Hypothetical case example:

Allison is an 18 year old female student is the first year of an undergraduate university degree. She shares a double room in the university dorm with another female student.

Allison was referred to the university counseling centre by the residence Don, who was "concerned" about her recent weight loss, eating habits and general mood. The Don also was concerned about the effect of Allison's behavior and mood on her roommate. He reported that the roommate was having difficulty focusing on her schoolwork due to her concern about Allison.

Allison reported losing 15 pounds enrolling since enrolling at the university, but said she did not "see it as a problem". At the time of the interview session, Allison was 5ft 6in. tall and weighed 105 pounds. She did not consider herself thin or preoccupied with her weight. Allison stated that "all girls diet in the dorms" and that it was "critical to be thin to find a boyfriend". She also mentioned that her father sent her to university not only to get an education, but also to "hook a nice young man whom she will eventually marry". She stated that maintain a "good figure" would be critical to her "success", both at university and eventually in whatever career she chose to pursue.

She denied bingeing and purging behaviors, although she did make herself vomit once in high school after eating too many sweets at a cousin's wedding Allison said that she would like to lose approximately ten more pounds in order to "look just right". Her diet consisted primarily of fruits, vegetables and grains. She exercised on a daily basis (twice a day for two hours each time). Allison stated that this routine was essential in order for her to maintain her desired body weight. She reported feeling anxious and depressed whenever she missed the one of her scheduled workout sessions.

Allison spoke openly about her relationship with her parents. In particular, Allison said that her parents called her at least once every day and that they "insisted" on knowing where she was at all times. Her parents recently bought her a cell phone in order for her to be contacted more easily. She also reported that her parents were disappointed by the fact that Allison has only come home three times during the past three months. Whenever Allison has a decision to make, she felt obliged to contact her parents to check on their opinions about the appropriate course of action that she should take. If for some reason a decision had to be made without the opportunity to speak with her parents, Allison again reported feelings significant feelings of anxiety and depression. In fact, these feelings at times seemed overwhelming that Allison had contemplated committing suicide several times over the past couple of years. She stated in the interview that she had attempted to overdose on medication as recently as one week prior to the counseling session, but had not told anyone about this incident and she did not want anyone else to know about it.

Another concern for Allison was her grades, Allison had an average of "B" during her first semester and expressed that she was devastated that she did not gotten straight A's. She was certain that her parents would be very disappointed in her results if she did not dramatically improve her academic performance. She was adamant that "nothing less than a grade of A" would be necessary for her to satisfy her self-expectations. She stated that all the other students in the dorm do much better academically than she does and all of then looked down on her because of her "lousy grades". Allison believed that poor grades would definitely lead to a "dead-end" and that she would be a "loser" for the rest of her life.

Allison reported that she was very confused about choosing a career path. Although she was enrolled in an undergraduate science program, she found her studies quite irrelevant and meaningless. Although her parents wanted her to become a physician, Allison had an interest in interior decorating and fashion design, but was concerned it would not be a "prestigious" enough career for her parents. She stated that unless she became a physician, she would consider herself a "total failure". She commented that her confusion about her future career left her feeling "empty and anxious".

As the session was drawing to a close, Allison mentioned that one important source of support to her had been her dorm roommate, Martha. She stated that she able to "really talk" with Martha when she felt anxious or depressed, and Martha was always ready to listen. At this point, you (the therapist) realize that Martha has been a client that you have been counseling for the past several weeks about issues related to her own mental health, including questions about how to deal with her concerns about her roommate Allison. The session concludes with an agreement that you and Allison will meet again in one week.

Question 1: Assume that the therapist has informed Allison about the nature of the counseling progress and that the client has given informed consent to proceed with counseling. Identify two potential ethical dilemmas involved in this hypothetical case. Discuss the specific ethical issues involved and the actions you would consider to try either to avoid the ethical dilemma in the first place or to resolve each of them once they occurred.

 Question 2: Assume that you are the therapist in this case and that you subscribe primarily to a cognitive therapy approach with an existential philosophy as a foundation for the way in which you conduct therapy. Describe how you (as therapist) would understand and approach this case from a combination of these theoretical orientations. Identify key concepts upon which you would base your counseling approach (cognitive and existential) and the types of therapeutic conditions, philosophical stances and methods you would apply to this case in order to  help Allison deal with the presenting problems that she has discussed with you. Use specific examples from the case to illustrate your points.