Lila is a Limited Licensed Professional Counselor who, for the past five months has been working in federally-assisted, outpatient mental health and substance abuse counseling agency. For the past month, Lila has been counseling Stephen, a 56-year-old, White male, who has been living with HIV for the past two years. To date, she has had four sessions with Stephen. Stephen started seeing Lila because one month prior to his first session with her, he completed a brief stint in rehab for his cocaine and methamphetamine use disorders. So far, Lila has felt very positive about the progress Stephen has made. He has maintained his sobriety, he has complied with his HIV medications and his viral load is undetectable, and he actively engages in therapeutic work. Lila feels a lot of empathy for Stephen because she has been sober for over five years, but she has started to notice that when Stephen talks about his urges to use, she has felt her own old cravings reemerge. Lila has not discussed this issue in supervision because she has not disclosed her personal addiction history with her supervisor due to fear that it would impact her ability to get her full license.
In a recent session, Stephen shared with Lila that he just started a new relationship with a woman. He expressed that when he has sex with her, it triggers him to want to use coke and meth again. Hearing this, Lila became concerned and asked Stephen if he had disclosed his HIV-status to the new girlfriend. Stephen defensively replied, “That’s none of your business! She doesn’t need to know anyway.” Because it was toward the end of the session, Lila did not pursue the discussion any further. She also realized that she never told Stephen that she may have to report that. In her next session with Stephen, before Lila could bring up the HIV disclosure issue, Stephen stated he was struggling with feelings of guilt about something he did just before he decided to stop using drugs. Lila listened non-judgmentally as Stephen disclosed that about two and a half months ago, to get money to buy drugs, he broke into several houses in the area. In one of the break-ins, the owner unexpectedly walked in on Stephen. Out of fear, Stephen attacked the man who ended up in the hospital in a coma. Stephen was able to get away and was never caught by the police. Lila recalled seeing this story on the local news and remembered that the victim was still in a coma in the hospital. In that moment, Lila felt her strongest urge to drink that she has felt in years, and thought to herself, “I have no idea what to do.”