The presentation described—rapid and significant weight loss (20 lb in one month), restrictive dieting, excessive exercise, possible purging after meals (bathroom use), and functional impairment (missing work due to fatigue)—strongly suggests a severe eating disorder with medical risk (e.g., risk of electrolyte imbalance, cardiac complications, severe malnutrition).

Within treatment planning, counselors are expected to:

Assess risk and severity,

Determine the least restrictive but safe level of care,

Refer to specialized services when problems exceed their scope or when intensive medical and psychological treatment is required.

Given the combination of rapid weight loss, ongoing disordered behaviors, and clear impairment, the safest and most appropriate choice is Option D: referral to an eating disorder inpatient facility, where the client can receive:

Medical monitoring and stabilization,

Nutritional rehabilitation,

Intensive specialized psychotherapy.

Why the other options are not appropriate as the best course:

A. Crisis unit – Typically used for imminent danger such as acute suicidality or psychosis; while eating disorders are serious, the scenario calls for specialized eating-disorder treatment, not just general crisis stabilization.

B. Peer support group – Helpful as an adjunct, but inadequate as the primary level of care for a case with this level of severity and medical risk.

C. Outpatient therapy group – More suitable for mild to moderate cases or for those stabilized medically; the client described likely requires a higher level of care first.

This reflects the Treatment Planning work behavior: using clinical information to select an appropriate level of care, prioritizing client safety, and coordinating referrals to intensive or specialized services when indicated.