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1

A 67-year-old woman meets with a therapist for the first time. She informs the therapist that her husband is physically abusive toward her and she can’t take it anymore. She shares her plan to finally stand up to him by taking a knife and showing him what it feels like to be hurt. She states she has never harmed him before. How should the therapist manage the legal obligations in this case?


A. Create a safety plan and maintain confidentiality.


B. Create a safety plan and report abuse to police.


C. Call police to report client’s plan and process it with client.



D. Call APS and warn her husband of her plan for violence.


C. Call police to report client’s plan and process it with client.

Rationale: The best answer is C. The client has made a serious threat of physical violence toward her husband, so the therapist’s duty to protect/duty to report has been triggered. We cannot maintain confidentiality in this case, so A is eliminated. B does not address the imminent danger at all. This leaves C and D. The first part of D is correct, as elder abuse is present, but notifying the husband of her threat is not clinically appropriate. There is a history of physical violence perpetrated by the husband; sharing this information with the husband could inflame the situation and increase the likelihood of violence between the husband and wife. This leaves C as the best available option.

2

A client reports that she recently awoke in the middle of the night to sounds of crying children in the apartment next door. She went to see if everyone was okay and discovered that the parents had left the 8-year-old, 5-year-old, and 2-year-old home alone. The client suspects that the parents are using drugs and expresses a desire to help the kids. How should the therapist manage the legal obligations?



A. Process client’s feelings about the situation and document the need to file a report in the file.


B. Discuss ways the client could help the kids.


C. Inform the client that the therapist must file a child abuse report.


D. Determine if the children are in danger.

C. Inform the client that the therapist must file a child abuse report.

Rationale: This would trigger a mandated report for neglect so C is the best answer as it manages the legal obligation. There is enough for reasonable suspicion so D is not indicated. A and B could be done at some point but a report has been triggered so that needs to be done first.

3

A therapist is meeting with a high school student who states that he is going to take his father’s gun and shoot the members of the football team who are bullying him. He then says that he would not really do it. Legally, what should the therapist do?



A. Inform boy’s father.


B. Maintain confidentiality.


C. Inform members of football team.


D. Contact police.

D. Contact police.

Rationale: The client states a plan with identifiable victims and he has access to a gun. In this case contacting the police would be the best thing to do even though the client backtracked from his statement. If the client did end up shooting kids at school and the therapist didn’t warn police the therapist would be held liable.

4

A therapist relocated to another city. Prior to moving, the therapist referred all active clients to appropriate therapists and services. A new therapist of a former client contacts the therapist with a release of information wanting to know about the past treatment and diagnosis of the client. This particular client had multiple suicide attempts and a history of substance use. The therapist should:

A. Only answer the new therapist’s questions.


B. Contact the client before sharing any information.


C. Answer the new therapist’s questions and include information about suicide and substance history.


D. Contact the client after sharing the information.

C. Answer the new therapist’s questions and include information about suicide and substance history.

Rationale: Due to the crisis issues that the client is dealing with C is the best answer. It is best practice for the continuity of care to collaborate with the new therapist when client has signed a release of information to do so. If a client has a history of suicide attempts that should be shared.

5

A therapist is pulled over by police after attending a happy hour with work colleagues. The therapist is cited with a DUI. At the conviction hearing the therapist agrees to attend Alcoholics Anonymous meetings. What other legal obligation does the therapist have in this case?



A. Inform his clients of his DUI and process their reactions.


B. Inform the BBS of his conviction within 30 days of conviction.



C. Inform his supervisor of his conviction.


D. The therapist has no responsibility due to agreeing to attend Alcoholics Anonymous.

B. Inform the BBS of his conviction within 30 days of conviction.

Rationale: By law, you must notify the BBS within 30 days of any conviction, name change or address change.

6

A 7-year-old child is referred to the school therapist because he is unable to sit still in class. The child exposes a large, red rash on his torso and complains that the lotion his mom puts on it makes it worse. The therapist calls the mother who shares that she doesn’t have time to take her son to the doctor and that she had the same thing as a kid and had to learn to be tough. Ethically the therapist should:



A. Inform the mother that she must take the child to the medical doctor.


B. Process a possible child neglect report with mother.



C. Schedule a meeting with mom and child.


D. Schedule an appointment at a community health clinic.

B. Process a possible child neglect report with mother.

Rationale: A is out because that was already done. There is enough here to file a report for medical neglect, so B is the best answer. If the mother understands that there will be a report made she may change her mind. C and D could be done at some point, but the issue of a possible neglect report is the priority.

7

A therapist has been meeting with a client for several months. During a session, the client informs the therapist she is moving out of the area to a different part of the state. She tells the therapist that she doesn’t want to find a new therapist and would like to continue by receiving therapy by Skype. How should the therapist legally and ethically respond to the client’s request?


A. Terminate services and provide three referrals.


B. Discuss treatment options in the client’s new community.



C. Start internet therapy and obtain informed consent.


D. Refer patient to providers in her new area.

B. Discuss treatment options in the client’s new community.

Rationale: You should have gotten it down to B or C. If a therapist is going to engage in teletherapy, they do have a responsibility to be familiar with the available resources for the client in the area they are residing in the event of a crisis. If a client is moving to an area with few services, then teletherapy would be more indicated. However, if a client is moving to an area with an abundance of therapists it would be important to weigh the pros and cons of teletherapy over in-person therapy. Also, C implies that you would start teletherapy right away and it is not clear in the stem when the client is moving.

8

During an initial assessment with a 7-year-old boy, a therapist observes that the boy is small in stature and appears listless and gaunt. He is difficult to engage in play and mostly unresponsive to questions about school and friends. The therapist notices that the boy is trying to sneak candy from a dish into his pockets. What should the therapist do to legally handle this situation?



A. Comment on the child’s behavior.


B. Call in the boy’s mother to tell her about the behavior.


C. Assess for further signs of child neglect.


D. Make a note of the behavior and intervene if it is repeated.

C. Assess for further signs of child neglect.

Rationale: The question stem hints at possible neglect. There is not enough to make a report, but there is enough to indicate assessing further so C is the best answer.

9

A therapist receives a call from a local hospital. The therapist’s client has been hospitalized following a psychotic episode. The hospital psychologist requests information regarding the client’s history and diagnosis. How should the therapist legally respond to the request for information?



A. Release the information due to the crisis situation.


B. Speak with client to receive consent to share information.


C. Obtain a signed release from client.


D. Refuse request to protect client’s confidentiality.

A. Release the information due to the crisis situation.

Rationale: In a situation of crisis, the therapist may provide information needed to treat the client without their consent so A is the best answer.

10

During a therapy session, an 18-year-old client reports that he assaulted his neighbor’s son whom he suspects broke into the client’s car and stole his radio. The client is bragging and showing no remorse. What action should the therapist take to manage the legal responsibilities in this case?



A. File a child abuse report and process it with client.


B. Determine the age of the victim and file a report if necessary.


C. Maintain confidentiality and document incident in record.


D. Identify alternative coping skills and role-play in session.

B. Determine the age of the victim and file a report if necessary.

Rationale: If the victim is a minor, then the therapist is mandated to file a child abuse report so B is the best answer. A and C would depend on the age of the child. D could be done at a later time.

11

A 29-year-old female client is referred to therapy by her MD for postpartum depression. She shares that she self-medicated in the past with marijuana and that her newborn had a positive toxicology test at birth. Her doctor recently prescribed antidepressants but the client does not think they are working. What are the therapist’s legal obligations in this case?


A. Report the positive toxicology report to CPS and document it in the record.


B. Obtain a signed release to contact MD and assess for risk.


C. Refer client to a substance abuse treatment center for an assessment.


D. Obtain a signed release to contact husband and MD.

B. Obtain a signed release to contact MD and assess for risk.

Rationale: According to California law, a positive toxicology test at birth is not in and of itself enough to trigger a report, so answer A is incorrect. B is the best answer because you need a signed release to contact MD, which you would want to do in this case in order to coordinate care. Assessing for risk is also important because she is coming in with postpartum depression and reporting that the meds aren’t working. C is wrong because there is no clear reason to refer to treatment at this time. D is wrong because there is no indication of there being a husband.

12

A therapist is referred a woman who was recently discharged from a short-term stay in a mental hospital following a manic episode. The woman is living with her parents and is being seen monthly for medication monitoring by a psychiatrist. Legally, the therapist should:



A. Request to meet with client’s family to gather additional information.


B. Obtain signed consent to speak with client’s psychiatrist.


C. Ask client to sign a no harm contract.


D. Identify treatment goals that the client should focus on.

B. Obtain signed consent to speak with client’s psychiatrist.

Rationale: B is the best answer in order to provide the best care for this client. At this time, the clinician should consult with the psychiatrist. This provides continuity of care coming out of hospitalization and gives the therapist important information regarding medication. It is also the only “legally required” answer. A and D are possible interventions for later. C is out because there is no indication that the client is intending to harm herself.

13

A therapist in private practice works predominantly with adolescents and uses text messaging to remind them of upcoming appointments. The therapist accidently sends a message to a client that was intended for her son that says, “I love you.” How should the therapist ethically manage the situation?


A. Acknowledge mistake and discuss the boundary violation.


B. Explore the impact of texting on the therapeutic relationship.


C. Stop using text messaging in clinical practice.


D. Send a follow-up text apologizing for the mixup.

A. Acknowledge mistake and discuss the boundary violation.

Rationale: Many of these answers sound okay. The best answer is A because it includes discussing the boundary violation. Even though it was a text sent to the wrong person, it still included the client into the therapist’s personal relationship. B, C, and D, could all be done as well, but A should certainly be done after such mishap.

14

A 13-year-old client with anxiety returns to therapy after a month at summer camp in Nevada. The client reports that his camp counselor exposed himself to the kids in his cabin and fondled the client at night. The client does not want his parents to know about the incident because he is ashamed that he “let it happen” and knows his parents will be angry with him. How should the therapist legally handle his disclosure?



A. Assure him that his parents will understand and need to be told.


B. File a report with Nevada Child Protective Services.


C. File a report with California Child Protective Services.


D. Obtain a release to contact the camp and inform them of allegations.

C. File a report with California Child Protective Services.

Rationale: A child abuse report must be filed because child abuse occurred and it must be filed in California because that is where the therapist is licensed to practice so C is the correct answer.

15

After meeting with a Japanese-American family for several months, the family has experienced improvements in communication and their children's behavior has improved. The parents give the therapist a gift card in appreciation of the good work with the family. Ethically, what should you do?



A. Acknowledge the parent’s appreciation and accept gift.


B. Acknowledge the parent’s appreciation and decline gift.


C. Determine whether "fee for service" is acceptable in area.


D. Explore cultural importance of providing gift.

B. Acknowledge the parent’s appreciation and decline gift.

Rationale: The reason B is the best answer is because there is no indication of the cash value of the card so the best response would be to decline the card. The other issue here is that, unlike other types of gifts that may have cultural meaning, a gift card is essentially cash. If a client tried to pay you a “bonus” for doing your job, it would be unethical to accept that.

16

During a family therapy session, the therapist notices that both the 6-year-old and the 4-year-old children have bandages on their hands. The mother discloses tearfully that she can’t trust her 16-year-old stepson to stay alone with her young children because he superglued their hands to his door. The husband shakes his head and says, “We already dealt with this. It won’t happen again.” How should the therapist clinically manage the legal issues in the case?


A. Find out how they dealt with it.


B. Document the incident in the notes.


C. Inform the family that the therapist must file a child abuse report.


D. Ask if other incidents like this have happened before.

C. Inform the family that the therapist must file a child abuse report.

Rationale: Answer C is the correct answer because this situation would require a mandated report as the older child is much older and it was not mutual fighting. The children were clearly injured from the incident so there is enough reasonable suspicion of abuse. Informing the family would be the correct way to clinically manage the situation.

17

A therapist runs an anger management group at a community mental health agency. A group member meets with the therapist individually, to complain that another group member shared confidential information outside of the group. Ethically, how should the therapist manage the situation?


A. Encourage the client to address concerns during the next group session.


B. Address the issue with the other group member at next group session.


C. Remind group members of the importance of maintaining confidentiality.


D. Meet with the offending group member and discuss concerns.

A. Encourage the client to address concerns during the next group session.

Rationale: The best answer is A. Like couple’s therapy, you want to direct the person to bring the issue up in the group session. As the leader you would help facilitate that discussion but you would not want to be the one who brings it up as it would indicate that the leader has had outside discussions with a group member. You could also do C as part of the discussion, but you would want to start with A.

18

A therapist begins an assessment with a mother and her 13-year-old son. During the course of the assessment, the therapist learns that the mother has previously used a belt to discipline the son for breaking curfew. The mother and son insist that a child abuse report has already been filed and that Child Protective Services (CPS) has closed their case. How should the therapist legally and ethically respond?



A. Elicit information from the mother regarding referrals made during contact with CPS.


B. Contact CPS to ensure that a report has already been made, and if not, make the report.


C. Explore how the mother and son are handling disciplinary situations now.


D. Help the mother and son process the emotional aftereffects of CPS involvement.

B. Contact CPS to ensure that a report has already been made, and if not, make the report.

Rationale: If a client discloses abuse and reports that it has already gone through CPS, the therapist must confirm that the report was already made or file it him/herself. Each new incident of abuse must be filed even if the client is already in the system.

19

A therapist has been meeting with a client for several months. The client has been using his insurance and is struggling financially after his wife lost her job. He asks the therapist to temporarily waive his co-pay, since he can no longer afford to pay it, and bill insurance for the full fee. The therapist submits the request to the insurance company and they deny the waiver. Ethically, what should the therapist do?



A. Agree to waive the copay and continue with therapy.


B. Appeal insurance company’s denial and continue with therapy while in appeal process.


C. Terminate with client due to inability to afford fees.


D. Appeal insurance company’s denial and discuss fee options.

D. Appeal insurance company’s denial and discuss fee options.

Rationale: You would want to appeal the decision so that gets it down to B and D. D is better because it would be important to discuss the fee options as soon as possible in the event the insurance denies again.

20

A preschool mental health consultant meets with a teacher who is concerned about one of her 4-year-old students. The teacher reports that the child has become increasingly aggressive with peers, has started wetting the bed during naptime, and has come to school with bruises that look like belt marks on the backs of her legs. How should the therapist manage the legal issues in this case?


A. Discuss the necessity of reporting the suspected abuse immediately.


B. Meet with the child and attempt to clarify the cause for the bruises.


C. Call the child’s parents to gather more information.


D. Make a referral to a pediatrician.

A. Discuss the necessity of reporting the suspected abuse immediately.

Rationale: There is enough here for reasonable suspicion of child abuse so the best answer is A. The teacher is also a mandated reporter so she may be the one to make the report but the therapist can also make the report. Just because another mandated reporter doesn’t make a report doesn’t mean a report isn’t mandated.

21

A therapist is developing a website to promote his new private practice. All of the following are ethical, except:



A. Highlighting the therapist’s expertise.


B. Providing information about the therapist’s training and background.


C. Including information about the therapist’s office policies.


D. Including client success stories.

D. Including client success stories.

Rationale: In order to maintain confidentiality the therapist would need to ask the client to provide a success story. This is unethical because it is asking a client to do the therapist a favor which could also be seen as misuse of influence and power the therapist has over the clients.

22

A 13-old-girl is referred to therapy by her middle school counselor because she is withdrawn in class and displays signs of anxiety. Her middle-aged mother attends the first session wearing a Muslim headscarf. The therapist is wearing a Jewish Star of David necklace. The mother notices the necklace and inquires whether the therapist is Jewish. How should the therapist manage the ethical issues in this situation?



A. Acknowledge the mother’s question and remind her that they are there for her daughter.


B. Acknowledge the mother’s question and provide an honest answer.


C. Acknowledge the mother’s question and explore its significance.


D. Acknowledge the mother’s question and remove the necklace.

C. Acknowledge the mother’s question and explore its significance.

Rationale: The best answer is C. It is important to explore the significance of her question because it will clarify the cultural issues at play for her. All the other answers bypass exploring the significance. B could be done after we explore the significance of the question, but not before.

23

A therapist in private practice meets with a client who is working through issues related to his father’s recent death. During one session, the client talks of feeling overwhelmed by his feelings of grief and is unable to deal with his own son’s crying and sadness about the loss. The client reveals becoming so frustrated with his son over the weekend that he grabbed the child forcefully and left bruises on the child’s arm. How should the therapist manage the legal obligations in this case?



A. Assess the child.


B. Let the client know that the child protection agency must be notified about the incident.


C. Educate the client on the stages of grief and provide him with relaxation skills.


D. Refer the client to a grief support group.

B. Let the client know that the child protection agency must be notified about the incident.

Rationale: This would require a mandated report, so the best answer is B.

24

A client is the leader of a criminal street gang. He has been seeing a therapist for several years. One day the client shows up to session desperate for a place to hide some guns that could be used as evidence of a gang killing. He brings the guns to the appointment, asking the therapist to conceal them for him. The therapist denies his request. What are the legal issues present in this situation?



A. The therapist must report the client to the police.


B. This communication between the therapist and the client is not covered by psychotherapist-patient privilege.


C. The therapist must assert privilege if the client’s records are ordered by the court.


D. The therapist must inform the client that he no longer is covered by psychotherapist-patient confidentiality.

B. This communication between the therapist and the client is not covered by psychotherapist-patient privilege.

Rationale: This communication between the client and the therapist is not covered by the psychotherapist-patient privilege, because the client is seeking help to avoid being charged with a crime.

25

A therapist has been seeing a 17-year-old girl for panic attacks who consented for her own treatment because her parents were against therapy. After four sessions the client emails the therapist and informs her that she told her parents about therapy and they no longer want her to attend because they think she doesn’t need it. The therapist responds that she thinks the client could still benefit from treatment and she hopes she reconsiders. The client does not respond. How should the therapist manage the ethical obligations in this case?



A. Provide client with three referrals.


B. Call client to discuss the need for therapy over the phone.


C. Document the reason for termination in the client’s record.


D. Provide client with alternative treatment options for panic disorder.

C. Document the reason for termination in the client’s record.

Rationale: The therapist has already reached out via email. At this point, the therapist should respect the client’s decision and document termination - answer D. The client initiated termination so the therapist does not need to provide three referrals.

26

A therapist in a family service agency is working with an 8-year-old girl who discloses in session that she was sexually molested by an older boy at school. As she is talking, the therapist realizes that the boy is in a therapy group that she facilitates at the school. The therapist should NEXT:



A. Obtain more specific details about the abuse.


B. Question the other client about the allegation after the next group.


C. Report the abuse to the appropriate authorities.


D. Contact the school principal to report the abuse.

C. Report the abuse to the appropriate authorities.

Rationale: Answer C is correct. There is enough for reasonable suspicion so a report is required.

27

During a session, a client informs the therapist that she is concerned for her neighbor who has been behaving strangely since his wife died. The client explains that her neighbor, an elderly man in his 70s, has been doing yard work naked. In addition, the client informs the therapist that she has seen the man foraging in the trash cans and running through the streets shouting profanities. How should the therapist proceed?



A. Maintain client's confidentiality.


B. Encourage the client to make a report to adult protective services.


C. Request client signs a release prior to contacting adult protective services.


D. Explain that the therapist must file a report to adult protective services.

D. Explain that the therapist must file a report to adult protective services.

Rationale: This qualifies as self-neglect and thus warrants a mandated report to adult protective services so D is the best answer.

28

A 25 year-old-woman is in treatment for Borderline Personality Disorder following a discharge from a psychiatric hospital due to a suicide attempt. The client has a severe trauma history and a deep fear of abandonment. After five months of treatment the client shares that she is dating someone special and wants the therapist to see them for couples therapy to make sure the relationship works out. Offering concurrent couples therapy to this client would be:



A. Ethical as long as the risk and benefits are reviews.

B. Ethical as long as the expectations of couples therapy are addressed.


C. Unethical because concurrent couples therapy is never acceptable.


D. Unethical because it is clinically inappropriate with this client.

D. Unethical because it is clinically inappropriate with this client.

Rationale: The best answer is D. Ethically you need to consider impact of seeing a client in multiple treatment units and you should only do so if it would not be harmful to client. A client with Borderline Personality Disorder and issues with abandonment would not be a client that should also be seen for couple’s therapy because in couple’s therapy the therapist needs to be neutral to the individuals in the relationship and that could easily trigger this type of client.

29

A 54-year-old woman seeks therapy for depression. She shares that her 82-year-old mother with dementia moved in with her three months ago and she feels overwhelmed taking care of her. The woman reports, “Sometimes I just leave the house all day, because I can’t deal with all her neediness. She’s like a whiny baby.” What should the therapist do NEXT?



A. Refer client to a psychiatrist for medication evaluation.


B. File an elder abuse report.


C. Determine who is caring for her mother when client is gone all day.


D. Refer client to respite care services.

C. Determine who is caring for her mother when client is gone all day.

Rationale: There is not enough to file an elder abuse report because there may be someone else caring for the mother while she is out. C is the best answer because it furthers the assessment. Answers A and D could be done at some point.

30

A therapist meets with a 45-year-old client who has a history of being violent, for an intake assessment. During the intake assessment, the client states that his wife claims to have been visiting family for the past week but he believes she is lying to him. When probed further, he says that he thinks she is actually having an affair with someone. The client says that he plans on hurting her when she gets home so that she doesn’t do this again. What action must the therapist take to fulfill legal obligations in this case?



A. Suggest other ways to deal with his anger.


B. Determine the level of pathological paranoia in the client.


C. Inform the police of his statement.


D. Discuss the reasons for his suspicions to help the client with reality testing.

C. Inform the police of his statement.



Rationale: This would trigger a duty to warn which requires the therapist to contact local police and inform them of the client’s statement and history of violence. Answers A, B, and D could also be interventions that could be done but C is legally required.