his maladaptive way of relating to other human beings by understanding the importance of
MAQE 12
connecting with others, particularly, recovering addicts in the rooms of Alcoholic or Narcotic
Anonymous. It will be essential for Mr. A to replace old ways of thinking and to develop healthy
behaviors and new habits to fill the void that addiction will leave. The key point is for Mr. A to
develop and enhance his social interest and sense of belonging and significance. According to
Adler (as cited in Slavik, 1995), social interest is a guiding line that can replace other guiding
lines. Hence, Mr. A—with the help of the therapist—can release himself from the chains of
Mr. A is a man of above average intelligence, however, he appears to lack meaning for his
living and feels alienated from society expectations. Mr. A views himself to be different and he
lacks a sense of identity. Hence, it seems appropriate to apply the existential therapy to understand
Mr. A’s world. Existential therapists strive to enter the private world of the client rather than focus
on the manner in which the patient has deviated from the norms (Fisher, 2005).
Mr. A exhibits what Jean-Paul Sartre calls “bad faith,” by avoiding taking personal
responsibility (Pitchford, 2009). He said, “I am an addict and there is nothing could be done about
it. I am going to keep living this way.” Existentialism emphasizes individual potential and growth.
It is essential for the individual to take responsibility of his or her life and to be free to choose.
Existentialists see individuals struggling with four main concerns in the pursuit of an
authentic life, freedom, isolation, meaningless, and death (Yalom, as cited in Pitchford, 2009).
Individuals who experienced childhood sexual abuse, as Mr. A, face these concerns in an
unusually pervasive manner. He probably lived in a world characterized by isolation and fear,
while his parents failed to protect him. Mr. A’s sense of freedom was impaired by lies, and his
From an existential view, Mr. A has the capacity to expand his self-awareness and to
make an optimal decision for his future. The concept of freedom is at the heart of existential
therapy (Pitchford, 2009). Mr. A is a classic example of a person who is longing for freedom while
trying to escape from it. During the counseling sessions, Mr. A wanted to go back to prison, rather
than facing his addiction and take action toward recovery. Mr. A, with the help of the therapist,
needs to feel free to design his own future. He does not need to be victimized by his past childhood
experience. Mr. A needs to face his anxiety, rather than hiding behind his fear of life by his heroin
dependency.
The therapist, from existential therapeutic stance, works with Mr. A on accepting his own
responsibility and directing his own life. Mr. A needs to realize that he is free to be who he is and
to choose to participate in a meaningful life. The therapist, after creating an authentic and trusting
relationship with Mr. A, will confront him he is trying to escape from his freedom and
responsibility by being addicted to heroin. The therapist will provoke Mr. A’s anxiety and invite
him to take risk by opening up and uncover his authentic self. Mr. A needs to look at himself to
find his own identity rather than seeking confirmation through others.
Yalom (1980) noted that existentialism perceives a person “as a consciousness who participates in
the construction of reality” (p. 23). Mr. A’s inability to participate fully in his internal and external
world drives much of his behavior. Thus, existential work can help the survivor acknowledge and
embrace his autonomy by allowing him to reconnect with his inner self and begin to trust his
perceptions of the world. Several of Yalom’s eleven therapeutic factors could be applied to this
case.
Mr. A needs to gain hope as a starting point in his recovery. Yalom considered the
instillation of hope to be a central aspect of all forms of therapy. Yalom specifically noted that the
presence of recovered alcoholics in the fellowship of AA directly inspires hope in newcomers and
MAQE 14
enhances their self-efficacy (1995). Mr. A sees himself as a hopeless heroin addict who does not
have meaning for his existence. He thinks this is the way his life is meant to be and he is
condemned living life of dependency. The therapist makes a point of sharing with Mr. A about
other recovering heroin addicts who have been in recovery for many years and who are leading
According to Yalom (1995), The therapeutic factor of universality (and all other factors)
plays a role in individual therapy as well. Mr. A has feelings of uniqueness and of being different
from others. He thinks that he alone has frightening experiences. To Yalom (1995), the
“disconfirmation of a patient’s feelings of uniqueness is a powerful source of relief” (p. 6). One of
the most powerful slogan at AA is, “You are not alone anymore.” Thus, Mr. A will benefit
drastically from being with others, sharing with them, and most importantly, listen to their
didactic and psycho-educational that is essential to this case. Given that Mr. A is suffering from
heroin dependency, explaining and clarifying the disease concept of addiction could serve as a
turning point in his self-perception. That is viewing his addiction as a disease rather than moral
deficiency will remove all the guilt and shame associated with his addiction. This implies that Mr.
A is not responsible for his addiction; nonetheless, he is responsible for his recovery. The
Imparting information may also be given through successful stories of other recovering
addicts as the case of AA and NA. Mr. A will benefit more by listening to others’ stories while
all therapeutic orientations. Victor Frankl noted that life meaning materializes when the individual
MAQE 15
forgets oneself and become absorbed in something outside of oneself (2006). Mr. A needs to
appreciate the concept of altruism and to understand how he can benefit himself by helping others,
by accepting help from others, and by sharing his experience. He needs to find interest and purpose
The Corrective Recapitulation of the Primary Family Group is another important factor in
the case of Mr. A, given his traumatic childhood experience. Given Mr. A’s childhood experience,
he probably uses denial, repression, and regression as a defense mechanism. However, dissociation
is often the most used and effective defense by childhood sexual abuse survival. This dissociation
The therapist and Mr. A should revisit and process the early childhood sexual abuse experience in
a therapeutic manner, while encouraging openness and vulnerability. However, the therapist must
exercise caution and patience as he seeks to cultivate and encourage these qualities.
Development of Socializing Techniques, Imitative behavior, and Interpersonal Learning are related
factors.
Diagnostic Impressions
Axis IV: Legal Issues, Occupational Problem, And Problem with Primary Support
GAF = 65 (Current)
Treatment Plan
Goals
MAQE 16
2. Establish and maintain total abstinence while increasing knowledge of the disease
5. Develop Social Interest and a sense of belonging to help with reducing isolation.
The last goal is essential to Adlerians, existentialists, and to the 12-step fellowship. It is
expressed in Bill Wilson’s writing that the goal of AA is to restore the alcoholic’s sense of
belonging to the family of man, from a position of self-centeredness, of “self-will run riot”
Objectives
Reconnecting with the social group from which the client has become estranged by
times a week.
Gaining an insight of the problem from an Adlerian term. For Adlerian there is no
Therapeutic Interventions
the misguided guilt and shame that accompanies most addicted client)
Require the client to name some people that he can trust and connect with them.
Facilitate the client’s understanding of his personality, social, and family factors,
Course of Treatment
The therapist is currently using Adlerian counseling and the 12-step program in this case.
Although the client appears to have trust issues, the first phase in therapy (i.e., establishing a
therapeutic relationship) was developed successfully. The therapist worked with the client on
establishing egalitarian relationship in which the client feels comfortable to share feelings and
cognitions. The goals of treatment were aligned with the client and the drug court expectations,
which are to stay sober, to attend at least three AA/NA meetings per week, and to find a steady
job. The therapist has been focusing on the client’s strengths while confronting him when needed.
The therapist has been encouraging the client to look at himself and face his problems, to see the
discrepancy in his speech and behavior. The therapist also encourages the client to expand his
social interaction in a healthy way. For example, contacting family members and old friends who
are not using drugs, and to go to NA/AA meetings and share his feelings and thoughts.
Unfortunately, client has relapsed during our counseling sessions. He called and
acknowledged this therapist regarding his relapse. He said, “I need to get admitted to inpatient
treatment; I cannot keep doing this.” The therapist knew that the client needs to be away for a
while from his environment, so he can develop a clearer mental state and commit to recovery and
MAQE 18
counseling in a deeper level. However, the therapist did not want to force any opinion on the client
and waited for the client to be ready. Fortunately, Mr. A is ready now and hopefully, he will find
12-Step Program
The client goes to three Narcotic Anonymous meetings weekly as required by court,
however, he states that he does not get involved in the discussion and that he does
The client states that he is an atheist and that he struggles with spirituality and the
concept of the higher power or God. Hence, he has difficulties accepting some
Adlerian Counseling
Inferiority and Social Interest. Since the client has difficulties with the spirituality
of the 12-step program, it is beneficial to integrate Adlerian therapy with the 12-
step.
problems.)
Style of life.
Early recollections.
The Question.
Confrontination:
Spitting in the soup: this technique was used more than once with Mr. A. The
therapist understands client’s lifestyle and how he belongs and finds significance.
MAQE 19
For example, client relapsed and called his stepfather just to let him know. Client
was seeking attention from his family. The therapist asked the client, “How did it
Involvement
The client shows up on time and he appears involved in the counseling process. He
Client always tries to get closer to the therapist in a personal level, by asking
questions about the therapist’s own life and asking to have the session at the library.
The therapist strives to be objective while remaining a person. Thus, the therapist
The therapist feels reluctant to ask the client more about his sexual abuse.
however, client needs to gain hope and to trust the process. Social interest is a key
a. Several ACA codes of ethics may be relevant to this case. They are as follows:
1. A.4.b. Personal Values—“Counselors are aware of their own values, attitudes, beliefs, and
behaviors and avoid imposing values that are inconsistent with counseling goals.
Counselors respect the diversity of clients, trainees, and research participants.” Mr. A
identifies himself as an atheist while this therapist is a spiritual and believes in the
MAQE 20
importance of spirituality in the individual’s life, however, this therapist does not impose
and during the counseling process explains to Mr. A about the limitations of
confidentiality.
3. B.2.d. Minimal Disclosure—“To the extent possible, clients are informed before
counseling, Mr. A’s probation officer asks about Mr. A’s progress in therapy and treatment
goals. However, the therapist discusses with the client the kind of information in which the
probation officer will receive. The therapist initially obtained the client’s consent to accept
these limits of confidentiality before entering the counseling relationship. The therapist
participation by a treatment team, the client will be informed of the team’s existence and
composition, information being shared, and the purposes of sharing such information.” Mr.
A’s treatment was assessed for the second time after two months from the initial admission
for continued stay. The therapist has informed Mr. A regarding the process of the
assessment. Meanwhile this therapist was asked by the treatment team to discuss the
client’s case progress and struggle in therapy for educational purpose. This therapist has
MAQE 21
not share any information and will discuss this possibility with his supervisor and with the
client.
recording sessions through electronic or other means.” The therapist has obtained a written
Mr. A—as mentioned above—comes from Italian heritage and he describes his family as a
high status criminal family. He seems proud of his heritage and he engages in story telling about
members of his family that involve criminal act. Given the limits to confidentiality and the lack of
consistent definition of privileged communication (Corey, Corey, & Callanan, 2011), the therapist
had to explain to Mr. A that there are certain circumstances where confidentiality cannot be
Diversity/Multicultural
Mr. A is Caucasian male who comes from Italian heritage, however, whereas the therapist
is Middle-Eastern Egyptian male. Although there are similarities between those cultures, there are
differences as well. The therapist has biases about atheism; however, he is aware of his biases and
The therapist is aware of his own negative and positive attitude toward the client’s culture.
He is also aware of the stereotypical assumptions, cultural biases, and mistaken beliefs that could
be at play. For example, therapist understands client’s struggle with the environment and with
addiction. He appreciates the nature of addiction and does not hold judgmental view regarding
client’s motivation. The therapist is also aware of the faulty assumption, which holds that will
power is sufficient to maintain sobriety. In this regard, the therapist works first on understanding
the client’s worldview before inviting him to decide on change that is congruent with his own
MAQE 22
beliefs. Hence, the therapist does not impose spirituality on the client and encourages the client to
find belonging and significance through social embeddedness. The therapist appreciates the
importance of having a higher power as a key element in addiction treatment, however, accepting
References
Clark, A. J., & Butler, C. M. (2012). Degree of activity: Relationship to early recollections and
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