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1

A therapist meets with a 25-year-old woman who lives at home with her parents. The client reports feeling extremely depressed, has a history of self-harm, and after a suicide assessment, the therapist determines she is at a high risk of serious self-harm. The client reports she does not have insurance and cannot afford to be hospitalized. How should the therapist address the ethical and legal issues in this case?



A. Notify client’s parents and refer client for a low fee psychiatric evaluation.


B. Initiate a 5150 because the client may need to be hospitalized.


C. Explore low fee resources to meet client’s financial needs.


D. Notify client’s parents of her plans and safety plan with client.

B. Initiate a 5150 because the client may need to be hospitalized.

Rationale: The therapist “determines this is at a high risk for serious self-harm”, this would be the time to initiate a 5150. They may determine she does not need to be hospitalized, but the therapist would have covered the standard of care.

2

A 13-year old boy discloses a history of sexual abuse. He informs the therapist that his former therapist touched him during several sessions to demonstrate what is appropriate versus sexually inappropriate touch. What actions should the therapist take to address the legal issues in this case?



A. Maintain confidentiality and provide BBS brochure.


B. Call police and inform his parents.


C. Report to CPS and process it with client.


D. Report misconduct of therapist to BBS and document in file.

C. Report to CPS and process it with client.

Rationale: The best answer is C. The information shared by the boy points to sexual abuse, which requires the therapist to make a child abuse report, answer C. Answer A and D are incorrect because they do not address the legal mandate to report abuse. While the therapist can contact the police to make the report, the child is over 12, so processing with client is better than answer B, informing parents.

3

A therapist working in a community agency receives a referral for a child with severe PTSD from sexual abuse. The therapist has no training or experience treating children with PTSD from sexual abuse. The therapist should:



A. Attend a training on PTSD in children.


B. Conduct an initial assessment and make treatment recommendations.


C. Refer the child to appropriate services.


D. Treat the child after getting consultation.

C. Refer the child to appropriate services.

Rationale: C is the best answer for this particular client because it is outside of the scope of competence of the therapist. Neither attending a training nor seeking consultation would be adequate for this type of case, so A and D are out. B is wrong because the therapist would need training in how to assess and what to recommend.

4

After referring a client to an acupuncturist for treatment the acupuncturist calls the therapist and invites him to lunch to discuss how they can work together. He tells the therapist that he is willing to pay for referrals. How should the therapist manage the legal and ethical issues in this situation?



A. Discuss how much he wants to be paid per client.


B. Decline the lunch invitation because of client’s confidentiality.


C. Inform him that he cannot accept payment for referrals.


D. Discuss how the therapist can pay acupuncturist for referrals as well.

C. Inform him that he cannot accept payment for referrals.

Rationale: C is the best answer because it is illegal to take kick-backs for referrals. A and D are engaging in unethical and illegal behavior. B is not the addressing the issue of payment for referrals.

5

A younger therapist has been treating a 60-year-old Navajo woman for 3 months and has a particularly ground-breaking session. At the next session, she arrives with a gift, a beautiful handmade blanket. After the therapist explains that it would be unethical to accept the gift, the woman appears insulted and quietly mumbles that she wishes to end the session and discontinue therapy. Ethically, the therapist should have:



A. Accepted the gift, but leave it in the office to use.


B. Accepted the gift and discussed its significance.


C. Consulted with a supervisor regarding the appropriateness of accepting the gift.


D. Declined the gift, which was the most appropriate course.

B. Accepted the gift and discussed its significance.

Rationale: It is not unethical to accept gifts. In this case, B is the better way to respond to handmade gift.

6

During the sixth session with a 64-year-old man he breaks down in tears while discussing his relationship with his estranged 40-year-old son. He confesses that when his son was younger the client was physically abusive to his son on a number of occasions, especially when the client had been drinking. He says that besides his wife, he’s never told this to anyone before. How should the therapist manage the legal obligations in this case?


A. Explore client’s feelings about disclosure and document the session in his record.


B. Inform the client that child abuse is a mandated report and file a report.


C. Review the limits of confidentiality and determine whether the client is currently abusing any minors.


D. Maintain confidentiality of the reported abuse and document session in his record.

D. Maintain confidentiality of the reported abuse and document session in his record.

Rationale: You would not report child abuse if the victim is no longer a minor. There is no indication that the client is currently abusing any children. This leaves you with A and D. D is better because it addresses the legal obligations, where “explore client’s feelings” would be a clinical, not legally required, response.

7

A therapist has been treating a 42 year-old, single man for five months. The client is a successful partner at a prestigious law firm. For the past month, the client has noticed improvements in his mood and his relationships with others. Around the holidays the client leaves the therapist a bottle of wine outside the office as an expression of his gratitude. What action should the therapist take to address the ethical issues in the case?



A. Accept the gift graciously during the next session.


B. Explain to the client that the therapist is not allowed to accept gifts.


C. Assist the client in finding someone else in his life he could give the wine to as an expression of gratitude.


D. Determine the estimated value of the wine.

D. Determine the estimated value of the wine.

Rationale: D is practicing the standard of care when considering accepting a gift. Consideration of monetary value of the gift is stated in the ethical guidelines and the value of wine can vary greatly.

8

A therapist at a mental health clinic meets with a single mother who recently moved back in with her mom and stepdad after losing her job. She reports that her stepdad has been threatening to kick her out of the house if she does not contribute more to the household needs. The client says that she is afraid to be around him. What should the therapist do FIRST?


A. Discuss alternate housing possibilities to empower the client.


B. Encourage the client to call the police.


C. Ask the client why she is afraid.


D. Develop a safety plan and monitor the client's safety.

C. Ask the client why she is afraid.

Rationale: The answer is C because it allows the therapist to assess potential safety concerns for the client and/or her children. There is not enough evidence to warrant a call to police or developing of a safety plan at this time thus B and D are out.

9

A therapist attends a group consultation. Another therapist begins presenting a case and based on the information the therapist realizes that she is friends with the client. How should the therapist deal with the realization?



A. Disclose to the group that she is friends with client.


B. Keep all information about the client confidential.


C. Excuse herself from the discussion of the client.


D. Not disclose that she knows the client but refrain from participating in the discussion.

C. Excuse herself from the discussion of the client.

Rationale: C is the only answer that doesn’t violate or risk violation of confidentiality.

10

A long-term client comes to therapy and reports that he has been evicted and is in need of housing immediately. The therapist’s brother owns an apartment building and has an available unit he’s been struggling to rent. The therapist should:



A. Provide the client with the brother’s number without disclosing the relationship.


B. Refer the client to several apartments, including the one owned by the brother.


C. Assist the client in coming up with short and long-term solutions.


D. Refer the client to several apartments, including the one owned by the brother, and disclose the relationship.

C. Assist the client in coming up with short and long-term solutions.

Rationale: C is the only answer that does not risk an inappropriate dual relationship with the client. Consider the implications of your client renting an apartment from your brother-in-law.

11

A client seeks therapy to help deal with problems with a roommate. After two sessions, the therapist realizes that the client’s roommate is a personal friend who has often confided in the therapist about difficulties with this relationship. How should the therapist address the ethical issues in this case?



A. Continue working with the client without revealing the therapist’s relationship with the client’s roommate.


B. Explain to the client the therapist’s relationship with the roommate and allow the client to decide whether or not to continue treatment with the therapist.


C. Tell the client about the therapist’s relationship with the roommate and refer the client to another therapist.



D. Tell the client about the therapist’s relationship with the roommate and explore how it could affect the therapeutic relationship.

C. Tell the client about the therapist’s relationship with the roommate and refer the client to another therapist.

Rationale: C is the best answer since the client has come to therapy to specifically discuss the issues with the roommate. It would be impossible for the therapist to not be biased when hearing about these same issues from her friend. B is not a good answer since the conflict of interest is too strong to continue therapy.

12

A long-term client being treated for bipolar disorder announces her pregnancy and her intent to continue taking lithium medication despite possible negative effects to the fetus. Her psychiatrist has informed her of the consequences but agreed to continue monitoring her medication. The therapist has a negative emotional reaction to the client’s decision. Ethically, the therapist should:



A. Express a genuine sense of being perplexed by the client’s decision.


B. Contact the psychiatrist and share concerns.


C. File a child abuse report.


D. Take appropriate steps to manage countertransference.

D. Take appropriate steps to manage countertransference.

Rationale: In this scenario the therapists should manage countertransference, answer D. There is no reason to be perplexed as the client has a good reason to want to stay on her meds and is being monitored by a psychiatrist. There is no reason to share concerns with psychiatrist at this point. And there is no reason to file a child abuse report in this situation. Taking any drugs while pregnant is not enough to file a child abuse report. There needs to be additional concerns that justify the report and it would not be made on an unborn child.

13

A client receives treatment for substance abuse by a therapist who is a recovering alcoholic. During the course of this client's treatment, the therapist begins to experience cravings and begins to use alcohol after sessions with this client. Which of the following actions should the therapist take in order to address the ethical issues in this situation?



A. Terminate services with the client immediately.


B. Seek immediate consultation to resolve countertransference issues.


C. Seek alcohol treatment to address relapse.


D. Share feelings with client as way of creating a supportive common ground of experience.

C. Seek alcohol treatment to address relapse.

Rationale: The therapist needs to address their own relapse first therefore C is the best answer. The other answers do not address the therapist getting the help that is needed. Answer A could be seen as abandoning the client. B is a possibility after seeking treatment and D could be placing undue burden on the client.

14

A woman calls a therapist at an agency and informs the therapist that her brother received therapy from another therapist in the same agency and a business relationship developed between that therapist and the client’s brother. How should the therapist manage the ethical issue in this case?



A. Discuss ethical expectations around dual relationships with the client.


B. Assist the woman in filing a complaint with the licensing board.


C. Confront the colleague regarding the alleged ethical violation.



D. Review agency’s policies regarding unethical behavior of therapists.

C. Confront the colleague regarding the alleged ethical violation.

Rationale: When dealing with ethical violations of colleagues it is always advised to first go to the colleague and express your concern therefore answer C is the best answer.

15

A therapist is meeting with a 16-year-old boy who reports he recently broke into his parents locked liquor cabinet when they were sleeping and got drunk. What legal responsibilities does the therapist have in this case?



A. File a report with CPS for neglect and document it in the record.


B. Maintain confidentiality and assess for risk.



C. Inform client that his parents must be informed and document it in the record.


D. Maintain confidentiality and safety plan with client.

B. Maintain confidentiality and assess for risk.

Rationale: The best answer is B. If you shared this info with the parents (C) you would undermine the therapy relationship. It is better to maintain confidentiality complete a full risk assessment to determine how serious the issue is.

16

A licensed therapist moves to another city in a different part of the state and relocates his private practice. What are his legal obligations in this case?



A. Maintain the same system he was previously using for record keeping.


B. Provide all of his previous clients with his new office address.


C. Notify the Board of Behavioral Sciences of his change of address within 30 days.


D. Provide all of his previous clients with referrals to appropriate local therapists.

C. Notify the Board of Behavioral Sciences of his change of address within 30 days.

Rationale: C is the right answer. 30 days is the standard time you need to notify the BBS of name or address changes or convictions.

17

A therapist lowered his fee for a client following the client losing his job. The client informs the therapist that he was able to find a new job that pays even more than his former job. The therapist would like to raise fees now that the client’s financial situation has improved. How should the therapist ethically manage the situation?



A. Inform the client of the need to raise fees and provide one month’s notice of increase.


B. Reassess the change in client’s situation and raise it in an agreed about amount of time.



C. Ask client when he plans to pay the full fee again and document it in his record.


D. Provide client with a written notice of the fee policy and discuss implications.

B. Reassess the change in client’s situation and raise it in an agreed about amount of time.

Rationale: Ethically, therapists are permitted to raise fees after adjusting them to meet a client’s needs. Prior to adjusting the fees, the therapist should assess the client’s situation and, with the client, agree on an acceptable timeline, making answer B the best option. Answers A, C, and D overlook the process of engaging the client and determining what is appropriate.

18

A therapist has terminated with her client due to presenting issue being outside the therapist’s scope of competence. The client was provided with a referral and has a first session with the new therapist scheduled. Prior to meeting with the new therapist, the client experiences a crisis situation and contacts the old therapist. What are the therapist’s legal obligations in this case?

Score: 1 of 1

A. Provide client with a crisis hotline number.


B. Talk with client and help address crisis since she has not started with the new therapist.


C. Contact her new therapist to inform them of client’s situation.


D. Tell client you are unable to provide services and they should contact new therapist.

B. Talk with client and help address crisis since she has not started with the new therapist.

Rationale: Answer B is the best option. While the therapist and client terminated, the client is in crisis and needs immediate assistance. In this case the therapist initiated the termination, so to avoid abandonment you’d want to do B.

19

A 14-year-old girl consents to her own treatment after the therapist determined it would not be appropriate to involve parents. After several sessions, the girl tells the therapist that she would like to include her mother in treatment. How should the therapist manage the legal issue of fees?


A. Inform the client that she will continue to be responsible for fees.


B. Inform the client that once the mother is involved in treatment that she will be responsible for fees.


C. Inform client the mother does not have a responsibility to make payment regardless of involvement.


D. Inform client that both she and mother will be responsible for payment.

A. Inform the client that she will continue to be responsible for fees.

Rationale: The client who consented to treatment is responsible for fees, answer A. Involving the mother in treatment does not change the fee agreement.

20

An 83-year-old man is brought to therapy by his conservator. The conservator is concerned the man is experiencing symptoms of depression and could benefit from therapy. Legally, who should sign the consent?


A. Client


B. Conservator


C. Client’s doctor


D. Court


B. Conservator

Rationale: The conservator must sign the consent. It would be good to have client sign as well, but the conservator must sign.

21

A therapist receives a phone call from a former client requesting access to his records. The therapist terminated with the client several months back due to lack of payment and sent the client’s information to a collection’s agency in an effort to collect the outstanding balance. Ethically, how should the therapist respond to the client’s request?



A. Inform the client that he will be required to communicate directly with collection agency prior to accessing records.


B. Provide client with access to records within 5 business days of request.


C. Require client to pay balance prior to allowing access to records.


D. Inform client that he can access his records within 5 business days after therapist receives written request.

D. Inform client that he can access his records within 5 business days after therapist receives written request.

Rationale: The client has a right to the records in spite of the lack of payment for services. Allowing 5 business days and having a written request is protocol for accessing records, therefore D is the best answer.

22

A therapist is treating a client with a history of suicide attempts and multiple hospitalizations. During a session, the client reports a plan to take all his prescription medications at once. He refuses to contact his psychiatrist. How should the therapist legally manage this crisis?



A. Contact a family member for a 24-hour watch.


B. Increase the frequency of the sessions.


C. Have the client sign a no suicide contract.


D. Call Psychiatric Emergency Team (PET) and initiate 5150.

D. Call Psychiatric Emergency Team (PET) and initiate 5150.

Rationale: D is the correct answer because the client has a plan, means and a history of suicide attempts. A, B, and C are not enough to protect the client in this situation.

23

A therapist has been treating a 16-year-old girl for depression and social phobia. The client recently shared that she is being bullied at school by some older girls. The following day her mother calls the therapist and reports that she thinks her daughter took some pills. What should the therapist do NEXT?


A. Explain to the mother that the therapist does not have a release to talk about client.


B. Ask the mother to put the client on the phone.


C. Determine the type and quantity of pills taken.


D. Direct the mother to call 911.

D. Direct the mother to call 911.

Rationale: Due to the potential medical crisis in this scenario D is the correct answer. All of the other answers do not address the immediate medical attention that may be necessary. C is out of scope of practice to determine effects of medication.

24

During a session with a 16-year-old, a therapist learns that the client has been having strong suicidal ideation for the last week. The client has a tentative plan and access to means. What should the therapist do to manage the legal and ethical obligations in this case?


A. Initiate an involuntary hospitalization.


B. Inform the client that her parents must be informed.


C. Provide the client with the number for a suicide prevention hotline.


D. Explore the events leading up to the client’s suicidal feelings.

B. Inform the client that her parents must be informed.

Rationale: The best place to start is B. When treating a minor with suicidal risk, the parents should be included in the discussion unless there is potential harm to the client if they know. If the client refused B, then A would be the next step. C and D are possible interventions at some point.

25

A therapist at a women’s shelter is asked to see a woman in crisis who has been abused by her husband. The woman enters the therapist’s office stating that she plans to return home in the morning and “just needed to spend the night somewhere else and talk to someone about this.” What action should the therapist take to manage legal obligations in this case?



A. Explore the woman’s reasons for wanting to return home.


B. Encourage the woman to address her feelings about her husband.


C. Provide psychoeducation on the cycle of violence.


D. Develop a safety plan with the woman.

D. Develop a safety plan with the woman.

Rationale: D is the correct answer because it addresses safety concerns for the client. Since the client has stated she is not staying it is important that in this one counseling encounter the therapist has with this client they collaborate on ways the client can stay safe in the future. A, B, and C may also be done, but D is the MOST appropriate because it addresses the crisis issue.

26

A therapist has been working with a Mexican American family to address communication problems and recent loss of the grandmother. At the beginning of a session, the mother gives the therapist an assortment of freshly baked home goods and expresses her appreciation to the therapist for continued support of the family. How should the therapist manage the ethical issues in this case?


A. Accept the gift and process the meaning of it with the family.


B. Determine the value of the gift prior to accepting it.


C. Consult with a colleague who is knowledgeable about Mexican American culture.


D. Explain to the family that it is your agency’s policy not to accept gifts from clients.

A. Accept the gift and process the meaning of it with the family.

Rationale: A is the best answer. A gift of home baked goods is not of high monetary value, also this answer includes the processing of the gesture which can often lead to valuable therapeutic interaction.

27

A therapist is completing a psychosocial assessment with a 45-year-old woman. While asking about the client's current stressors, the therapist learns that the client has been out of work for the past year. The client also reports that she has been emotionally and physically abused by her spouse. The therapist should FIRST help the woman to:


A. Stay safe by developing a plan of action should the abuse escalate.


B. Collaborate on ways to manage the husband’s anger.


C. Create a plan to leave her spouse.


D. Re-establish her sense of self-worth and independence by finding employment.

A. Stay safe by developing a plan of action should the abuse escalate.

Rationale: A is the best answer because the therapist needs to FIRST help the woman establish a safety plan before other steps can be taken. B would not help the client stay safe. D may need to be done but only after a safety plan has been created. C is pushing the client to leave.

28

A 23-year-old female client with a diagnosis of Bipolar I informs her therapist that her father is petitioning the court to be appointed her conservator. The client does not agree with her father’s position and asks the therapist to evaluate her and testify at the court hearing on her behalf. How should the therapist address the legal issue in this case?



A. Inform the client that she will appear at the court hearing.


B. Explain the request is outside the therapist’s scope of practice.

Rationale: It is not within the therapist's scope of practice to provide testing and evaluation for this client, therefore B is the only answer that indicates the therapist's inability to move forward with the request.


C. Agree to testify if the therapist does not believe the client is a danger to self.


D. Consult with colleagues to discuss benefits of testifying.

B. Explain the request is outside the therapist’s scope of practice.

Rationale: It is not within the therapist's scope of practice to provide testing and evaluation for this client, therefore B is the only answer that indicates the therapist's inability to move forward with the request.

29

A client calls the therapist and requests access to her records. The therapist determines that there is no reason to withhold access. Legally, the therapist should comply with the request within which time frame?


A. 2 days to inspect; 5 days for summary; 10 days for copy


B. 5 days to inspect; 10 days for summary; 15 days for copy


C. 5 days to inspect; 15 days for summary; 20 days for copy


D. 1 week to inspect; 10 days for summary; 15 days for copy

B. 5 days to inspect; 10 days for summary; 15 days for copy

Rationale: Answer B is the timeframe indicated for providing a client with their records.

30

A school therapist has been meeting with a 16-year-old boy who has been experiencing academic difficulties at school. During the second meeting, the teen reports that he has been having difficulties concentrating in school due to an intimate relationship with another male classmate. The student states that he hasn’t told his parents he is gay and is afraid to do so. The teen’s parents have provided written authorization for the therapist to provide treatment to the student and recently submitted a request for a copy of his records. The therapist had made note in the record of the boy’s relationship with his classmate. What should the therapist do FIRST to manage the legal and ethical issues in this case?


A. Discuss the request with client.


B. Obtain an authorization of release from client.


C. Give the parents full access to the records.


D. Provide parents with a treatment summary.

A. Discuss the request with client.

Rationale: A is the best answer before moving forward with a decision about how to respond to the parents request. The boy has a right to confidentiality even though parents consented for treatment. The therapist has the right to refuse the request if it could be damaging to the client to release the records. D might be a good response but only after discussing the request with the client.