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Joe, a thirty-five-year-old, male mental health counselor, received a client referral, thirty-five-year-old Jill,
from a community counseling clinic. He began providing counseling services to her. Jill’s complaint was that
she was unsatisfied with her current job as a bank teller and was experiencing mild anxiety and depression.
Joe had been providing services to Jill for three weeks when she disclosed that she was confused about
her sexuality because she experienced sexual attraction toward some women. Joe immediately responded
to Jill with wide eyes and a shocked look. He told Jill that he was a traditional Catholic, who felt that this
type of feeling was immoral and wrong. He informed her that she should avoid thinking about this and pray
for forgiveness. He also told her that he felt uncomfortable talking about the issue any further. Jill continued
to talk to Joe about dealing with her family issues.
Joe had recently read about a new technique and immediately became excited about trying it. He explained
to her that he had read an article in a magazine about a new technique called rebirthing. The new technique
was being used in Europe to help people change their views about their relationships with their family. Joe
said, “It is supposed to be really effective in almost wiping out your memory of your family; it is like
hypnosis.” “I would really like to try it on you today, what do you think?” Jill declined his offer and continued
to talk about her family. Joe thought to himself that even though Jill said no, he was still going to try to
hypnotize her as they talked because he thought she could benefit from the technique.
Jill disclosed that she was raised in a traditional Asian American home with many cultural influences and
culture-specific rules and behavior. Jill was struggling with balancing her individualism and her cultural
heritage. Joe explained to her that because he was living and working in a rural community, mostly
consisting of people of East European descent, he could not relate to Jill’s culture and the issues with which
she was struggling. He apologized and explained that he was not required to study these cultural issues
because of his geographical location.
Jill moved on to talk about her depression. She began talking about feeling lonely and how it contributed to
her depression. During a counseling session several months later, she revealed that she was attracted to
Joe and would like a closer, intimate relationship with him. Joe, aware that he was also attracted to Jill,
talked about his feelings toward her but explained that engaging in a relationship outside the established
counseling relationship was unethical. He informed her that because of the mutual feelings of attraction, the
counseling relationship would be ineffective and that he would refer her to another counselor for continued
services. Jill agreed, and they terminated the counseling relationship. Later, she contacted him to continue
counseling and to discuss the referral. Joe agreed to meet her that evening at a restaurant and bring her
the referral information. That night they began an intimate sexual relationship.
Joe never got around to providing the referral for Jill even though he was aware of her ongoing state of
depression and anxiety. Joe stopped seeing Jill after a month of intimate sexual encounters. Joe enjoyed
the relationship but felt guilty due to the unethical nature of the relationship. Because of his continued
concern about Jill’s depression, Joe considered going to his current clinical supervisor to discuss the case
but decided against it. This was because he and his supervisor were good friends and he suspected his
supervisor would be hurt by knowing the real reason he had been cancelling get-togethers.
Joe decided to call Jill’s boss at the bank to check on her and see how she was doing. He called her boss
and explained that he had been counseling her for anxiety and depression and wanted to check if she was

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