Final Mock I Flashcards

Question

A 17-year-old emancipated minor initiates therapy. The client reports he has been struggling with depression since his girlfriend broke up with him. The client discloses that his girlfriend was substantially older than him and they met when she was a substitute teacher at his school. The client expresses feelings of betrayal and isn’t sure how to “get over the heartbreak.” Which of the following goals would a Client-Centered therapist include in the treatment plan? Score: 1 of 1 A. Decrease client’s self-induced constraints to move toward self-actualization Empathize with client by highlighting he was taken advantage of by a person in a position of power Increase level of congruence both within self and relationship with others D. Decrease client’s self-induced constraints to move toward self-actualization Empathize with client by highlighting he was taken advantage of by a person in a position of power Challenge client to reclaim locus of control C. Facilitate client’s awareness regarding view of self and relationship to others Increase client’s level of trust in therapist through provision of empathy and genuine positive regard Challenge client to reclaim locus of control D. Facilitate client’s awareness regarding view of self and relationship to others Increase client’s level of trust in therapist through provision of empathy and genuine positive regard Increase level of congruence both within self and relationship with others

Answer 1

A 17-year-old emancipated minor initiates therapy. The client reports he has been struggling with depression since his girlfriend broke up with him. The client discloses that his girlfriend was substantially older than him and they met when she was a substitute teacher at his school. The client expresses feelings of betrayal and isn’t sure how to “get over the heartbreak.” Which of the following goals would a Client-Centered therapist include in the treatment plan? Score: 1 of 1 A. Decrease client’s self-induced constraints to move toward self-actualization Empathize with client by highlighting he was taken advantage of by a person in a position of power Increase level of congruence both within self and relationship with others D. Decrease client’s self-induced constraints to move toward self-actualization Empathize with client by highlighting he was taken advantage of by a person in a position of power Challenge client to reclaim locus of control C. Facilitate client’s awareness regarding view of self and relationship to others Increase client’s level of trust in therapist through provision of empathy and genuine positive regard Challenge client to reclaim locus of control Correct D. Facilitate client’s awareness regarding view of self and relationship to others Increase client’s level of trust in therapist through provision of empathy and genuine positive regard Increase level of congruence both within self and relationship with others Rationale: The correct answer is D. Answers A and B can be ruled out for two reasons. First, the first part of the answer requires an assumption; the vignette does not indicate the client is experiencing self-induced constraints. Second, a therapist would not demonstrate empathy by highlighting the client was taken advantage of by his girlfriend, as this may or may not align with his perception of the situation. Answer C and D are both strong options, but D is better for a Client-Centered approach since answer C includes the therapist challenging the client. (Treatment Planning)

Answer 2

A therapist who specializes in mood disorders has been providing individual counseling to a client for several months to address issues of depression. The therapist and client determine the client also has a co-occurring substance use disorder that must be addressed. The client requests a referral for a substance abuse counselor to provide adjunctive services. What are the therapist’s ethical responsibilities in this case? Score: 1 of 1 Correct A. Honor client’s self-determination and provide referral since it is acceptable to see multiple therapists if there is no overlap in services. Rationale: The best answer is A. The therapist is not required to terminate treatment with the client, which means answers B and D can be eliminated. Answer C is incorrect because it disregards the client’s right to make treatment decisions. Answer A is the best remaining choice. The vignette clearly states the therapist specializes in mood disorders, not substance abuse. Our code of ethics states that therapists generally refrain from treating a person who is receiving therapy from another psychotherapist. However, it also notes that this can be done if agreement exists between the two therapists. In addition, in this scenario, it is clear the therapists will not be duplicating services and will each have a separate focus for treatment. (Ethics) B. Refer client to substance abuse counselor and temporarily terminate therapy to avoid duplication of services. C. Decline request and assure client therapist can incorporate substance abuse into treatment and collaboratively re-formulate goals. D. Refer client to therapist specializing in co-occurring disorders and terminate with client.

Answer 3

A therapist meets with a new client who was referred to therapy by his employer for displaying inappropriate behaviors at work. The client informs the therapist that he had been dating a coworker for several months and following a break up, she falsely accused him of sexual harassment. The man appears nervous and avoids eye contact with the therapist. Which of the following should the therapist initially assess when working with this client? Score: 0 of 1 A. Complete a mental status exam to determine current cognitive functioning Should have chosen B. Identify the role the referral source will play in client’s treatment. Rationale: The correct answer is B. The vignette states the client was referred by his employer, so we would need to know if this means short-term therapy or if there are predetermined goals for treatment before proceeding. Once the role of the referral is known, the therapist could assess other areas of clinical concerns, such as answer A and C. Answer D does not appear to be necessary based on the information provided in the vignette, there are no hints of being a danger to self or others that requires further assessment. (Clinical evaluation) C. Gather information regarding client’s history of intimate relationships and attitude toward women. Incorrect D. Assess client for danger to self or others.

Answer 4

A therapist is meeting with Max, a 15-year-old high school student who is brought to therapy by his mother. On the intake form completed by Max’s mother, she indicates that he enjoys spending time with his friends, plays football, is loyal and determined in his character. The form also states Max regularly receives negative reports by teachers and administrators about his behavior at school and is frequently arguing with his mom at home. When asked to further clarify her statements, Max’s mom notes that he often curses at her in the house, stays out at night despite being told that he has a curfew, and initiates physical altercations at school. When asked, Max says that his mom is intentionally mean and rude to him and that it is her fault that he disregards her “stupid” rules. What preliminary diagnosis should the therapist consider in this case? Score: 1 of 1 A. V Code Parent-Child Relational Problem Oppositional Defiant Disorder Depressive Disorder Unspecified Correct B. Oppositional Defiant Disorder Conduct disorder V Code Parent-Child Relational Problem Rationale: The correct answer is B. This is a DSM Diagnosis question. Let us recap the symptoms we see in the stem. There is clearly a conflict between Max and his mom. He is also swearing, refusing to comply with rules, blaming others, and being aggressive. For this exam we will never have a full list of symptoms, thus we are to come up with various preliminary diagnoses that might fit with these symptoms. The diagnoses that best fit this case are ODD, Conduct and Parent-Child Relational problem V code (B). Answer (A) is out since there is no symptomatic support for Depressive Disorder Unspecified. Answer (C) is not applicable since there are not symptoms of ADHD indicated. And answer (D) is incorrect, since Parent-Child Relational Problem V code is more applicable here than Relational Problem V code. (Clinical Evaluation) C. V Code Parent-Child Relational Problem Conduct disorder ADHD D. V Code Relational Problem Oppositional Defiant Disorder Conduct disorder

Answer 5

A 28-year-old woman initiates individual therapy, reporting a history of sexual abuse and a family history of alcoholism. She informs the therapist that she abused alcohol when she was a teenager, but stopped using after she was raped while passed out at a party. The client reports that she was recently involved in a car accident that left her with chronic back pain and subsequently her doctor prescribed opiate medication to treat her pain. She admits that she did not disclose her history to the prescribing doctor because she did not believe he would provide the prescription with this knowledge. How should the therapist clinically manage this case? Score: 0 of 1 A. Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction Request release of information to disclose client history to prescribing physician Refer client to 12-step program due to history of substance abuse B. Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction Request release of information to disclose client history to prescribing physician Discuss alternative nonpharmacological pain management treatments Incorrect C. Develop a medication management plan in collaboration with prescribing physician Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction Explore alternative nonpharmacological pain management treatments Should have chosen D. Explore alternative nonpharmacological pain management treatments Develop a medication management plan in collaboration with prescribing physician Refer client to 12-step program due to history of substance abuse Rationale: The correct answer is D. Based on the information in the stem, the client already has an awareness of her genetic predisposition and environmental susceptibility to addiction--she notes the family history of alcoholism, her personal history of alcohol abuse, and purposefully withheld this information from her doctor. Therefore, answers A, B and C can all be eliminated because psychoeducation is unnecessary. This leaves us with answer D as the strongest option. The priority in this case would be to collaborate with the prescribing physician; failure to do so would be detrimental to the well-being of the client. It would also benefit this client to discuss and explore alternative nonpharmacological pain management treatments, such as meditation, biofeedback or hypnosis. Finally, given the client’s history and her knowledge of the risks associated with narcotics, a 12-step program would be a useful preventative resource. (Treatment)

Answer 6

A therapist working in a homeless shelter meets with a resident for individual therapy. The client presents to the session showing signs of current substance use, including unsteady gait, confusion, and slurred speech. The client denies current use when confronted by the therapist, though the therapist believes there is faint odor of alcohol in the room. How should the therapist proceed? Score: 0 of 1 A. Continue with the provision of therapy since client has denied current use. Incorrect B. Refer client for a medical evaluation to rule out organic factors for behavior. C. Terminate session and refer client to inpatient treatment. Should have chosen D. Refer client for a toxicology examination and discuss concerns with shelter staff. Rationale: The correct answer to this question is D. The client’s presentation, along with suspected odor of alcohol, points to substance use. Since the therapist works in a homeless shelter, it is important to engage all members of the support team. Answer D allows the therapist to properly assess for substance use and involve the shelter staff. Answer A is inappropriate since providing therapy when a client is under the influence is contraindicated. Answer B is incorrect since the vignette notes the scent of alcohol in the room. If this were not mentioned in the vignette, then a medical evaluation would be indicated. Answer C is a possible option, but it does not fully address the current concern that the client is under the influence of substances, nor does it engage other members of the support staff in a discussion regarding ways to address this situation. In addition, answer C includes a referral to inpatient treatment, which is too extreme at this time. (Crisis Management)

Answer 7

A 63-year-old woman seeks individual therapy to address low-grade depression and body image issues. The woman characterizes herself as extremely overweight and informs the therapist she was diagnosed with diabetes approximately 5 years prior. She shares a history of struggling with diets and a tendency to overeat, especially when her depressive symptoms are more severe. Which of the following adjunctive services should the therapist consider to augment the client’s treatment? Score: 1 of 1 Correct A. Nutritionist for dietary assistance Overeaters Anonymous for group support Medical doctor to monitor medications Rationale: The strongest answer to this question is A. This question is worded in a way that may have confused you at first. This question is just asking what additional services would also assist the client while they are in therapy. We would want to prioritize an answer that includes a medical referral due to the client’s diagnosis of diabetes, which could be affecting her depression. Therefore, answers B and D can be eliminated. Answer B includes a psychiatric referral, which may have sounded good, but we would want a more general medical attention before considering referral for psychotropic medications. Answer C is not as strong as A because it is redundant to provide two support groups while overlooking the importance of involving a nutritionist. Answer A covers all bases. The nutritionist can assist the client with developing a healthy diet to address weight and diabetes; Overeaters anonymous can assist the client with her stated tendency to overeat; and the medical doctor can assess for any organic issues affecting her mood and weight. (Clinical evaluation) B. Nutritionist for dietary assistance Overeaters Anonymous for group support Psychiatrist for a psychotropic medication evaluation. C. Overeaters Anonymous for group support Medical doctor to monitor medications Emotional eating support group D. Overeaters Anonymous for group support Nutritionist for dietary assistance Emotional eating support group.

Answer 8

A therapist meets with a teenage boy who was mandated by his probation officer to attend individual therapy. The client is also participating in family therapy with his mother, father, and younger brother. He reports that he was placed on probation following an altercation with a classmate and being caught in possession of illicit drugs. The client was adopted into his current family as an infant. He expresses feelings of rejection by his biological parents and resentment toward his younger brother who is the biological child of his adopted parents. He feels his parents always find fault in his behavior, while his brother is treated like a prince. Which of the following goals would a Bowenian therapist include in the treatment plan for this case? Score: 1 of 1 A. Increase healthy expression of feelings regarding adoption and engagement within adoptive family Increase client’s compliance with probationary requirements Decrease anxiety by resolving emotional cut-off with biological parents B. Increase healthy expression of feelings regarding adoption and engagement within adoptive family Increase client’s compliance with probationary requirements Decrease levels of emotional reactivity between all family members C. Assist the client in moving toward resolution with feelings of abandonment and rejection Improve client’s ability to verbally express emotions with family and societal members Improve communication skills between the client, parents, and his sibling Correct D. Assist client in moving toward resolution with feelings of abandonment and rejection Improve client’s ability to verbally express emotions with family and societal members Increase level of self-acceptance and ability to accept love within adoptive family Rationale: The correct answer is D. Answer A is incorrect for two reasons: first, the question stem does not mention lack of compliance with probationary requirements and second, it’s not clear the client wants to or would be able to connect with his biological parents. Answer B is incorrect because of the part regarding probationary requirements and the third part of the answer would require the entire family as treatment unit. Answer C is incorrect because the third part, improve communication skills would also require the entire family as treatment unit. Answer D takes into account that the boy is client, while it also incorporates Bowen’s focus on the family system. (Treatment Planning)

Answer 9

A therapist has been working in an agency setting for 2 years prior to licensure. Now that the therapist is licensed, she intends to leave the agency and start her own private practice in the community. Several clients have expressed a desire to continue receiving treatment with therapist in her private practice. What actions should the therapist take in this case? Score: 0 of 1 A. Inform agency of plan to transfer clients to private practice Copy client's medical records Complete new informed consent with clients B. Inform agency of plan to transfer clients to private practice Close client files and create new client charts Complete new informed consent with clients Should have chosen C. Ensure clients understand all available treatment options Determine if transfer of client to private practice is appropriate Properly document future treatment plans for all clients Rationale: The correct answer to this question is C. Answer A is incorrect because the therapist would not be permitted to copy medical records; they are the property of the agency. Answer B is okay, but informing the agency of plan to transfer is not as important as addressing client needs. Answers C and D each focus on the clients by ensuring they understand the option to continue receiving treatment at the agency, transfer with the therapist, or follow a different course of action. Each of these answers also determines the appropriateness of transferring the clients from the agency to private practice. Answer C is a slightly stronger option than D because we would need to properly document transfer of all clients, regardless of whether or not they continue to receive treatment in private practice. (Ethics) Incorrect D. Ensure clients understand all available treatment options Determine if transfer of clients to private practice is appropriate Properly document termination of clients discontinuing treatment in agency charts

Answer 10

A woman from Mexico meets with a therapist after learning that her husband, who is also from Mexico, had an affair while she and her 15-year-old daughter were spending time abroad visiting their family. The woman is a devout Catholic, and doesn’t know how to reconcile the husband’s behavior with her religious beliefs. She is also uncertain how she can stay with him now that he has broken trust and the sacred vow between them, but fears how her family and church community would react if she were to separate from her husband. Which of the following goals addressing human diversity should be included in the treatment plan? Score: 1 of 1 A. Develop a stronger sense of self and begin to shift focus away from role as mother and wife. B. Reduce the level of guilt and shame the woman is experiencing as a result of the external pressures from her Mexican family and church. C. Decrease fears of diminished socioeconomic level frequently linked to marital separation and divorce. Correct D. Increase the client’s understanding of how her Mexican heritage and religion influence her current situation. Rationale: The strongest answer for this question is D. The question is specifically asking for goals that incorporate human diversity, so you can quickly eliminate any answers that are not goals or do not address human diversity. With this in mind, we can quickly eliminate answer A. Answer B incorporates human diversity, but incorrectly states she is already experiencing external pressures; this is not accurate as she fears what the reaction would be from her family and church, but those pressures are not already present. Answer C is irrelevant based on the client’s stated fears; she does not express any concern regarding the effects of separation on socioeconomic levels. Answer D incorporates human diversity into the treatment goal and would allow the client an opportunity to expand on the themes specifically mentioned in the question stem. (Treatment Planning)

Answer 11

A therapist runs an open DUI (driving under the influence) group at a local community mental health agency. All of the clients in attendance are court-mandated to attend and all are first time offenders. The current group is comprised of four male and two female members, all of whom have attended for several weeks. During a session, the therapist observes that the men are dominating the group and at times exhibiting disrespectful behaviors toward the female members. During a discussion regarding triggers for drinking, a male member points at a female member and states, “It’s because of women like you that I drink!” Which of the following actions is most appropriate for the therapist to take in this case? Score: 1 of 1 A. Confront the group member who made the inappropriate comment and encourage him to apologize to the female group members Correct B. Ask each group member to share their thoughts about the comment and how it made them feel Rationale: The strongest answer to this question is B. More often than not, when you have a question regarding group therapy, the best answer will include engagement of the entire group. The exceptions to this general rule would include a group member who has a personal need that is unrelated to the group or if there are safety concerns. Answer A is incorrect because it would be better to empower group members to share how the incident affected them, rather than taking charge and forcing an apology. Answer C is incorrect because it only has the female members speaking up, excluding the other male clients from expressing their thoughts and feelings. Answer D is a decent answer, but B is more process-oriented and it addresses the situation more directly, making it the better option. Once B is completed, D could take place. (Treatment) C. Encourage female group members to express their thoughts and feelings regarding the statement and explore their perception of group power structure D. Revisit group rules and ensure all members of the group feel safe and supported

Answer 12

A 24-year-old woman from Nigeria meets with a therapist on the advice of a friend. The woman, who speaks limited English, shares that she arrived in the United States roughly four months earlier to join her fiance who is an American citizen. The woman has a K-1 visa and was required to marry her fiance within 90 days of arrival, but they did not fulfill the requirement so her visa is no longer valid. She explains that her family is Muslim and she met her fiance while he was visiting her country. Since arriving in the United States, she reports he has been physically abusive, but she cannot leave because her parents will not allow her back in their home. The client is visibly scared when speaking with the therapist about her situation and reveals recent injuries on her body. Which of the following actions should the therapist take in this situation? Score: 0 of 1 Should have chosen A. Provide information for a domestic violence shelter and encourage her to call while in the office Provide referral for legal assistance regarding immigration status Encourage the woman to seek medical attention Rationale: The best answer to this question is A. The vignette presents you with multiple crisis issues at once; we have a woman who is in legal jeopardy due to an invalid visa and no home to return to if deported, as well as domestic violence that has resulted in physical harm. Ideally, we want to find an answer that addresses both of these issues. Answer B and C do not address the legal concerns presented in this case and can be eliminated. Answer D does not adequately address management of domestic violence, providing psychoeducation regarding the cycle of violence is an insufficient respond to what the client has described in the vignette. Answer A is the only option that addresses both the legal issues presented and the domestic violence. (Crisis Management) B. Provide information for a domestic violence shelter and encourage her to call while in the office Encourage the woman to file a police report Encourage the woman to seek medical attention Incorrect C. Encourage the woman to file a police report and obtain a restraining order Develop a comprehensive safety plan including referral to a domestic violence shelter Provide a referral to a community medical center D. Provide referral for legal assistance regarding immigration status Provide psychoeducation regarding the cycle of violence Provide referral to community medical center.

Answer 13

The client, a 26-year-old Indian-American woman, has been meeting with a therapist for 6 months. The work has primarily focused on depression that is a byproduct of feeling caught between two cultures and not feeling a sense of belonging within either. The client is first generation American and refers to her parents as “traditional Indian parents with no tolerance for American culture.” Her parents would like her to settle down with an Indian man and have children. She is focused on her career and does not want to get married, nor does she care about the cultural background of men she dates. How would a Narrative therapist versus a Solution Focused therapist intervene in the early stages of treatment? Score: 1 of 1 A. A Narrative therapist would help the client externalize the cultural pressures imposed on her by her parents A Solution Focused therapist would explore how the client is able to fulfill her daily activities when coping with symptoms of depression. B. A Narrative therapist would help the client externalize the cultural pressures imposed on her by her parents A Solution Focused therapist would explore what the client’s life would look like if she were able to feel a sense of belonging. Correct C. A Narrative therapist would delve deeper into the client’s understanding of the depression and feeling caught between two cultures A Solution Focused therapist would explore what the client’s life would look like if she were able to feel a sense of belonging. Rationale: The best answer for this question is C. Both answers A and B incorrectly use the Narrative concept of externalization. The therapist would externalize the depression or the anxiety caused by cultural pressures, but not externalize the cultural pressures themselves (they are already external to the client). Answers C and D include the same Narrative part, so we just need to focus on which Solution Focused answer is stronger. The question is not only asking about theory, but it is also focused on early stages of treatment. Answer C is stronger because the intervention linked to Solution Focused therapy is referring to the miracle question, something that is done in the earlier stages of treatment. It is also directly linking to the client’s stated concern. The second part of answer D is okay for Solution Focused and beginning stage, but there is nothing in the vignette that points to completion of daily activities being an issue. (Treatment) D. A Narrative therapist would delve deeper into the client’s understanding of the depression and feeling caught between two cultures A Solution Focused therapist would explore how the client is able to fulfill her daily activities when coping with symptoms of depression.

Answer 14

A therapist has been meeting with a couple that is working on rebuilding trust following an incident of marital infidelity. The therapist notices she sometimes becomes angry with the wife when the wife seems dismissive of her husband’s expressed feelings of hurt. In one session, the therapist lashes out at the wife and expresses how painful it is to watch the wife brush aside her husband’s feelings when he is willing to be vulnerable. The wife is surprised by the therapist’s reaction, but begins to open up and the couple experiences a breakthrough in their treatment. Which of the following actions should the therapist take in this case? Score: 1 of 1 A. Refer the couple to a different therapist due to the unethical treatment of clients and inability to manage countertransference. B. Seek consultation because the therapist’s behavior is considered unethical. Correct C. Seek consultation to address countertransference and process experience with clients Rationale: The best answer to this question is C. The therapist should first seek consultation since the vignette makes it clear that the therapist’s personal feelings are interfering with treatment. In addition, it would be important to process the experience with the clients to understand how it affected them and work to repair the therapeutic alliance.. Answer B is not as strong as C, because it does not include processing the experience with clients. Answer D is a strong option, but it would be important to seek consultation before processing the experience with the clients, plus consultation would help the therapist determine whether or not it would be appropriate to continue providing treatment to the couple. (Treatment) D. Process the experience with clients and determine appropriateness of continuing treatment or referring clients to new therapist.

Answer 15

A Chinese woman is referred to therapy by her doctor. The woman recently underwent a botched cosmetic procedure on her eyes and is devastated by the results. The woman describes herself as clinically depressed and is considering a lawsuit against the plastic surgeon for emotional damages. The woman is wearing sunglasses that she refuses to remove during the therapy session. What human diversity issues should the therapist consider in developing a treatment plan? Score: 1 of 1 A. The influence and perception of beauty within the dominant culture of America. B. The role and expectations of Chinese women to differentiate themselves from members of their cultural group. Correct C. The woman’s perception of beauty and the origins of these perceptions. Rationale: The correct answer is C. When it comes to human diversity questions, you want to prioritize questions that are more exploratory and allow for variations in individual’s understanding of and experiences within their culture. Answer A is incorrect because it assumes the client’s decision to have surgery was in response to the dominant culture of America. We have no evidence of this. Answer B also makes an assumption about the role and expectations of Chinese women. Answer D is possible, but the focus is incorrect. The woman clearly states the depression and behavior is in response to her surgery. Answer C addresses human diversity by exploring the client’s perceptions of beauty and their origins. This answer is client-centered, avoids false assumptions, and is focused on the presenting issue. (Treatment Planning) D. The perception of depression within Chinese culture and how this influences the woman’s behaviors.

Answer 16

A therapist meets with an 11-year-old girl and her adoptive mother for family therapy. The mother adopted the girl shortly after marrying the girl’s biological father. The girl’s biological mother died when she was an infant. The mother and daughter historically got along, but the girl now complains that her mother is too controlling and the mother believes the daughter is defiant. After several sessions, the father asks to see the records. How should the therapist handle the legal obligation in this case? Score: 0 of 1 A. Deny the father’s request if the therapist believes it would be detrimental to the therapeutic relationship or the well-being of the minor. B. Inform the father that he can receive a redacted version of the medical record that limits information shared to the daughter. Incorrect C. Inform the father that both the daughter and his wife must sign a release before sharing records. Should have chosen D. Inform the father that his wife would be required to sign a release before the therapist can share records. Rationale: The correct answer is D. Answer A could be tempting because typically, the father would have a right to the records of his child, unless it would be detrimental to the well-being of the minor or therapeutic relationship. However, the client is not just the daughter, the wife is also part of the treatment unit. The therapist cannot just not deny the request if they believe it would be detrimental to the minor, they would also deny the request if the mother refuses to sign a release. Answer B is incorrect because information shared by the daughter still runs the risk of breaking the mother’s confidentiality, so a release from the mother would be needed even in this case. Answer C is incorrect because the daughter legally does not need to sign a release for the father to access records. The best answer is D; the wife would need to sign the release before the father can access records. (Law)

Answer 17

Gladys, a 78-year-old woman with a mild neurocognitive disorder and diminished mobility resides in an extended care facility. An attendant in the facility reports that Gladys became distraught when the attendant attempted to bath her and was found to have bruises all over her body. The therapist observes a poverty of speech, but client is lucid and coherent during the session. When asked about the bruises on her body, Gladys informs the therapist that her roommate had a visitor who sexually assaulted her when the roommate exited the room. How should the therapist respond to this disclosure when accounting for legal responsibilities? Score: 1 of 1 A. Inform Gladys that you must report the alleged sexual abuse to the facilities executive staff for an investigation to be started. B. Consider Gladys’ cognitive deficits prior to determining if reasonable suspicion exists warranting an elder abuse report. Correct C. Immediately report physical abuse to law enforcement, and follow with written report to law enforcement, ombudsman, and the facility’s licensing agency. Rationale: The correct answer is C. The scenario provided above is testing your knowledge of when to report elder abuse and when we would hold off on reporting because of cognitive deficiencies. Therapists do not report elder abuse if all of the following are true: 1. Client has dementia, 2. Client makes verbal report and there are no witnesses to the abuse, 3. There is no supporting evidence of abuse, and 4. The therapist does not have reasonable suspicion of abuse. In this case, the client does have dementia and there were no witnesses to the abuse. However, there is supporting evidence of abuse (bruises on her body) that leads to reasonable suspicion of abuse, so we must report. Answers A and B can be ruled out since they do not include the legal mandate to report. Answer D can also be ruled out since we do not report to APS when the abuse takes place inside a long-term care facility. Answer C correctly addresses our legal requirements of reporting elder abuse to law enforcement, the ombudsman and the licensing agency. (Law) D. Immediately report physical abuse to Adult Protective Services since the perpetrator of violence does not reside or work in the extended care facility.

Answer 18

A therapist works on a multidisciplinary team in an inpatient psychiatric hospital. The therapist’s client, a 24-year-old female, entered treatment after suffering her second psychotic episode in two years. After completing a thorough assessment the team unanimously arrived at the diagnosis of Schizophrenia. The goal of treatment is to provide evidence-based individual therapy to this client. Which of the following adjuncts should the therapist consider in order to augment individual treatment with this client? Score: 1 of 1 Correct A. Group therapy to aid in social skills once client is considered stabilized through medication management. Rationale: The correct answer is A. Group treatment for social skills is generally considered a strong adjunctive service for clients diagnosed with schizophrenia. Answer B is incorrect, because stabilization is an important prerequisite for participating in group treatment. Answer C and D are possible, but the vignette does not mention the client’s family. We do not know her relationship with them; is her family involved or is she estranged from them. This lack of information allows us to rule out these two answer choices. (Treatment Planning) B. Group therapy to aid in social skills development for all clients with diagnoses of schizophrenia. C. Family therapy to assist client in understanding how the diagnosis affects family functioning. D. Family therapy to improve communication for client once client is considered stabilized through medication management.

Answer 19

A couple that has been married for five years was referred to couples counseling by the wife’s individual therapist. The wife was raped shortly after the couple married and has since struggled with symptoms of PTSD. The wife’s symptoms have not significantly abated and while the husband has tried to be supportive, the couple acknowledges their relationship is suffering. After completing the informed consent process, which of the following actions should the therapist take? Score: 0 of 1 A. Ask the husband and wife to each share their hopes for couples counseling Explore how the husband responds to the wife’s symptoms of PTSD Ask the couple to share what they view as strengths in their relationship Incorrect B. Ask the husband and wife to each share their hopes for couples counseling Explore how the husband responds to the wife’s symptoms of PTSD Inquire about how the wife’s PTSD manifests itself in the context of the couple’s relationship Should have chosen C. Ask the couple to share what they view as strengths in their relationship Explore techniques utilized by the couple in an effort to overcome relational stressors Normalize the couple’s struggle and acknowledge the difficulties that still lay ahead Rationale: The correct answer is C. The client is the couple, so it’s important to prioritize actions that include both the husband and the wife. Answers A and B are not strong because include an exploration of the husband’s response to the wife’s symptoms. Answer C is stronger than D because you want to prioritize normalizing their presenting issue before exploring their desired and perceived levels of intimacy. Through normalization of their struggles and an acknowledgement that it could take time to heal, the therapist provides a safe space for the clients to hold different feelings regarding perceived and desired levels of intimacy. (Clinical Evaluation) D. Ask the couple to share what they view as strengths in their relationship Explore techniques utilized by the couple in an effort to overcome relational stressors Explore the couple’s desired and perceived levels of intimacy

Answer 20

Meredith, a 29-year-old environmental consultant and her 34-year-old husband, Patrick, seek treatment for relational issues. Patrick is an environmental engineer who grew up with three siblings, a stay-at-home mother and an alcoholic father. He reports witnessing violence between his parents, particularly when his father was under the influence of alcohol. Meredith’s parents divorced when she was 6-years-old and the most vivid memories from her childhood have to do with being shuttled between each of her mother’s homes. Meredith and Patrick have been together for seven years. They have struggled with jealousy and poor communication from the very beginning of their relationship, and these issues escalated after they married. Meredith states, “Patrick got a promotion at work and he turned to drinking to cope with the added stress.” She adds, “He would then come home and find something to fight about. Those fights often turned physical with him throwing things at me.” Patrick responds, “But we have since sought help and are now ready to work on our relationship.” How can the therapist ensure they can safely provide couples counseling in this case? Score: 0 of 1 Should have chosen A. Ask Patrick to name his healthier coping mechanisms for when he becomes stressed Identify Meredith’s safety plan and assess her adherence to it Make sure both partners agree on the level of violence that occurred Rationale: It is OK to engage in couples therapy with a couple who have had a history of violence if the following three things are present: 1. Both partners agree on the level of violence that occurred between them; 2. The perpetrator takes responsibility for their actions and has an arsenal of alternative coping mechanisms that they regularly practice; 3. The victim takes responsibility for their safety and sticks to the safety plan if needed. The answer that has all three of these elements present is A. Answer B is a strong answer; however, it is not enough for us to assess how often and how hard Patrick drinks. The scope of our assessment with him needs to be broader and needs to include information about his coping skills. Answer C is lacking an important element of making sure that Meredith has a safety plan and sticks to it. Answer D does not explicitly assess for the presence of violent episodes. We must have that information before we can safely move forward with couples counseling. (Clinical Evaluation) Incorrect B. Verify lack of violent episodes over the last two months Gauge frequency and severity of Patrick’s substance use Identify Meredith’s safety plan and assess her adherence to it C. Ask Patrick to name his healthier coping mechanisms for when he becomes stressed Gauge frequency and severity of Patrick’s substance use Verify lack of violent episodes over the last two months D.Identify Meredith’s safety plan and assess her adherence to it Make sure both partners agree on the level of violence that occurred Appraise the current level of stress in the relationship.

Answer 21

A client is referred by his EAP for six sessions of individual therapy to address symptoms of anxiety that are interfering with his level of productivity at work. During the initial assessment, the client tells the therapist that the reason he is unproductive at work is not due to anxiety, but because he is dissatisfied with his career. The client informs the therapist that he believes career counseling might be most helpful at this time. How would a Solution Focused therapist work with this client? Score: 1 of 1 A. Ask client to think of times when he found his career fulfilling and what was different during that time. B. Ask the client to identify on a scale of 1 to 10 how dissatisfied he is with his career and what would need to change to increase his level of satisfaction. Correct C. Acknowledge the client’s desire to focus on career counseling and determine if there are times the client does enjoy his career. Rationale: The correct answer is C. The only answer that addresses the client’s stated desire of career counseling is answer C. Answers A and B are okay for Solution Focused therapy, but they are not as strong as answer C since they disregard the client’s stated interest in career counseling. Answer D assumes the client would like a new career, but that is not clearly stated in the vignette, so it can also be ruled out. (Treatment Planning) D. Acknowledge the client’s interest in a new career and ask him to identify issues at his current job that could improve his level of satisfaction

Answer 22

A 49-year-old male is referred by his physician to a therapist working in a substance abuse treatment facility. The client immediately expresses his reluctance in seeing a therapist and shares that his level of drinking is not a problem because it is completely on par with that of his peers. During a routine blood test, his doctor detected elevated levels of liver enzymes in his blood. The client said the only reason he was attending the session was because his partner was scared by the test results and was pushing him to see the therapist and to change his drinking patterns before his health issues became more severe. Which initial action would a therapist using Motivational Interviewing take in the case presented in this vignette? Score: 0 of 1 Incorrect A. Acknowledge the client’s reluctance in attending therapy and explore the doctor and partner’s concerns regarding the dangers of continued drinking on the client’s overall health. B. Utilize reflective listening to demonstrate an empathic understanding of the client’s presenting concerns and collaboratively develop treatment goals. Should have chosen C. Acknowledge the difficulty of attending therapy when it doesn’t feel necessary and reflect on the social aspect of drinking as well as recent blood test results. Rationale: The best answer to this question is C. Motivational interviewing emphasizes providing empathy and rolling with the client’s resistance. Answer A is incorrect because it emphasizes the doctor and partner’s concerns, which would likely make the client feel defensive and increase his level of resistance. Answer B is a possibility, but it would be important to build rapport first and acknowledge the client’s resistance to change prior to developing treatment goals. Answer D is also a possibility, but if we put the answers in order, it would be important to start with the Motivational Interviewing tools of affirmations and reflective listening. Answer C is illustrating the use of affirmation, (highlighting it is difficult to meet with the therapist, but the client is still there) and the use of reflective listening. (Treatment) D. Utilize reflective listening to demonstrate an understanding of the client’s problem and inquire about frequency and quantity of alcohol consumption.

Answer 23

A 69-year-old therapist has maintained a private practice for 25 years while also working part-time at a county agency as a wraparound clinician and supervisor. His private practice typically includes a caseload of ten to fourteen clients and he works 20 hours a week at the agency. Over the past five years, the therapist finds he is slowing down and unable to keep up with the competing demands of his private practice and agency work. He shares with colleagues that he is possibly experiencing burnout. He constantly feels tired, is struggling to keep up with his paperwork, and occasionally feels resentful during sessions with some of his clients. Which of the following actions should the therapist take to manage the ethical obligations presented in this case? Score: 1 of 1 A. Immediately refer private practice clients to appropriate services to ensure continuity of care and prioritize the well-being of clients. B. Discontinue providing direct client care in private practice and in county agency to avoid causing harm to clients and identify appropriate referrals to avoid client abandonment. Correct C. Consult with colleagues and seek personal psychotherapy to identify changes necessary to improve personal mental health and maintain efficacy as a clinician and supervisor. Rationale: The correct answer is C. The best place to start would be to consult with colleagues and seek personal therapy. The therapist has identified clear concerns that are affecting his ability to provide adequate services to his clients, so he must act. It’s unclear what actions would be best for the therapist and his clients, so consulting with colleagues and processing his concerns with a therapist would help him sort this out. Once the therapist consults and seeks personal psychotherapy, he could choose to take the actions included in answer A, B, or D. (Ethics) D. Decrease number of private practice clients and number of hours working at agency to mitigate feelings of burnou

Answer 24

A therapist is an administrator for an online mental health practitioner network. The therapist receives a request from a former client who is a social worker and would like to join the group. How should the therapist respond to the request? Score: 0 of 1 Incorrect A. Deny the request because it would create a conflict of interest B. Deny the request because it would create a dual relationship C. Accept the request if an appropriate amount of time has passed since termination Should have chosen D. Accept the request and maintain healthy boundaries Rationale: The correct answer is D. The scenario described is considered an ethical dual relationship, as the code of ethics does not prohibit all dual relationships In fact some dual relationships can be beneficial for the client. The main thing the code of ethics cares about is that we discuss the boundaries with the client. It would be inappropriate and unnecessary to exclude this person from a professional network because they were a former client. The social worker has a right to join professional networks. Answers A and B can therefore be eliminated. Answer C is also wrong because this would be considered an ethical dual relationship, regardless of how much time has passed following termination. Answer D is the most appropriate option, the client has a right to join the network, but the therapist should still ensure healthy boundaries to avoid any conflicts or harm to former client. (Ethics)

Answer 25

A therapist participates in the Parent Teacher Association (PTA) at his youngest son’s school. A member of the PTA is an acupuncturist who specializes in prenatal care. The acupuncturist would like to refer clients struggling with anxiety to the therapist. What ethical obligations does the therapist have in this case? Score: 1 of 1 A. Inform the acupuncturist that it would be unethical to accept referrals due to the potential conflict of interest. B. Inform the acupuncturist that it would be unethical to accept referrals because it presents a dual relationship. Correct C. Accept the acupuncturist’s referrals since it is ethical, but ensure client confidentiality is maintained. Rationale: The correct answer is C. Answers A and B can be ruled out because accepting referrals is not unethical. In addition, the concepts of conflict of interest and dual relationship refer to the therapist/client relationship. They do not refer to relationships between therapist and other professionals. Answer D is not very strong since therapists are not required to collaborate with acupuncturists. Answer C is the strongest option because it correctly states the referrals would be ethical and addresses the importance of maintaining client confidentiality. (Ethics) D. Accept the acupuncturists referrals since it is ethical and collaborate in services provided.

Answer 26

A therapist is conducting a comprehensive assessment with a new client. The client is an elderly woman who complains of sadness and feelings of loneliness. The therapist utilizes the mental status exam as part of the assessment. What is the benefit of using the mental status exam in this case? Score: 1 of 1 Correct A. The therapist will have a structured approach to observe and document the client’s current psychological functioning. Rationale: The correct answer is A. The purpose of the mental status exam (MSE) is to take a snapshot of the individual’s psychological functioning including their appearance, behavior, mental functioning, and general demeanor during the examination. Answer B is incorrect because the MSE does not ask about external stressors. Answer C is incorrect because the MSE focuses on present functioning, not the client’s history of mental health issues. Answer D is incorrect because it is too limited in scope. The MSE could be used to consider depression or dementia, but this is not its sole purpose. (Clinical Evaluation) B. The therapist will be able to increase understanding of external factors affecting client’s current level of psychological functioning. C. The mental status exam can assist the therapist in understanding the client’s current psychological functioning and history of mental health issues. D. The mental status exam is helpful to differentiate depression from possible dementia in elderly clients.

Answer 27

A therapist meets with a 57-year-old married woman who initiates therapy to develop healthier coping skills. The woman has older parents who live close by, and while they are not dependent on her, she feels pressure to take care of them and fears what would happen if she stopped. Her husband has complained that she neglects him and their children. She shares that her parents live in a private home, but she thinks they need to move into an assisted living facility because her father has fallen several times and her mother recently started a small fire when she forgot to turn off the stove. How should the therapist proceed? Score: 0 of 1 Should have chosen A. Assess current coping skills Determine if an elder abuse report is required Explore what balance would look like for the client Rationale: The correct answer is A. Answers B and D can be ruled out because it is unclear that an elder abuse report is required. The stem is teasing at possible self-neglect, but the information shared does not meet the threshold for a mandated report. Answer A and C overlap with assessing for elder abuse report. However, answer A is stronger because it is more holistically approaching the client’s presenting concerns. Assessing coping skills, in answer A, would include the client’s ability to assert personal needs. In addition, exploring what balance would look like for client, also in answer A, is more appropriate than assisting client in identifying assisted living facilities for parents. This is a very narrow focus, it’s not clear the parents are open to moving into an assisted living facility, and the therapist should help clients identify supports for self, not others. Answer A is therefore the stronger option. (Clinical Evaluation) B. Inform the client an elder report is required and process Assist client in identifying additional support for parents Evaluate client’s ability to assert personal needs with husband and parents C. Determine if an elder abuse report is required Evaluate client’s ability to assert personal needs with husband and parents Assist client in identifying additional support for parents Incorrect D. Inform the client an elder report is required and process Assess current coping skills Explore what balance would look like for the client

Answer 28

A therapist conducts intake appointments at a prison. The prison superintendent requests intake records for the therapist’s new client. The superintendent is concerned the client might be a danger to other inmates. He has observed a marked shift in this inmate’s behaviors and believes a review of records would help him understand how to manage the situation. How should the therapist respond to the request? Score: 1 of 1 A. Release the records to the superintendent as he is the holder of privilege in this case and there are safety concerns B. Deny access to records and only release them in the event of a subpoena Correct C. Deny access to records and only release them if the client signs an authorization to release the information Rationale: The correct answer is C. Answer A is incorrect because the client is the holder of privilege. This holds true even if the client is incarcerated. Answer B is too narrow in scope. We are also permitted to release records if a client signs a release. Answer D is again too narrow in scope. Answer C correctly indicates the therapist could share records with the prison superintendent if the client signs an authorization to release information. (Law) D. Inform the superintendent that records are generally confidential and refuse to release them

Answer 29

A recently separated couple is referred to therapy by the mediator who is handling their divorce. The couple has two children, a 5-year-old and an 8-year-old. Since the separation, the 5-year-old has engaged in regressive behaviors, including nocturnal enuresis. The couple is on amicable terms and wants to develop a healthy co-parenting situation that minimizes stress on the children. What initial goals would a Systems therapist incorporate into the treatment plan? Score: 0 of 1 A. Increase the family’s ability to develop new coalitions as a response to the parents’ separation. Incorrect B. Assist the family in developing new boundaries that allow for greater flexibility as the family adapts to new structures. Should have chosen C. Strengthen the co-parenting subsystem and encourage the parents to re-establish and maintain clearly defined boundaries. Rationale: The correct answer is C. It’s always important to pay close attention to the treatment unit; in this case it is the couple that is the client, not the family. Answers A and B can therefore be eliminated, since they focus on the entire family. Answer D assists the parents, but it also includes a referral for the son, which is wrong for two reasons; one, we actually do not know the gender composition of the children and two, we do not need to provide referrals for someone who is not our client. Answer C is left as the strongest option available; it is appropriate for a Systems therapist and links back to the information provided in the vignette. (Treatment Planning) D. Assist the parents in creating greater structure for the children and refer the son for individual therapy.

Answer 30

A 15-year-old boy and his family are referred to therapy by the boy’s school. The parents are distraught because they recently caught their son kissing another boy. The parents express strong disapproval of homosexuality and fear the consequences of their son’s immoral behaviors. They ask if the therapist is aware of reparative therapy and if she could help “fix” their son. Which of the following interventions would a Satir family therapist use in the beginning stage of treatment? Score: 0 of 1 A. Validate parents concerns and provide psychoeducation regarding sexual exploration Inquire about family’s history with a particular focus on their religion Provide the son with an opportunity to share his goals for therapy B. Validate parents concerns and provide psychoeducation regarding sexual exploration Inquire about family’s history with a particular focus on their religion Inform the family that reparative therapy is unethical and harmful Should have chosen C. Create a safe holding environment that allows all family members an opportunity to be authentic Provide the son with an opportunity to share his goals for therapy Teach the family how to utilize “I” statements to avoid harmful communications Rationale: The correct answer is C. Answers A and B can be ruled out because they include validation of parents concerns, which could be detrimental to the relationship with the son. Plus, based on the information in the vignette it is not clear if the child is engaging in sexual exploration or if he has already explored and established his sexual orientation. The final part in answer D is generic, whereas the final part of C is very specific to Satir therapy, thus making C the stronger answer. (Treatment) Incorrect D. Create a safe holding environment that allows all family members an opportunity to be authentic Provide the son with an opportunity to share his goals for therapy Inquire about family’s history

Answer 31

A therapist working in a community agency receives a call from a Child Protective Services investigator regarding the therapist’s 12-year-old female client. The client was brought to therapy by her parents, who consented to treatment, because they were concerned she was exhibiting signs of depression. The investigator informs the therapist that she received a child abuse report from a different agency regarding the therapist’s client and would like to gather additional information to help with the case. What actions should the therapist take to manage the legal obligations presented in this case? Score: 1 of 1 A. Answer the investigator’s questions because as mandated reporters the therapist should comply with the CPS investigation. B. Answer the investigator’s questions only without offering information beyond the CPS investigation. Correct C. Maintain the client’s confidentiality and inform the client of the request for information. Rationale: The best answer for this question is C. Therapists are only permitted to break confidentiality when legally mandated or permitted to do so, or if the client provides written authorization. Answer A and B are incorrect because the information provided in the stem does not indicate the therapist has reasonable suspicion or knowledge of child abuse. Therefore the therapist does not have a legal mandate, nor do they have permission to break the client’s confidentiality. Now it is down to answers C and D. Answer D is incorrect because a minor who is 12 or older, regardless of who consents, has a right to confidentiality. We would not ask the client’s for permission to share information, but would discuss this request with the client directly, answer C. (Law) D. Maintain the client’s confidentiality and request a release of information from the client’s parents since they consented to treatment.

Answer 32

A long-term client informs his therapist that he is starting a new job and will be moving out of state. The client wants to continue treatment via technology, but the therapist explains that the laws related to the practice of telemedicine make this request impossible. The client becomes extremely agitated and demands the therapist immediately provide him with his personal medical records. How should the therapist respond to the client’s request for records? Score: 1 of 1 A. Explore the reason for client’s request Inform client a written request for documentation is required Inform client of fee for records in accordance with office policy B. Explore the reason for client’s request Inform client a written request for documentation is required Discuss pros and cons of summary of treatment versus complete records Correct C. Determine if provision of records would be detrimental to client Inform client of fee for records in accordance with office policy Inform client of processing time for request Rationale: The correct answer is C. Answers A and B can each be eliminated because the client’s reason for the request is not as important as determining if access would be detrimental; the therapist must comply with the request regardless the reason. The final part of answer D is incorrect and allows you to rule out this option as well. A therapist is only permitted to deny a client’s request for records if they believe viewing or receiving the records would cause significant harm or be detrimental to the client. This may or may not be the case with a client whose emotional state is unstable. Answer C is the strongest option. The client must provide a written request for records, would be required to pay a fee for copies, and allow the therapist the legally permitted amount of time to process the request. (Law) D. Determine if provision of records would be detrimental to client Inform client of fee for records in accordance with office policy Deny client’s request if therapist believes client’s emotional state is unstable

Answer 33

A 70-year-old man seeks therapy on the advice of his daughter. He is married, but has lived apart from his wife for nearly 10 years. He was diagnosed several months ago with lung cancer and the doctors believe his prognosis is good. However, he does not believe his medical team and is convinced they are “sugarcoating what they share,” because they think he is “too fragile to handle the truth.” Which of the following goals would a Narrative therapist establish for the middle stage of treatment? Score: 1 of 1 A. Improve the client’s ability to externalize the effects of his cancer diagnosis on his health. B. Provide client with the tools to develop an alternative story of the cancer and its effect on his ability to enjoy his life. Correct C. Help the client separate his diagnosis from who he is as a person and how he wants to live his life. Rationale: The strongest answer to this question is C. Once again, answer A is improperly using the Narrative concept of externalization. Although externalization is a middle stage goal, the incorrect use of it in A knocks that answer choice out. Answers B and D include appropriate goals for Narrative, but they would follow the goal of externalization that occurs in answer C. (Treatment Planning) D. Increase his ability to integrate the role of cancer in his life and develop a new narrative that incorporates the disease.

Answer 34

A therapist has been working with a 34-year-old African American male for close to four years. Four and a half years ago, the client was arrested and treated very harshly while being detained. Even though his case was dismissed, the client began experiencing disturbing and persistent images of the way he was treated. He reported having frequent nightmares, feelings of intense fear, the need to remain hypervigilant, as well as difficulties concentrating. After four years of therapy the client reports feeling 90% better. His nightmares have dissipated, he is able to openly discuss the traumatic event without experiencing severe distress, and he no longer experiences intrusive event recollections. As the termination nears, which interventions should the therapist consider in order to help the client learn and implement strategies of PTSD relapse prevention? Score: 1 of 1 A. Rehearse future circumstances in which temporary setbacks could occur Instruct the client to regularly use coping strategies learned in therapy Discuss the risks of relapse due to substance abuse Correct B. Aid the client in grasping the distinction between lapse and relapse Rehearse future circumstances in which temporary setbacks could occur Instruct the client to regularly use coping strategies learned in therapy Rationale: The best answer here is B. It is the only answer that contains all late stage intervention techniques that aim at PTSD relapse prevention. Discussing with the client the difference between lapse and relapse is an important intervention to help the client know when and if he needs help in the future. Lapse is a term used to describe a temporary setback, while relapse is used to describe a return to a sustained pattern of thinking, feeling and behaving that is characteristic of PTSD. The last part of answer A has the therapist assessing the client for substance dependence and this should have been done in the initial stage of treatment. Answer C talks about assigning the client the task of maintaining a daily record, and is something that would have been initiated in the middle stage of treatment. Answer D also contains a middle stage intervention of teaching the client how to utilize positive self-dialogue. (Treatment) C. Aid the client in grasping the distinction between lapse and relapse Instruct the client to regularly use coping strategies learned in therapy Assign the client to keep a daily record of fearful self-talk D. Rehearse future circumstances in which temporary setbacks could occur Encourage the client to return for a periodic maintenance session Teach the client ways to utilize self-dialogue in which he reinforces his accomplishments

Answer 35

Alexandra, a US citizen and her husband Elias, a citizen of Nicaragua present for therapy. They met in Nicaragua 15 years earlier and Elias moved to the US to be with Alexandra. Elias has a green card, but has not applied for citizenship. They have two children, ages 3 and 7. They are seeking therapy because Elias was recently physically attacked in what was deemed a hate crime and Alexandra was harassed at a local park for speaking Spanish to her children. They report feeling on edge all of the time and scared for their family’s safety. They are considering moving to Nicaragua, but are uncertain if this would be best for their children. How would a therapist develop a complete clinical assessment in this case? Score: 0 of 1 A. Observe how the couple interacts Complete a PTSD screening for Alexandra and Elias Identify the desired outcome of treatment B. Complete a Beck Depression Inventory for Alexandra and Elias Separate the couple to assess safety Collaboratively develop a genogram of their family spanning back at least two generations Incorrect C. Observe how the couple interacts Inquire about family and social supports in their community Determine expectations of therapy Should have chosen D. Complete a PTSD screening for Alexandra and Elias Obtain information about cultural and religious backgrounds Collaboratively develop a genogram of their family spanning back at least two generations Rationale: The correct answer to this question is D. The presenting issues relate to Elias being physically attacked, Alexandra being verbally attacked, and the ensuing anxiety and fear they are experiencing. We want to prioritize answers that include a PTSD screening since the symptoms and events causing them point in that direction. Answers B and C do not include the PTSD screening and can, therefore, be eliminated. Cultural issues are present in this stem; the vignette makes several references to culture and the couple reports they are being discriminated against because of their cultural backgrounds. Answer D is stronger because it addresses culture whereas answer A does not. In addition, A includes observation of how the couple interacts, which could be helpful, but is not as specific to the vignette as culture. (Clinical Evaluation)

Answer 36

A therapist meets with a 43-year-old Armenian-American male client who was just released from the hospital following a 72-hour involuntary hold. The client explains his parents called the police on him because his behavior was scaring them. He acknowledges that he had been binge drinking for several days after being fired from his job and was told by the attending psychiatrist that he had experienced alcohol-induced psychosis. He shares that he moved into his parents’ home because he cannot afford his own place now that he is divorced and has to pay child support. He is scared because he does not think he will find a job now that he’s been hospitalized and tells the therapist, “My ex-wife has destroyed my life. She won’t let me see my children but takes all of my money. It is her fault I am in this situation and I can’t wait for her to experience pain and suffering like she has caused me.” Which of the following issues presented in the vignette requires immediate assessment? Score: 1 of 1 Correct A. Current and prior level of substance use Access to psychiatric resources Level of risk client presents to self and family Rationale: The best answer is A. There are several issues in this vignette that require immediate attention. The client’s statement, “My ex-wife has destroyed my life. She won’t let me see my children but takes all of my money. It is her fault I am in this situation and I can’t wait for her to experience pain and suffering like she has caused me,” makes it clear that we must assess the potential danger to others. Therefore, we can eliminate answer B and C, which only assess for risk to self. This leaves us with answers D and A. The vignette notes the client was just released from an involuntary hold, so psychiatric resources would take precedence over employment resources. We want to ensure the client is stabilized before we can connect him to other, less urgent resources. (Crisis Management) B. Current and prior level of substance use Current medication regimen and level of compliance Level of risk client presents to self C. Current medication regimen and level of compliance Level of risk client presents to self Access to employment resources D. Level of risk client presents to self and family Current level of substance use Access to employment resources

Answer 37

Juanita, a 55-year-old Haitian-American woman attends therapy following the death of her husband. Juanita informs the therapist that she and her husband were fighting a lot before he suddenly died. She practices Voodoo and informs the therapist she believes in the afterlife. How should the therapist manage the client’s disclosure? Score: 0 of 1 A. Normalize the desire for those grieving to hold onto the concept of the afterlife. B. Ask the client to elaborate on her religious beliefs and demystify Voodoo for the therapist. Incorrect C. Research the Voodoo religion and ask client if she would like to incorporate it into treatment. Should have chosen D. Determine the client’s goals of treatment and how her religious practice affects her presenting problem Rationale: The correct answer is D. Answer A normalizes something that is not necessarily a belief held by everyone, not everyone grieving holds on to the concept of the afterlife. If this answer were more focused on the client’s belief in the afterlife and what it meant to her, A would be a possible option. Answer B is incorrect because the client is not responsible for educating their therapist about their religion. Answer C is incorrect because the therapist does not practice Voodoo, so researching it and then trying to incorporate into treatment would be inappropriate. Answer D is the best option because it honors the client’s self-determination in determining the goals of treatment and inquires about the role of religion at a personal level. (Clinical Evaluation)

Answer 38

A therapist meets with a client diagnosed with Borderline Personality Disorder. The client informs the therapist that she cuts her wrists when her emotions become too intense. The therapist attempts to safety plan, but the client refuses to engage in safety planning, stating, “I don’t need to safety plan. I said I would not do it anymore.” Which of the following actions should the therapist take to assess the client’s safety? Score: 0 of 1 A. Inquire about past suicide attempts Identify alternative coping mechanisms Explore presence of substance use B. Inquire about past suicide attempts Identify social supports Identify potential triggers for emotional distress Should have chosen C. Explore current lethality Identify potential triggers for emotional distress Identify alternative coping skills Rationale: The best answer choice is C. In crisis situations, we would prioritize current over past information about a client. While a past suicide attempt is a good indicator of future risk, exploring current lethality would still be an even stronger determining factor. We can therefore eliminate options A and B. (Side note: lethality is defined as someone having the ability to cause death or serious harm.) Answer C is stronger than D for the following reasons: 1. Identifying potential triggers for emotional distress is broader and would actually include substance use and 2. Identifying alternative coping skills is stronger than exploring client’s support system. Alternative coping skills would include external support systems. (Crisis Management) Incorrect D. Explore current lethality Explore presence of substance use Explore client’s family support system

Answer 39

A therapist with a National Provider Identification meets with a new client who was referred for ongoing therapy following hospitalization after an attempted suicide. The client shares his psychiatric history with the therapist, including past suicide attempts, a history of severe depression, and childhood trauma. The therapist contacts the referring physician as part of the assessment. What legal obligations does the therapist have in this case? Score: 0 of 1 A. The therapist does not need a release of information from the client since this was a crisis situation. Incorrect B. The therapist would need to obtain a release of information from the client prior to speaking with the physician. Should have chosen C. The therapist would only need a release of information if discussing concerns beyond treatment and diagnosis with referring physician. Rationale: The correct answer is C. Answer A can be eliminated since the crisis already passed by the time the therapist meets with the client. Answer B is also incorrect since HIPAA covered entities are permitted to discuss diagnosis, treatment, and payment with other providers without a release. Answer C accurately reflects the law, making it the strongest answer. Answer D is not completely accurate, since the therapist would be limited in what information can be shared without a release. D. The therapist does not need a release of information to speak with the physician since the hospital is a HIPAA covered entity.

Answer 40

A therapist referred a short-term client out to a colleague in order to hire the client as a nanny for her children. The referring therapist provided the colleague with the original client chart and continued meeting with the client until the new therapist took charge of the case. Which of the following statements most accurately describes the ethical issues presented in this case? Score: 1 of 1 A. The therapist engaged in an unethical dual relationship that could have been avoided and risks exploitation of client. B. The therapist engaged in unethical management of client records. C. The therapist’s actions are considered ethical because client was short-term and received continuity of care through referral and sharing of records. Correct D. The therapist’s actions are considered unethical due to a breach of therapeutic boundaries and improper recordkeeping. Rationale: The correct answer is D. Our code of ethics prohibits us from terminating therapy with clients in order to pursue other relationships. Answer C can easily be eliminated. Answers A and B are both correct, but neither is as comprehensive as answer D. Answer D encompasses the problematic behavior with records as well as boundaries. (Ethics)

Answer 41

A couple in their mid-70s meets with a therapist to address sexual dysfunction in their relationship. The couple reports that the husband met with his primary care physician who ruled out any underlying organic issues. The couple shares that they had an active and healthy sex life until recently, when the husband began to struggle with sustaining an erection. Which of the following should the therapist emphasize when developing a treatment plan? Score: 0 of 1 A. The couple’s ability to communicate their sexual pleasures to one another and the realities of aging on diminished sexual functioning. B. The common characteristics of sexual dysfunction that develop in long-term marriages. Should have chosen C. The husband’s thoughts on the underlying causes and the wife’s reaction to his inability to sustain an erection. Rationale: The correct answer is C. Answer A is incorrect because it makes assumptions about their communication and falsely states that aging automatically leads to diminished sexual functioning. Answer B is incorrect because it is promoting a false stereotype regarding long-term marriages and sexual dysfunction. Answer D can be ruled out since it does not connect to anything in the stem and does not address the presenting issue. Answer C is the best option since in creating a treatment plan we would want to explore the thoughts and emotions clients have about it. (Treatment Planning) Incorrect D. The couple’s strengths and pleasures that continue to thrive outside of their sexual relationship.

Answer 42

A 56-year-old man engages in treatment with a therapist who is on his family’s insurance panel. The man has a diagnosis of Obsessive Compulsive Disorder that increasingly interferes with his activities of daily living. The man would like his wife to participate in treatment with him and wants to use their insurance to pay for treatment. How should the therapist proceed to address legal obligations? Score: 0 of 1 Should have chosen A. Only bill insurance if conjoint treatment is the most effective modality to treat the identified patients’ mental disorder and accurately represent diagnosis and treatment unit. Rationale: The correct answer is A. Answer B and D can be eliminated because the client is the husband who is being treated for obsessive compulsive disorder, the presenting problem is not the couple’s relationship. Answer C is incorrect because it is possible to include the wife in treatment and bill insurance if it is considered an effective treatment option. Answer A acknowledges that conjoint treatment, if effective, is permitted and the therapist would need to provide accurate information regarding diagnosis and treatment to the insurance company. (Law) B. Review the identified patient’s insurance policy and only bill insurance if coverage includes marriage counseling. C. Deny request for wife to participate in treatment and provide informed consent to client. Incorrect D. Determine if client’s insurance covers marriage counseling and provide informed consent to treatment unit.

Answer 43

A family consisting of a mother, father and two teenage sons attend the first session of therapy. The parents explain they have a 22-year-old son who is estranged from the family. The son has a history of substance abuse and was removed from the home after physically assaulting the youngest child. The parents want to reunify with their son, but the children are not sure it is a good idea. How would a Bowenian therapist assess for the appropriateness of reunification in this case? Score: 0 of 1 A. Assess estranged son’s current relationship with substances Explore how the emotional cut-off is affecting all family members Identify level of differentiation among family members Incorrect B. Assess estranged son’s current relationship with substances Explore how the emotional cut-off is affecting all family members Explore safety plans that have been established in the event of reunification Should have chosen C. Explore how the family will address safety concerns in the event of family reunification Ask family members what they envision if they open the cut-off relationship Assess estranged son’s current relationship with substances Rationale: The correct answer is C. The question is not only asking you to consider how a Bowenian therapist would assess the family, but specifically how they would assess for the appropriateness of reunification. Answer A, identify the level of differentiation among family members is important for Bowen, but does not directly address appropriateness of reunification. In addition, answer A as with answer B includes exploration of how the emotional cut-off is affecting family members. This information would not help the therapist determine the appropriateness of reunification. Answer D, invite the son to join in a future session, is incorrect because it jumps to reunification before determining the appropriateness of it. (Treatment Planning) D. Explore how the family will address safety concerns in the event of family reunification; Ask family members what they envision if they open the cut-off relationship Invite the son to join a future session

Answer 44

The parents of a 4-year-old boy seek therapy to address their son’s behavioral issues. The couple reports feeling hopeless and are convinced they are failures as parents because they are unable to control their son. They report frequent yelling and temper tantrums that lead to their son hitting and kicking them. How would a Structural versus Strategic therapist intervene in the middle stage of treatment? Score: 1 of 1 A. A Structural therapist would meet with the entire family and instigate conflict to modify family member responses and a Strategic therapist would instruct the parents to preemptively tantrum if conflict begins. B. A Structural therapist would meet with the parents and assist them in solidifying their hierarchical position and a Strategic therapist would meet with the entire family and direct the parents to articulate clear boundaries with their son. Correct C. A Structural therapist would insist on meeting with the entire family and engage in role play with the family and a Strategic therapist would insist on meeting with the entire family and encourage family to schedule tantrums. Rationale: The correct answer is C. Answer A can be eliminated since a Structural therapist would not instigate conflict. Answer B can be ruled out since the second part of the answer is more Structural than Strategic. Finally, answer D can also be eliminated since the first part of the answer is too harsh for a Structural therapist; Structural therapists would not take the position of challenging clients, which would be more appropriate for Strategic. (Treatment) D. A Structural therapist would meet with the parents and challenge how the parents respond to their son’s tantrums and a Strategic therapist would meet with the entire family and direct the son to tantrum in session.

Answer 45

A Filipino family consisting of a mother, father and twin female teenagers, attends therapy at a community mental health agency. The parents moved to California from the Philippines as adults and the children were born in the states. The family was referred by their church pastor because the children have been fighting frequently and one daughter recently found out she is pregnant. The parents are very religious and oppose premarital sex, as well as abortions. They express feeling anger toward their daughter for bringing shame to the family and don’t know how they can ever engage in their community again. What actions would a Cognitive Behavioral therapist take in the early stages of treatment? Score: 0 of 1 A. Separate the family members to complete functional analyses with the parents together and then with each of the daughters Provide an overview of how CBT works and what the family can expect over the course of treatment Help family members to express their thoughts regarding the presenting issues Incorrect B. Separate the family members to complete functional analyses with the parents together and then with each of the daughters Provide an overview of how CBT works and what the family can expect over the course of treatment Help the family articulate what they want to achieve from family therapy Should have chosen C. Complete a functional analysis with the entire family Collaboratively develop a problem list that can be addressed over the course of treatment Ensure the family understands who the client is and the role of the therapist Rationale: The correct answer is C. The client is the family, which means the functional analysis should be completed with everyone who is part of the treatment unit, together. This allows you to rule out options A and B. The additional components of answers A and B are all right, but the first part of each answer allows you to rule them out. The final part of answer D is not as strong as the final part of answer C. It is more important to ensure the family understands who the client is and the role of the therapist in the beginning stage of treatment. This is especially true with this vignette because the parents express anger toward their daughter and may wrongly expect the therapist to align with them. (Treatment) D. Complete a functional analysis with the entire family Collaboratively develop a problem list that can be addressed over the course of treatment Ask the daughters to respond to their parents’ expressed feelings of shame

Answer 46

An 18-year-old client who identifies as transgender was referred for individual therapy by her physician. The client states she was born anatomically a boy, but identifies as a woman and is currently using hormones prescribed by her doctor to bring her body into alignment with her gender identity. The woman feels relieved that she can finally pursue the medical support to help her transition, but is struggling with depression because her family does not accept her for who she is and she feels very alone in the world. Which of the following goals would a Systems therapist incorporate into a treatment plan? Score: 1 of 1 A. Increase client’s feelings of belonging within family structure Decrease symptoms of depression Improve client’s ability to communicate effectively with family members B. Increase client’s feelings of belonging within family structure Increase client’s level of self-acceptance Increase client’s social support network C. Decrease symptoms of depression Decrease client’s internal conflict between anatomical sex and gender identity Improve client’s ability to communicate effectively with family members Correct D. Decrease symptoms of depression Refer client to community resources for transgender people Increase client’s ability to cope with family relationship dynamics Rationale: The correct answer is D. The question is asking for goals of a systems therapist, so the focus of treatment will incorporate family. However, it’s important to keep in mind that the client is an individual. Answers A, B, and C include goals that would require the entire family to participate in treatment. This includes increasing feelings of belonging within family structure and improve ability to communicate effectively with family members. Answer D is the strongest option because it acknowledges the role of family, but the goal is focused on the client in the room--increasing the client’s ability to cope with family dynamics. (Treatment Planning)

Answer 47

A couple in their mid-40s and their 14-year-old son attend a session with a therapist because the parents are separating. The father has been questioning his sexual identity for several years and intends to leave the marriage. His wife and he have discussed this over time, and though hurt, she has accepted this decision. The son is struggling with this change and feels his entire life was a lie. What actions should the therapist take in this case? Score: 0 of 1 Incorrect A. Meet with the son alone to provide him with a safe space to explore his emotions regarding his parents’ relationship, his father’s sexual identity, and his understanding of the family structure Should have chosen B. Meet with the entire family to explore their understanding of the family structure and their emotional responses to the impending changes Rationale: The correct answer is B. Answer A can quickly be eliminated because the entire family is present and the presenting concerns affect the entire family. Answer C emphasizes the father’s sexual identity, which unfairly places the focus on one person for disrupting the family system. Answer D includes a referral to NAMI, which is incorrect. A referral to NAMI would be appropriate if a family member indicated the presence of a mental health illness, but questioning sexual identity does not constitute a mental health illness. Answer B addresses the correct treatment unit and avoids placing blame on any one member for the impending changes. (Treatment) C. Meet with the entire family to discuss how the father’s sexual identity is affecting the family structure and their emotional relationships with each other D. Meet with the entire family to explore the changes to the family structure and provide a referral to NAMI (the National Alliance on Mental Illness)

Answer 48

A therapist meets with a family consisting of two fathers, a teenage daughter and an 11-year-old son. The family attends therapy because the daughter was recently suspended from school after getting into a fight. The daughter explains that a classmate was bullying her and making homophobic comments about her parents. One father states he is glad that his daughter put the kid in his place, while the other states “It is completely unacceptable to fight, regardless of how wrong and hateful someone behaves.” What primary goal would a Narrative therapist consider when working with this family? Score: 1 of 1 A. Restoration of the familial hierarchy and enhancement of the parental alliance B. Externalizing the homophobia and allowing the family to reauthor their presenting problem Correct C. Understand the cultural context that is influencing the family and develop a narrative that empowers the family Rationale: The correct answer is C. The question is asking for goals for a Narrative therapist. Answer A can quickly be ruled out because it is using language associated with Structural family therapy. Answer B is using the language associated with Narrative therapy, but incorrectly. Narrative therapy externalizes problematic thoughts or feelings, something that is part of the person or the family. Externalizing homophobia does not make sense, it is already external to the family. Answer D is not outright wrong, but it is also not a very strong option. Increasing the family’s communication skills would be acceptable for any theoretical orientation. The second part of the answer is weaker; a Narrative therapist would not work to separate the family from societal adversities, but help them feel empowered and able to overcome societal adversities. Answer C describes goals that are appropriate for Narrative therapy, with a focus on culture and empowerment. The goals also align with the information shared in the vignette. (Treatment Planning) D. Increase the family’s communication skills and their ability to separate themselves from societal adversities

Answer 49

A therapist works in a mental health clinic for university students. The therapist meets with a freshman year student, Joseph, who shares he is currently rushing a fraternity and, as part of the process, has been drinking frequently and excessively. In addition he states that he has been experimenting with some recreational drugs. During the session, the therapist notices the client is having difficulty staying focused, appears lethargic and has red eyes. Which of the following actions should the therapist take in this case? Score: 0 of 1 A. Confront client regarding suspicions that he is under the influence of drugs and inform him that therapy must be postponed. Should have chosen B. Confront client regarding suspicions that he is under the influence of substances and assess appropriateness of continuing session. Rationale: The correct answer is B. The starting point would be to confront the client about his presentation and then decide how to proceed, which aligns with the wording in answer B. Answer A does not allow for processing of the therapist’s belief with the client, but instead assumes the session will be postponed, which may or may not be appropriate. The client’s behavior may not be due to current substance use, but could instead be signs of withdrawal symptoms, lack of sleep, illness, etc. Answers C and D are incorrect because they do not engage the client regarding his current presentation in the session. (Clinical evaluation) C. Inform client of the therapist’s substance use policy and complete a comprehensive assessment. Incorrect D. Inform client of the therapist’s substance use policy and refer client to substance abuse treatment.

Answer 50

A 24-year-old male client was released from prison following two years of incarceration. The client is on parole and is mandated to receive mental health counseling once a week as a condition of release. The man presents as guarded and tells the therapist he does not believe it’s possible to be honest in therapy because his probation officer is going to ask the therapist for information. What should the therapist do in this case? Score: 0 of 1 A. Inform the client that prior to onset of treatment he is legally required to sign a release of information allowing therapist to share information with probation. B. Review the limits of confidentiality and mandate a release of information in order to communicate with probation officer. Incorrect C. Review the limits of confidentiality and clarify what information must be shared with probation and what information will stay confidential. Should have chosen D. Inform client of the limits of confidentiality and request a release of information to share limited information with probation required for compliance. Rationale: The correct answer to this question is D. Answers A and B are incorrect because the client always has a choice to sign a release or not, we cannot force them to sign a release. Answer C is a better option, but still not the strongest choice. We would want to review the limits of confidentiality, but would need a release to determine what information can be shared. Answer D is the strongest option available; we would request a release of information prior to sharing any information with probation. If the client is mandated to attend therapy, we would let them know that we can only confirm compliance with their probation officer if they provide the release of information. (Law)

Answer 51

A therapist working in the psychiatric unit of a hospital meets with a patient who is being discharged from the hospital following a 72-hour involuntary hold. The client was admitted to the hospital after his therapist initiated a 5150. The client has a diagnosis of Major Depressive Disorder, and has a history of suicide attempts. Which of the following are considered key elements to the therapist’s discharge plan? Score: 1 of 1 Correct A. Identifying and engaging support systems willing and able to provide help Ensuring collaboration between various care providers Providing clear instructions on how to access crisis intervention and other resources Rationale: The strongest answer to this question is answer A. The risk of suicide is high following discharge from hospitalization, so it’s important to develop a discharge plan that takes this into account. We can easily eliminate answers that include signing of a no-harm contract because this is not considered an effective preventative tool (it can be helpful as an assessment tool). Therefore, answers B and C can be eliminated. Answer A and D are identical except for the first component of each; therefore you are left choosing between 1. identifying and engaging support systems versus 2. providing psychoeducation. The stronger and more protective measure would be engaging the client’s support systems. Support systems can monitor the client’s well-being, provide emotional support, and link client to resources as needed. (Crisis Management) B. Identifying and engaging support systems willing and able to provide help Ensuring collaboration between various care providers Ensuring client signs a no-harm contract C. Providing psychoeducation to patient regarding post-discharge suicide risk Providing clear instructions on how to access crisis intervention and other resources Ensuring client signs a no-harm contract D. Providing psychoeducation to patient regarding post-discharge suicide risk Providing clear instructions on how to access crisis intervention and other resources Ensuring collaboration between various care providers

Answer 52

A 38-year-old male client was referred to a Cognitive Behavioral Therapist by his EAP. The client suffered severe burn injuries in his last job and is now back at work in a similar setting. The client is failing to stay on task at work and informs the therapist he recently started engaging in non-suicidal cutting on the scarred parts of his body when not at work. What actions would the therapist take in the middle phase of treatment? Score: 0 of 1 Incorrect A. Assist the client in identifying precipitating situations that lead to self-harming behaviors and practice self-soothing techniques to replace unhealthy behaviors. Should have chosen B. Elicit automatic thoughts from the client that occur during the work day and outside of work that lead to dysfunctional behaviors Rationale: The best answer for this question is B. There are three components to consider in this question, 1. The therapist uses CBT (this could be tricky because the modality is noted earlier in the vignette and not in the actual question), 2. It’s asking for actions/interventions, and 3. It is middle stage of treatment. Answers C and D can be eliminated easily because they are both early stage actions-baseline functioning would be determined as part of the initial assessment and goals are a first step of treatment. Answer A could be tempting because it is feasible to do in the middle phase of treatment, however it only addresses the self-harming behaviors, not the work issues. It’s important to take into account that the vignette notes that the client was referred by an EAP, which means work concerns would need to be a part of treatment. Answer B is the only answer that is middle stage, appropriate for CBT, and addresses the client’s work and self-harming behaviors. (Treatment) C. Utilize self-reporting symptoms inventory to establish a baseline functioning in order to track client’s progress D. Collaborate with client to develop goals appropriate for brief therapy and provide referrals for long-term therapy to address trauma.

Answer 53

A 39-year-old male client from Latvia has received treatment through the county mental health department for seven months. The man was initially referred by the county’s psychiatrist who felt Cognitive Behavioral Therapy would be an appropriate adjunctive treatment for his depression. The client has achieved minimal progress and his Beck’s Depression Inventory score remains high. The therapist does not believe the client is motivated to change, and feels frustrated when he does not follow through on agreed upon homework. How should the therapist clinically manage the client’s lack of progress? Score: 0 of 1 A. Explore client’s resistance to completing homework and threaten termination if client is not benefiting from treatment. B. Refer client back to the psychiatrist for a medication reevaluation and explore client’s resistance to treatment. Should have chosen C. Consult with client’s psychiatrist to discuss lack of progress and collaborate with both psychiatrist and the client to develop a revised care plan. Rationale: The correct answer is C. Answer A is too harsh; it has the therapist threatening termination rather than discussing options with the client. We would want to take several other steps, including consultation, possible reformulation of treatment goals, etc., prior to discussing termination. Answer B is a possibility, but would come after consultation with the psychiatrist. The first part of answer D is good, but the second part assumes the client is unaware of the benefits of homework, something that is not noted in the vignette. Answer C is the strongest answer. As part of a multidisciplinary team in the county mental health department, it would be best to discuss the case with the treating psychiatrist to determine if the care plan needs to be reformulated or if the client’s resistance could be addressed through changes in medication. (Treatment) Incorrect D. Explore client’s resistance to completing homework and provide psychoeducation on benefits of extending engagement of therapeutic activities to outside individual therapy.

Answer 54

A therapist working in a community mental health clinic meets with a new client. During the assessment, the therapist observes the client’s speech is disorganized and he is exhibiting signs of delusional thoughts. The therapist believes the client may be experiencing a brief psychotic disorder. In attempting to determine if this is the appropriate diagnosis, which of the following should the therapist assess? Score: 1 of 1 Correct A. Presence of substance use Medical history Presence of manic or depressive symptoms Rationale: The correct answer is A. The information shared in the vignette is alluding to possible psychosis. The two most important variables to rule out before diagnosing a client include substance use and biological/organic issues. These two variables are not present in answers C or D, so these answer choices can be eliminated. The DSM 5 states that a “diagnosis of brief psychotic disorder cannot be made if psychotic symptoms are better explained by a mood episode.” Answer A assesses for mood disorders, whereas answer B does not, thus making answer A the strongest answer choice. (Clinical Evaluation) B. Presence of substance use Medical history External stressors C. Presence of manic or depressive symptoms Current and past medications Trauma history D. Presence of manic or depressive symptoms External stressors Current and past medications

Answer 55

A therapist in full-time private practice has a caseload of over 25 patients. The therapist recently met with a neurologist to address changes in cognitive functioning and receives a diagnosis of Mild Neurocognitive Disorder due to Alzheimer’s Disease. Which of the following actions should the therapist take to meet ethical standards? Score: 1 of 1 A. Inform clients of diagnosis and process response to disclosure Continue working with clients until illness interferes with therapeutic abilities Provide referrals to clients seeking ongoing therapeutic services B. Inform clients of diagnosis and process response to disclosure Continue working with clients until illness interferes with therapeutic abilities Ensure professional will is intact and accessible C. Adhere to office policies Seek consultation to discuss therapist’s abilities and continuity of care Inform clients of diagnosis and process response to disclosure Correct D. Adhere to office policies Seek consultation to discuss therapist’s abilities and continuity of care Ensure professional will is intact and accessible Rationale: The best answer to this question is D. Ethically, therapists only maintain a therapeutic relationship when it is benefitting the client. If personal issues, including physical/mental health, interfere with the therapist’s ability to properly care for their clients, they must take appropriate steps to address this. In this case, the therapist has concerns regarding cognitive functioning and a diagnosis that reflects changes in cognition. It is not clear that informing clients of diagnosis would be appropriate; it could be for some clients, but not others. Before deciding on this, the therapist should consult. This quickly rules out all of the answers except D. In addition, answers A and B are incorrect because the therapist should not just continue working with clients until their illness interferes, they should take active steps to prepare for changes. The therapist should rely on their office policies to guide how they handle the diagnosis and should seek consultation to navigate a difficult situation. In addition, therapists should always have their professional will intact. (Ethics)

Answer 56

A 7-year-old boy is brought to therapy by his grandmother who states she and her husband have legal guardianship of the boy and his two younger siblings. The boy and his siblings were removed from the parents’ home after a child abuse case determined the boy was subjected to ritual torture and sexual abuse. The boy has been experiencing frequent temper tantrums and recently got into trouble at school for exposing himself in class. The grandmother shares with the therapist that she, too, was abused as a child and states, ”he just needs to deal with it like I did and move on. There is no excuse for this type of behavior.” Which of the following actions should the therapist take in this case? Score: 1 of 1 Correct A. Assist the grandmother in gaining empathy for the boy and understanding how his behavior is a result of the abuse he endured Rationale: The best answer choice for this question is A. The vignette notes it is the grandmother and boy in the room, so it is these two people actions would be directed toward, meaning answer B can quickly be eliminated. Answer D is incorrect because there is nothing in the vignette that would indicate the boy’s behavior is abusive; we only know he has temper tantrums-and the exposure in class may or may not be pointing to sexualized behaviors. This leaves us with answers A and C. While both A and C are good options, answer A directly responds to the grandmother’s comment, “he just needs to deal with it,” demonstrating a clear lack of empathy for the boy. Answer C would only be possible if the boy feels safe with his grandmother and enhancing her level of empathy and understanding would create an environment that would allow the boy to express himself without fear that his feelings would be dismissed. (Treatment) B. Help the grandmother and grandfather secure a healthy relationship between them and the children to ensure the existence of proper supervision C. Facilitate the boy’s expression of feelings about the abuse with his grandmother through the use of play therapy D. Assist the boy in identifying more adaptive techniques to have his needs met without using abusive or sexualized behaviors

Answer 57

A 6-year-old client is referred to therapy by his teacher. The teacher recommended the parents pursue therapy for their son because he is reporting frequent nightmares and has been bedwetting. Which of the following actions should the therapist initially take to assess the client? Score: 1 of 1 Correct A. Ask the parents if there have been any recent changes that would affect their son’s behavior. Rationale: The correct answer is A. The initial starting point would be to identify external factors leading to the client’s behaviors. Answer B is too extreme, nightmares and enuresis could be signs of sexual abuse, but we would want to see additional information and also rule out other reasons before considering this possibility. Answer C might be considered, but the nightmares in conjunction with bedwetting point more toward stress than organic issues. Answer D is also a possibility, but the starting point would be to identify external factors, and then move into how the parents manage his behaviors. Answer A would be the starting point and based on the information received, we could move to options B, C, or D. (Clinical Evaluation) B. Determine if the client has been exposed to possible sexual abuse. C. Ask the parents the last time the client received a physical exam from his pediatrician. D. Determine how the parents have managed the client’s changes in behavior.

Answer 58

A therapist meets for the first time with a 55-year-old Japanese American male client. The man reports he was in a car accident 3 years ago that caused him to spend several months in the hospital. He has since relied on painkillers to get through the days because the level of pain remains high. The client expresses fears of addiction to pain medication and doesn’t know what to do. He also reports symptoms of low-grade depression and wonders if there is a link between his pain medications and mental health. What actions should the therapist take to clinically manage the case presented? Score: 1 of 1 A. Explore alternative pain management treatments and refer client to his primary care physician to evaluate side effects of prescribed medication. Correct B. Refer client to his primary care physician to determine effects of prolonged use of prescribed medication and refer to pain management clinic. Rationale: The correct answer is B. The second part of Answer A is correct, but the first half makes the answer wrong; it is not the therapist’s role to explore alternative pain management treatments. Answer C is incorrect since a psychotropic medication evaluation is not indicated. Answer D is incorrect because the client expresses fears about addiction, but it’s unclear he actually is addicted. The most appropriate course of action is outlined in answer B, refer the client to his primary care physician to address medication concerns and refer to a pain management clinic, where experts can explore pain management options with the client. (Treatment) C. Refer client to psychiatrist for comprehensive assessment and medication evaluation. D. Refer client to a pain management clinic to explore alternative pain management treatments and refer to substance abuse treatment facility to address pain medication addiction.

Answer 59

A therapist is seeing a woman who works as a corporate lawyer and struggles with depression. The woman complains that most days she does not have time to eat because of her busy schedule with meetings and phone calls. The therapist encourages the client to pack some snacks that can easily be accessed throughout the day. Which of the following statements best describes the therapist’s actions? Score: 1 of 1 A. Illegal since it is outside the therapist’s scope of practice to offer nutritional advice to a client. B. Legal since it is within the therapist’s scope of practice to offer nutritional guidance to a client. C. Legal since it is within the therapist’s scope of practice, but unethical since it does not honor client self-determination Correct D. Legal since it is within the therapist’s scope of practice and ethical since it is acceptable to offer problem solving suggestions Rationale: The correct answer is D. Legally, therapists are able to address nutrition; it is part of the scope of practice. Therefore answer A can be ruled out. Answer B is correct, but is not as complete as answer D, which adds to B and acknowledges our ability to help problem solve. Answer C is incorrect since the second part of the answer is false. Offering problem solving ideas does not go against client’s self-determination. (Law)

Answer 60

A newly licensed therapist suffers from severe migraines and was issued a medical marijuana card by her doctor. Which of the following actions would not lead to disciplinary action by the Board of Behavioral Sciences? Score: 1 of 1 A. The marijuana use is altering how the therapist works with clients. Correct B. The therapist uses marijuana on a regular basis. Rationale: The correct answer to this question is B. It is acceptable for a therapist to use marijuana in accordance with state laws. However, if the use affects the therapist’s work with clients, is used in places outside the therapist’s private residence, or is used while driving, and the client is caught engaging in these actions, the BBS could take action. This disciplinary action could include suspension or revocation of the therapist’s license. (Law) C. The therapist uses marijuana in locations outside their private residence. D. The therapist uses marijuana when operating a vehicle.

Answer 61

A couple brings their 14-year-old son to therapy because he has recently been acting out at home and at school. During the intake, the therapist learns the parents are constantly fighting and are working through a possible separation. The son informs the therapist that he’s tired of his parents constantly fighting and trying to get him to take sides. The mother informs the therapist that the couple will continue living together until their son’s behavior improves. How would a psychodynamic therapist address the parents in this case? Score: 0 of 1 A. Tell the couple that the son is using introjection in response to the parents’ constant fighting and encourage them to attend co-parenting counseling. B. Tell the couple that the son is using identification in response to the parents’ constant fighting and discourage the couple from staying together for the sake of the son. Incorrect C. Interpret the son’s behavior as a response to the couple’s fighting and discourage the couple from staying together for the sake of the son. Should have chosen D. Interpret the son’s acting out behavior is likely a response to the parents’ constant fighting and encourage them to attend co-parenting counseling. Rationale: The best answer for this question is D. Answers A and B might seem like good options because they are using terms that are linked to psychodynamic therapy. However, a psychodynamic therapist would never use this type of jargon when talking with the parents. While the son’s behaviors can be linked to the defense mechanism “identification,” the therapist would not describe it as such when addressing the parents. Answer D is also speaking to identification, but has the therapist using laymen terms to interpret the reason for the son’s behavior when discussing it with the parents. Answer C is incorrect because the therapist would not discourage the parents to stay together for the sake of their son. (Treatment)

Answer 62

A therapist working in a family agency meets with a single mother and her three children who live in public housing across the street from a power plant. A teacher referred the family because the children regularly presented as fatigued and frequently missed school due to illness. The mother reports that she has no medical insurance and works two jobs to support her family but still struggles to get by. Which of the following short-term goals should the therapist initially consider in this case? Score: 1 of 1 A. Assist the mother in locating more appropriate living arrangements away from the power plant. B. Advocate on behalf of the client with the Department of Health to help ensure the safety of the family. Correct C. Assist family in connecting with community health clinical for a medical evaluation at a community health clinic. Rationale: The strongest answer is C. The most appropriate step the therapist can take, while remaining within scope of practice, is to refer for a medical evaluation. Answers A, B, and D all include an assumption that the proximity to a power plant is having adverse health consequences. Therapists do not have the training to know whether or not this is true. If the doctors at the community health clinic have concerns regarding environmental factors contributing to poor health, they could engage the Department of Public Health. (Treatment Planning) D. Increase the mother’s awareness of the link between their living environment and the children’s ongoing health issues.

Answer 63

A therapist is part of a multidisciplinary treatment team in a residential treatment facility. The therapist is providing individual therapy to a resident who is also involved in group therapy with a social worker and receiving medication management from a staff psychiatrist. How should the therapist manage the legal and ethical obligations surrounding confidentiality? Score: 0 of 1 Should have chosen A. Inform the client of the collaborative aspect of a multidisciplinary team and ensure they understand that information can be shared and client records can be accessed by other members of the team. Rationale: The best answer to this question is A. Answers B, C, and D all misrepresent what information can be shared when working on a multidisciplinary team. All members of the team working within the same facility can access the client’s records. Answer A clearly states the guidelines regarding accessibility of client records for multidisciplinary teams. (Ethics) Incorrect B. Inform the client of the collaborative aspect of a multidisciplinary team and ensure they understand what information will be shared with members of the team and what information will remain confidential. C. Inform the client of the collaborative aspect of a multidisciplinary team and ensure the client understands the therapist may discuss treatment, but individual therapy records are confidential. D. Inform the client of the collaborative aspect of a multidisciplinary team and ensure the client understands information shared in individual therapy and records are confidential.

Answer 64

A 69-year-old man is court-ordered as part of his probation to attend therapy following a physical altercation at a local bar. The man reveals a history of substance abuse and uncontrollable anger when he is under the influence of alcohol. He tells the therapist that his wife is scared of him and told him that he cannot return home until he gets help, but he plans to go home and “remind her who is in charge.” The therapist senses that the man is currently under the influence of alcohol and he appears agitated. How should the therapist manage safety concerns in this case? Score: 0 of 1 Incorrect A. Inform the client that you must end the session and contact the police due to client’s threat toward wife and current use of alcohol. B. Inform the client that you must end the session and contact the court due to client’s probation violation. C. Immediately leave the therapy room and contact law enforcement due to client’s danger to therapist and others. Should have chosen D. Demonstrate empathy to deescalate the situation and calmly seek clarification of client’s plans to return home. Rationale: The correct answer is D. The information shared by the client alludes to a situation in which our duties under Tarasoff are triggered. Answer D allows the therapist to assess further, while simultaneously attempting to deescalate the situation. This is the best starting point based on the information provided. If the client does not respond to the therapist’s attempts to deescalate, then the therapist could move on to the actions outlined in answers A or C. Answer B is wrong because it is unclear the client has violated terms of probation and therapists generally do not report to probation information other than attendance. (Crisis Management)

Answer 65

A 12-year-old girl is brought to therapy by her parents who believe their daughter needs individual therapy. They inform the therapist that their daughter’s grades have recently fallen and she is increasingly argumentative and defiant at home. Which of the following actions should the therapist take to complete an assessment? Score: 0 of 1 A. Meet with the daughter individually to assess safety concerns due to abrupt changes in behavior Meet with the parents separately to assess for external stressors affecting their daughter’s behavior Utilize the Beck Depression Inventory with daughter to assess for possible depression B. Meet with the daughter individually to assess safety concerns due to abrupt changes in behavior Meet with the parents separately to assess for external stressors affecting the client’s behavior Meet with entire family and complete a multigenerational genogram Should have chosen C. Meet with the entire family to gather family history and current stressors Meet with the daughter individually to complete a comprehensive biopsychosocial assessment Request release to speak with the daughter’s teachers Rationale: The correct answer is C. The vignette notes the client’s behaviors have changed, but the shift is described as increasingly problematic, not abrupt. In addition, the symptoms described, falling grades, argumentative and defiant behaviors do not clearly point in the direction of safety concerns. Therefore, answers A and B can be eliminated. The symptoms described are not indicative of possible biological concerns, so D can also be ruled out. Answer C is comprehensive and including a release to speak with the teacher is important since the client’s grades have fallen and it would be important to understand if the defiant behaviors are occurring at school as well. (Clinical evaluation) Incorrect D. Meet with the entire family to gather family history and current stressors Meet with the daughter individually to complete a comprehensive biopsychosocial assessment Provide referral to medical doctor to assess for underlying biological concerns

Answer 66

A 34-year old client with a diagnosis of anxiety has been meeting with a therapist for six months. She tells the therapist that she recently relapsed and has been using heroin daily for several weeks. The client informs the therapist that she no longer wants to address her heroin use, since her best efforts to quit have failed, but would like to continue working on her anxiety. The therapist informs the client that it is unethical to collude with the client’s ongoing substance use and explains how substance use affects mental health. What additional steps should the therapist initially take in this case? Score: 0 of 1 A. Provide the client a referral to psychiatrist for complete assessment and medication evaluation Should have chosen B. Refer client to an MD for a medication evaluation to identify a regimen that would reduce cravings and increase motivation to recover from addiction Rationale: The best answer option is B. Answer D can be eliminated immediately because we cannot continue treatment for anxiety while disregarding the role of heroin in the presenting problems. Substance abuse would need to be addressed before or while also treating the anxiety. Answer C is incorrect because it would be premature to terminate with a client who continues to want support. In addition, the client has stated she does not want to address the substance use, so just providing a referral for substance abuse treatment would not be clinically indicated. Answer A is a possibility, but is not as complete as answer B. Answer B directly acknowledges the client’s stated concern of not being able to overcome addiction and engages medical support to augment psychotherapy. (Treatment Planning) Incorrect C. Terminate treatment with the client and provide referrals to substance abuse treatment facilities D. Continue treatment with the client to address anxiety and treat issues of addiction at a later time

Answer 67

A 22-year-old client was killed during her spring break trip in a boating accident. The father, the executor of the client’s estate, requests his daughter’s records as part of a wrongful death lawsuit against the driver of the boat. What action should the therapist take in this case? Score: 0 of 1 Incorrect A. Maintain the client’s confidentiality since the right to confidentiality persists beyond a client’s death. B. Inform the father you will not provide records unless you receive a court-order Should have chosen C. Inform the father you will provide the records once a written request is received Rationale: The correct answer is C. The father has a right to the client’s records since he is the executor of the estate, so we can eliminate answer A and B. Confidentiality does persist beyond death, but as the executor, the father technically has a right to records. Answer D might seem tempting, however, the law is not concerned with the effect access to records would have on the father, it is only concerned with the effect on the client. The only viable option, based on those provided, is answer C. (Law) D. Maintain confidentiality and deny request if the therapist believes information in records would cause emotional damage to the father

Answer 68

A married couple, ages 73 and 70, meet with a therapist for couples counseling. The couple reports they have been married for 43 years, have two children and five grandchildren. The husband worked as a general contractor for many years and recently retired, while the wife continues to work in real estate. The couple is fighting because the husband would like to move out-of-state due to the cost-of-living in California being so high, but the wife does not want to leave their children and grandchildren. The wife feels that her husband only cares about finances and does not respect her career or needs. The husband rolls his eyes when his wife speaks and says that she has dictated their entire life together and it’s about time he gets to make some decisions. Which initial and long-term objectives should the therapist consider when developing a treatment plan for this couple? Score: 1 of 1 Correct A. Initially increase level of empathy demonstrated between partners and long-term increase the level of cooperation in the decision-making process. Rationale: The correct answer is A. The question is specifically asking for initial and long-term objectives, which is the same as asking for goals. Answers B and D can both be eliminated because they include interventions rather than objectives in the first part of each answer. The initial objective in answer C is too heavily focused on content, rather than process, and does not get at the underlying issues presented in the vignette. The husband and wife’s complaints toward each other highlight a lack of empathy; the wife feels the husband does not respect her career or needs and the husband feels the wife has consistently dictated decisions. Neither is understanding the position of the other, thus increasing empathy would be a strong initial goal. Once empathy is addressed, the couple can move toward a more collaborative and cooperative decision-making process in all aspects of life. (Treatment Planning) B. Initially teach the couple basic communication skills and long-term assist the couple in determining whether or not they want to stay in California. C. Initially increase the couple’s understanding of the costs and benefits of staying in-state and long-term establish a reciprocal and respectful relationship. D. Initially teach the couple conflict resolution skills and long-term ensure Franklin and Maria each feel their needs are being met.

Answer 69

A therapist meets for the first time with a new client. As the therapist begins the process of informed consent, the client reports that he is familiar with consent forms, wants to skip the process and “dive right into therapy.” How should the therapist manage this ethical dilemma? Score: 0 of 1 A. Request the client sign documentation stating the therapist attempted to provide informed consent and he is waiving his right to receive it. Incorrect B. Inform the client it would be unethical to proceed with therapy without first providing informed consent. C. Encourage client to review the informed consent documents outside of therapy and document client’s request in psychotherapy notes. Should have chosen D. Honor the client’s right to self-determination, provide consent forms in writing, and document request in client’s file. Rationale: The correct answer is D. Answer A is incorrect because the therapist is not required to receive signed documentation if the client declines participating in the process of informed consent. Answer B is incorrect because it is ethical to proceed with therapy for adults without informed consent if they decline to review it. Answer C has a detail that makes it incorrect; the therapist would need to document this in their client’s medical records, not psychotherapy notes. Answer D correctly states that we can honor client’s decision not to review informed consent, but must document it. If the therapist is a HIPAA covered entity, the therapist would need written acknowledgement that client received the Notice of Privacy Policies; documenting this in records would not be sufficient. (Ethics)

Answer 70

Max, a 9-year-old boy, is brought to therapy by his father and adoptive mother. During the intake the therapist learns that Max has numerous mental and physical health issues related to fetal alcohol syndrome, and is estranged from his biological mother, whom the father describes as an alcoholic. The father confirms he divorced Max’s biological mother shortly after his birth, that he remarried and has 2 children from his new marriage. He is concerned that Max is unable to get along with his siblings and Max’s ongoing behavioral issues are causing marital discord. Which of the following should the therapist consider when developing a treatment plan? Score: 1 of 1 A. Determine appropriate DSM diagnosis for Max Explore the father’s expectations of treatment Determine if Max should be seen individually or if family therapy is indicated B. Determine appropriate DSM diagnosis for Max Explore the parents’ expectations of treatment Refer father and stepmother for couples counseling with intention to collaborate with couples’ therapist C. Determine if Max should be seen individually or if family therapy is indicated Refer Max for neuropsychological testing to understand the effects of fetal alcohol syndrome on functioning Request release of information to collaborate with collateral resources Correct D. Determine if Max should be seen individually or if family therapy is indicated Refer Max for neuropsychological testing to understand the effects of fetal alcohol syndrome on functioning Explore the parents’ expectations for treatment Rationale: The strongest answer is D. The vignette is vague regarding the treatment unit, so answers that address treatment unit are a priority. Answer B, as with answer A, includes determining the appropriate diagnosis for Max, which may or may not be as important if family therapy is deemed clinically appropriate. Therefore answers A and B can be eliminated. The first 2 parts of answers C and D are identical. Therefore, you want to compare the final component of each answer and decide which is strongest. Answer C includes requesting the release to collaborate with collateral resources, which is important during treatment, but is not as important in treatment plan development. The 3rd part of answer D includes exploring expectations for treatment, this is the more appropriate answer for a treatment planning question. (Treatment Planning)

Answer 71

Audrey, a 10-year-old girl, is referred to therapy by her public school teacher. Audrey was diagnosed with Attention-Deficit/Hyperactivity Disorder when she was younger. Her teacher referred her for individual therapy because she has been increasingly instigating arguments with her classmates and disrupting the class. The teacher believes Audrey’s behaviors are too severe for her to remain in the general education class and would like her to be transferred into the special day class. The parents do not believe this change is warranted and have been fighting with the school psychologist and teacher. How should the therapist initially proceed in this case? Score: 1 of 1 A. Assess client’s compliance with medication Consult with the school psychologist and client’s teacher Teach client self-control strategies to decrease classroom disruptions B. Assess client’s compliance with medication Consult with the school psychologist and client’s teacher Request a meeting with parents, teacher and school psychologist Correct C. Explore what the parents and client hope to achieve through therapy Refer client for a medical and psychological examination Consult with the school psychologist and client’s teacher Rationale: The correct answer is C. Answers A and B wrongly assume the client is taking medication, which is not stated in the vignette. In addition, the final part of answer A is also incorrect because teaching client self-control strategies would be more of a middle stage action. Answer D also includes teaching self-control, so that answer choice can be eliminated as well. Answer C is left as the strongest answer option, with each component of the answer providing an opportunity for the therapist to gather information and collaborate/consult with other professionals involved in the child’s care. (Treatment Planning) D. Explore what the parents and client hope to achieve through therapy Refer client for a medical and psychological examination Teach client self-control strategies to decrease classroom disruptions

Answer 72

A young male African American therapist works in an outpatient clinic located in an agricultural community that is largely populated by farm workers from South America. The therapist meets with a teenage boy whose father was recently deported. During the intake session, the therapist asks the client about his family history, his immigration status and that of his other family members. The client becomes upset and tells the therapist, “It’s none of your business! Why would I trust a gringo like you?” How should the therapist ethically manage the situation? Score: 1 of 1 A. Apologize to the client and explain how therapy works and assure him the answers to these questions will be kept confidential. Correct B. Acknowledge the client’s concerns and process his feelings regarding cultural differences between client and therapist. Rationale: The correct answer is B. Answer A is incorrect because the therapist does not know what information the client would provide in response to questions. It is possible information shared would require the therapist to report (i.e. child abuse, elder abuse, Tarasoff). In addition, apologizing in this case does not make sense. Answer C is not as strong as answer B because it excludes processing with client, which is important. Answer D is also a weaker option because it, too, lacks processing with client. Answer B acknowledges the client’s concerns and provides an opportunity to process the stated differences between the client and therapist. (Ethics) C. Align with the client regarding the injustices of the immigration system and validate his feelings toward the therapist who is in a relative position of privilege. D. Validate client’s feelings of distrust toward non-Latino Americans and explore what the client hopes to achieve through the therapeutic relationship.

Answer 73

A therapist meets with a 5-year-old boy and his parents, Janet age 48 and Jose age 50. The parents explain they experienced difficulties trying to conceive and eventually were able to get pregnant through IVF. Their son’s pediatrician referred them after a recent check-up. He exhibits impairment in social communication and appears disinterested in the conversation occurring around him. The parents tell the therapist they are concerned he always appears to be an outcast in social settings and exhibits rigid behaviors. Which of the following diagnoses is most likely in this case? Score: 1 of 1 Correct A. Autism Spectrum Disorder, Level 1 Rationale: The correct answer is A. The clues that point to a diagnosis of autism spectrum disorder include a deficit in social-emotional reciprocity (lack of engagement in conversation) and rigid behaviors. The intensity or severity of symptoms is limited, thus pointing to the specifier of level 1. Answer B can easily be eliminated since there are no signs of disobedience or hostility toward authority. Answer C is a little trickier, but selective mutism is appropriate when a person does not speak in certain situations; this is not the case as presented. Answer D, can be ruled out because the diagnosis is too extreme based on symptoms. The client does exhibit diminished emotional expression, which is linked to schizophrenia, but that is the only symptom that points in this direction. The totality of symptoms are better explained through autism spectrum disorder, level 1. (Clinical Evaluation) B. Oppositional Defiant Disorder C. Selective Mutism D. Schizophrenia, Childhood Onset

Answer 74

A therapist is working at a homeless shelter and provides therapeutic services as well as case management to residents of the shelter. The therapist meets with a new resident, a 27-year-old woman, with a history of heroin use and Bipolar II. The woman shares she has lived on the streets for as long as she can remember and is estranged from her family. She informs the therapist that while living on the street she was sexually and physically assaulted on numerous occasions. What adjunctive resources should the therapist consider in this case based on the client’s presenting issues? Score: 0 of 1 Should have chosen A. Narcotics Anonymous Medical care Social Security Disability services and Medi-Cal Rationale: The best answer choice is A. We can quickly eliminate answers B and C because the question is focused on resources. While family therapy may be something that is considered further down the road, it would not constitute a resource. Answer D can be eliminated because employment training would not be considered until basic needs are met. Answer A is strongest because all components focus on the client’s more immediate needs; Narcotics Anonymous addresses stated heroin use, medical care addresses substance use and Bipolar Disorder, as well as other health issues that may have gone untreated when living on street, and SSD/Medi-Cal would provide financial assistance to aid in receiving treatment. (Treatment Planning) B. Narcotics Anonymous Medical care Family therapy C. Psychiatric care Social Security Disability services and Medi-Cal Family therapy Incorrect D. Psychiatric care Individual therapy Employment training

Answer 75

A 67-year-old woman has been receiving individual therapy for two years. She initiated therapy following the loss of her husband. The woman was recently diagnosed with a degenerative heart disease that increasingly causes her immense discomfort and prevents her from participating in most daily activities. During a session, the woman discloses that she wishes to stop medical treatment and end her life because her illness is terminal and her quality of life has deteriorated. The therapist has strong beliefs regarding end-of-life decisions. How should the therapist ethically manage responsibilities toward this client? Score: 1 of 1 A. Disclose the therapist’s concerns and refer client to therapist with expertise in working with terminal illness. B. Encourage client to identify the aspects of her life that make it worth living, including family and possible medical advancements. C. Discuss the differing moral and ethical principles that exist between the therapist and client. Correct D. Seek consultation that allows the therapist to provide treatment that aligns with the client’s belief system. Rationale: The correct answer is D. Answer A is possible, although the vignette does not actually state what the therapist’s beliefs are--based on the information provided, all we know is the therapist has strong beliefs, it is unclear if they conflict or align with the client’s beliefs. In addition, the client has been working with the therapist for two years, so consultation would come before referring out. Answer B does not honor the client’s right to self-determination, and is pushing for the client to reject the idea of ending her life (“The End of Life Option Act” was enacted in 2016, making this legal in California). Answer C is incorrect since the purpose of therapy is to support the client and allow them to process their thoughts and feelings, not discuss the differing moral and ethical beliefs between client and therapist. Answer D is the most appropriate answer choice; it would be important for the therapist to seek consultation around this difficult subject and ensure they are meeting the legal and ethical standards while supporting their client. (Ethics)

Answer 76

Marlena, a 45-year-old stay-at-home mother presents for therapy following the unexpected loss of her mother. Marlena is an only child and has not spoken with her father since she was a young girl. She states, “I feel all alone in the world now and I don’t know how to be happy. I find myself sitting around most days watching the world pass me by.” Which of the following goals would an Existential therapist include in the treatment plan for this client? Score: 1 of 1 Correct A. Help Marlena develop a sense of purpose in her life and increase understanding that she alone is responsible for the trajectory of her life. Rationale: The correct answer is A. Answers B and D are very narrow in focus and can both be ruled out. The client has expressed feelings of loneliness, sorrow, and lack of engagement in any activities. Answer B focuses solely on the feelings of loneliness, while ignoring the other issues presented by the client. Similarly, answer D only focuses on the client’s relationship with her father. Answer C assumes the client is struggling to cope with anxiety, which is not clearly stated in the vignette--in fact, her symptoms point more toward depression than anxiety. Answer A is a general goal that aligns with Existential therapy and the information provided in the vignette. (Treatment Planning) B. Identify how Marlena views her existing relationships and improve her awareness of how they provide meaning. C. Increase Marlena’s ability to be present with anxiety that increases with death of loved ones and develop a greater sense of purpose. D. Assist Marlena in taking responsibility for the lack of contact with her father and improve ability to focus on the present.

Answer 77

A therapist has been working with Nancy, a 27-year-old Latina woman, for 2 years and they have developed a strong rapport. Nancy informs the therapist that she was accepted into an MBA program at a university in Oregon, about 25 miles from the border of California and will be relocating to the university’s town. She expresses concerns about leaving and asks to continue treatment with the therapist. She notes that the university is close to the California border, she will be visiting frequently, and plans to return in 2 years. What is the therapist’s legal obligation in this case? Score: 1 of 1 Correct A. Provide the client with referrals for therapists located in the state of Oregon since that is where the client will reside. Rationale: The best answer available is A. The client will be relocating to a different state and needs to work with a therapist who is licensed to practice therapy in that state. This vignette includes additional information that is irrelevant to the legal issues presented. We cannot treat someone residing and located in a different state, regardless of their proximity to the border, how often they will visit, or if they state an intent to return. We can therefore rule out answers B and C. Answer D is incorrect because we are not legally required to continue meeting with the client until she moves. It is possible to properly terminate sooner, if indicated. (Law) B. Agree to continue providing treatment since the client is in close proximity to California and will only be temporarily residing out of state. C. Complete informed consent specific to telehealth, including a review or risks and benefits, and conduct online therapy. D. Continue meeting with client until she moves and ensure appropriate steps for termination.

Answer 78

A father and his two daughters, ages 5 and 10, are referred to therapy by their rabbi following the death of their mother. The mother had been fighting pancreatic cancer for a year and after spending several weeks in the hospital she passed away. The father appears stoic and the daughters sit quietly next to him, the younger staring at a picture on the wall and the older keeping her eyes focused on the floor. How would a Humanistic-Existential therapist intervene in the beginning stage of treatment? Score: 0 of 1 A. Invite the family members to share memories of their mother and explore what they hope to achieve in therapy Incorrect B. Invite the family members to identify the emotions they are experiencing while sitting in the room with the therapist and what they would say to their mother if she were present Should have chosen C. Provide family members space to sit with their emotions and give them the latitude to talk when they feel it is appropriate. Rationale: The correct answer is C. The treatment unit is the family, so we would immediately knock out answer D, which is focused too heavily on the father. Humanistic-existential therapy focuses on the here and now. Answer A is incorrect because it is focusing on past memories, rather than how the clients are feeling and what they are thinking in this moment. Answer B is a strong choice; however, asking the family members what they would say to their mother would be more of a middle stage intervention. Answer C aligns with Humanistic-Existential therapy and allows the therapist an opportunity to gather information and develop rapport with the client. (Treatment) D. Ask the father to express his current emotional state to demonstrate it is acceptable to be vulnerable and grieve the loss of their mother.

Answer 79

A therapist working on a mental health crisis line receives a call from a male college student who reports he was drinking all night in his apartment during a party and was just raped. The student is hysterically crying and tells the therapist he feels ashamed and does not want anyone to know this happened to him. He is fearful of going back to his apartment because he believes the perpetrator is still there. What actions should the therapist take in this case? Score: 0 of 1 Incorrect A. Recommend the student immediately take himself to the local rape crisis center for support. B. Obtain the student’s current location and call 911 to address safety concerns. Should have chosen C. Obtain the student’s current location and provide referrals for medical assistance and rape crisis center. Rationale: The correct answer is C. In emergency situations, such as this one, it is important to first determine the location of the client. This allows the therapist to determine if the client is in a safe place and also allows for follow up with support services, such as police or ambulance, if the call ends abruptly (i.e. client passes out or phone disconnects). Once we obtain current location, C would also allow for the caller to be connected with emergency services, including medical care, making this the best option available. Answer B has the therapist calling the police, which makes this option incorrect since we could not do so without proper authorization from the caller. Answer A would not be the first step since the client states he does not want anyone to know what happened to him. Answer D is incorrect because in crisis situations the focus is on immediate safety and needs, not the processing of events. (Crisis Management) D. Remain on the phone with student and demonstrate empathy while processing the rape with him.

Answer 80

A 16-year-old boy was referred to therapy by his school counselor. In recent months, his grades have fallen, and he was caught with marijuana on the school campus. During an initial call with the therapist, the mother shares concerns for her son’s safety and fears he may be suicidal. Which of the following actions should the therapist take to assess the client’s risk of suicide? Score: 0 of 1 Should have chosen A. Ask client’s mother if her son’s behaviors have shifted at home and determine if he has access to weapons. Rationale: The correct answer to this question is A. This question is asking you to assess current risk of suicide, which means you want to ask questions about the present. Since the mother is on the phone for an initial call, we want to address the risk immediately and not wait for the client to attend a first session. Therefore we can rule out answers C and D. Answer B asks about family history of mental illness, which is not very relevant to current risk of suicide. Answer A explores the son’s behaviors at home and potential means, making it the stronger answer. (Crisis Management) B. Ask client’s mother to describe her son’s behaviors at home and explore family history of mental illness. C. Meet with client for an initial assessment and administer the Beck Depression Inventory. Incorrect D. Meet with client for an initial assessment and ask if he has attempted self-harm in the past.

Answer 81

A heterosexual couple is referred by the husband’s EAP. The wife tearfully shares that the husband has been spending vast amounts of time on gambling websites and recently lost thousands of dollars. The husband expresses fear that his employer may find out he engages in illegal gambling and would fire him. The wife begins to yell at the husband, “you’ve ruined our lives! We are now in financial trouble because of your gambling and now may lose our only source of income!” Using an addiction model, how would the therapist gather additional information to develop a clinical assessment in this case? Score: 1 of 1 A. Explore the frequency of husband’s gambling Administer Beck’s Anxiety Inventory Discuss wife’s risk for codependency Correct B. Explore the frequency of husband’s gambling Administer an addiction scale inventory Assess for other potential addictions Rationale: The correct answer is B. This question is specifically asking for information gathering answers that focus on addiction. Answer A includes two components that are incorrect. First, the Beck’s Anxiety Inventory does not address addiction. Second, discussing the wife’s risk for co-dependency is not an information gathering action. Answer C is incorrect because it also includes discussion of wife’s risk for codependency. Answer D might be tempting because it addresses the couple’s conflict skills, but that is unrelated to the addiction aspect of the question. This leaves us with answer B, which includes three parts that are each focused on gathering information regarding addiction. (Clinical Evaluation) C. Discuss wife’s risk for codependency Administer an addiction scale inventory Assess for other potential addictions D. Explore the frequency of husband’s gambling Assess for other potential addictions Explore how the couple resolves conflict

Answer 82

A therapist provides individual therapy to a 16-year-old girl who has a diagnosis of Schizophrenia. The client’s parents refuse to give their daughter psychotropic medications due to religious beliefs, and instead use prayer in an attempt to rid her of Schizophrenia. The therapist is concerned because he observes the girl is rapidly decompensating. How should the therapist proceed? Score: 1 of 1 Correct A. File a child abuse report immediately and process the report with the client and her parents. Rationale: The correct answer is A. It is true that declining medical care for religious reasons, in and of itself, does not immediately translate into a mandated child abuse report. However, if the lack of medical attention is causing severe harm to the minor, which is apparent in this case, than a report would be appropriate, answer A. The vignette mentions the client is decompensating rapidly, however, this is not synonymous with danger to self. Therefore, answer B can be ruled out. Answer C might be something the therapist chooses to do, but the priority is to make a child abuse report. Answer D, as noted above, is not accurate and is not a protective enough measure for the client’s diagnosis and stated decline. (Law) B. Initiate a 5150 for involuntary hospitalization due to danger to self. C. Monitor the client’s symptoms and provide psychoeducation regarding schizophrenia and refer to psychiatrist. D. Acknowledge the parents religious rights and identify non-psychotropic treatments available for schizophrenia.

Answer 83

A therapist has been working with a client who is involved in a lawsuit. The client was the victim of an assault and has been receiving therapy for Post Traumatic Stress Disorder since the incident. The therapist receives a court order for the client’s records. What actions should the therapist take to address the legal and ethical obligations presented in this case? Score: 1 of 1 Correct A. Inform the client of the court order and comply with the request for records. Rationale: The correct answer to this question is A. This question has two components to it, legal and ethical obligations. The question stem makes it clear that this is a court order, our legal obligation is to comply with the order and provide records. Answer C can be eliminated because legally, we must provide records whether or not the client signs a waiver. Answer D can also be knocked out because sharing records due to a court order is not considered a breach of confidentiality. The next part of the question is a bit more challenging. We know records must be provided, but how do we most appropriately manage it? Legally, we could provide records without informing the client, but that would not be in the best interest of the therapeutic relationship, so answer B can be eliminated. Answer A addresses both parts of the question correctly, legally we must comply with the court order and ethically, it would be best to inform the client of the request. (Law) B. Document the court order in the records and comply with the request for records without informing the client C. Review client's records for accuracy and request the client sign a waiver for privilege prior to turning over records D. Comply with the request for records and process the client’s feelings around the breach of confidentiality

Answer 84

A therapist has been treating a family consisting of a mother, father, and two children ages 5 and 10. The family was referred for family therapy following a CPS investigation of physical abuse of a minor. During a session, the father appears increasingly agitated and the therapist becomes concerned for her own safety, as well as the safety of the children. How should the therapist clinically manage the situation? Score: 1 of 1 A. Terminate the session with the family and immediately notify Child Protective Services of ongoing risk of child abuse perpetrated by father. B. Attempt to de-escalate the situation by calmly and empathically addressing the father and ask the children to exit the room to ensure their safety. Correct C. Terminate the session immediately, ask the agitated parent to leave the room, and safety plan with other family members. Rationale: The strongest answer is C. The vignette clearly states the therapist is concerned for her own safety and that of the children. Therefore, we want to look for answers that take these concerns into account. Answer A can be ruled out because the scenario provided would not require the therapist to contact CPS; it’s unclear the relationship between the therapist and CPS caseworker and the assumption of an ongoing risk of child abuse is a leap. Answer B addresses the therapist’s concern for the children, but disregards the stated concern for her own safety. Answer D ignores the safety concerns for everyone that is in the room. Answer C is an acceptable option. Therapists have a right to terminate a session if they feel their safety or the safety of other clients is a concern. In addition, answer C includes safety planning, which would be appropriate due to safety concerns. (Crisis Management) D. Attempt to de-escalate the situation by calmly and empathically addressing the father and remind him of the limits of confidentiality.

Answer 85

A 42-year-old female with a diagnosis of Borderline Personality Disorder has been meeting with a therapist for several months and the therapist believes they’ve developed a positive rapport. The client arrives to a session visibly distraught and begins yelling at the therapist that therapy is not helping her, her life is a mess, and stands up to leave the room stating, “I’m sick of all this! Don’t expect to see me again!” How should the therapist clinically manage the situation? Score: 1 of 1 Correct A. Ask direct, close-ended questions to determine if client has thoughts of harming herself. Rationale: The correct answer is A. Ideally, the therapist would want to acknowledge client’s feelings of anger and then assess for potential danger to self. Since that option is not available, the best choice is to assess for harm, answer A. The client’s diagnosis, in conjunction with her presentation and statement, increases the risk of self harm. Answers B, C, and D are all possibilities, but would come after the therapist conducts a risk assessment. (Crisis Management) B. Ask direct, open-ended questions to determine the underlying cause of the client’s presenting distress. C. Acknowledge client’s feelings of anger toward the therapist and ask client to expand on disappointments with therapy. D. Acknowledge client’s feelings of anger toward the therapist and offer to complete a termination session with client.

Answer 86

A therapist is working with a 37-year-old woman who identifies as an adult child of an alcoholic (ACOA). During the assessment the therapist learns that both of the client’s parents severely abused alcohol. The client describes a family life that was extremely chaotic and, as the oldest of three children, she was frequently responsible for ensuring her younger siblings basic needs were met, while hers were often overlooked. The client has a history of dysfunctional interpersonal relationships and has experienced long bouts of depression. Which of the following goals should be included in the treatment plan for this case? Score: 0 of 1 A.Assist the client in developing a stronger sense of self and ability to advocate for personal needs Increase understanding of characteristics of healthy relationships Decrease client’s tendencies to perceive self as victim B. Assist the client in developing a stronger sense of self and ability to advocate for personal needs Increase understanding of characteristics of healthy relationships Decrease client’s reliance on others for approval Incorrect C. Assist client in understanding the link between childhood experiences and presenting problems Increase client’s ability to identify needs and express them to others Increase client’s ability to take responsibility for personal actions Should have chosen D. Assist client in understanding the link between childhood experiences and presenting problems Increase client’s ability to identify needs and express them to others Increase client’s ability to identify cognitive distortions and challenge negative thoughts. Rationale: The correct answer is D. The first two parts of answers A and B are acceptable, but the final part of each is incorrect. Nothing in the vignette points to the client feeling like a victim or relying on others for approval. Therefore, both of these answers can be eliminated. You are left choosing between answers C and D, which are identical except for the final part of each. Through process of elimination, the strongest answer is D. There is nothing included in the vignette that would point to the client’s lack of taking responsibility for personal actions. The client may or may not struggle with this; it is unclear based on the information provided. Answer D is the only answer choice that does not make assumptions about the client. This makes it the strongest answer choice available. (Treatment Planning)

Answer 87

A therapist recently joined an insurance panel and as a result is considered a HIPAA covered entity. One client the therapist works with has received treatment for depression and anxiety. The client is HIV positive. When complying with the insurance company’s request for client records, which of the following actions should the therapist take to manage their legal obligations? Score: 1 of 1 A. Provide the client’s medical records and redact any information that identifies the client’s HIV status. B. Provide the client’s medical records in full since a therapist would never include a client’s HIV status in their record. Correct C. Provide the client’s medical records in full, including any reference to the client’s HIV status. Rationale: The best answer to this question is answer C. The therapist is required to provide the full medical record and this would include any references to the client’s HIV status. Answers A and D can be ruled out because we cannot selectively redact information from the medical record, nor deny the insurance company’s request. Answer B is incorrect because it is appropriate for the therapist to include the client’s HIV status in the medical records if it is shared during the assessment. (Law) D. Deny the insurance company’s request since the medical records would contain information regarding HIV status and it is protected information under the law.

Answer 88

An 83-year-old client initiates therapy and reports that he recently lost his wife and cannot contain his sadness. He shares that they were married for 42 years. He has a 50-year-old son and 48-year-old daughter who travelled to be with him for the funeral, but live in different states with their families. He tells the therapist that he feels all alone and does not think he will be able to resolve his feelings of profound loss. He expresses feelings of emptiness and lack of purpose without his companion. What goals would a humanistic therapist versus postmodern therapist establish in this case? Score: 0 of 1 Should have chosen A. A humanistic therapist’s goal would be to assist the client in expanding his physical and emotional awareness in the moment; a postmodern therapist’s goal would be to increase client’s ability to write a new narrative that does not rely on his wife. Rationale: The correct answer is A. Answers C and D have the humanistic therapist focused on the future, which is not as strong as a focus on the here and now. Plus the second part of D is an intervention, as opposed to a goal. Therefore, these answers can be eliminated. The first parts of answer A and B are the same and are strong based on the theoretical approach and the information shared in the vignette. However, the postmodern goal in answer A is stronger than that included in answer B. The client specifically states that he feels a lack of purpose without his wife, so it would make sense to directly address this by helping him write a new narrative that does not rely upon her. This does not mean the man cannot continue to hold feelings for her and grieve her loss, but it allows him to build a new narrative where meaning can exist in her absence. The second part of answer B is an intervention and not a goal, which also makes this answer incorrect. (Treatment Planning) Incorrect B. A humanistic therapist’s goal would be to assist the client in expanding his physical and emotional awareness in the moment; a postmodern therapist’s goal would be to have the client to identify personal and external strengths. C. A humanistic therapist’s goal would be to improve client’s positive outlook of the future; a postmodern therapist’s goal would be to increase client’s ability to write a new narrative that does not rely on his wife. D. A humanistic therapist’s goal would be to improve client’s positive outlook of the future; a postmodern therapist’s goal would be to have the client to identify personal and external strengths.

Answer 89

A male therapist is running a weekly grief group at a local temple. The group is open to people of all faiths in the community. Toward the end of a session a group member expresses discontent in the group and states, “I feel that no one in this group cares about me.” As a psychodynamic trained therapist, what would be the most appropriate response to the group member’s statement? Score: 1 of 1 Correct A. Encourage each group member to respond directly to the client’s statement, while also ensuring the group ends on time Rationale: The correct answer to this question is A. Psychodynamic therapists emphasize containment and part of that is holding to the established structure and boundaries in the group. We can therefore eliminate answers B and D. Answer C is a possibility, but if the opportunity to process while holding to boundaries is an option, that is stronger. Answer A allows other group members to respond to the statement while maintaining boundaries. (Treatment) B. Encourage each member to respond directly to the client’s statement and allow the group to run late, if necessary C. Acknowledge the client’s statement and shelf the issue for the following week to ensure group ends on time D. Acknowledge the client’s statement and allow the group to run late to process the client’s feelings

Answer 90

A school-based therapist conducts a group for parents of teenagers who are enrolled in the school. The group is designed to provide a supportive environment, increase parenting skills, and provide psychoeducation regarding normal adolescent development. In one session, a parent complains that his son is disrespectful at home, doing poorly academically and causes him to feel like a complete failure as a parent. Which of the following interventions would a Cognitive Behavioral Therapist use to address the parent’s concerns? Score: 0 of 1 A. Ask other group members to challenge the father’s all-or-nothing thinking patterns. Incorrect B. Assist the parent in challenging his automatic thoughts and identifying a more nuanced perspective of the son’s behaviors. Should have chosen C. Explore if other parents have similar experiences and use the group discussion as a basis for the parent to challenge his cognitive distortions. Rationale: The correct answer is C. Cognitive Behavioral Therapy believes change occurs when the client is able to challenge their own automatic thoughts and cognitive distortions. Answer A is therefore incorrect because the group members are doing the challenging. Answer B does not engage the entire group, which makes it a weak answer for a group treatment question. Answer D is not strongly linked to CBT. Answer C is a strong answer for CBT and engages the entire group, making it the best answer choice. (Treatment) D. Normalize the parent’s feelings and ask other group members to discuss times when they felt like complete failures.

Answer 91

A prison inmate is referred to therapy because he is reporting symptoms of Major Depression. He reports ongoing sleep disturbance and an inability to perform daily activities that are required of him. Which diagnosis should the therapist consider in this case? Score: 0 of 1 A. Factitious Disorder Incorrect B. Somatic Symptom Disorder C. Conversion Disorder Should have chosen D. Z Code Malingering Rationale: The correct answer is D. This is a difficult question because the information shared in the vignette is limited. However, the lack of information makes it is easy to rule out two of the four choices. Answer B can be eliminated because somatic symptoms disorder requires physical symptoms, which are not mentioned. The same holds true for conversion disorder, so answer C can also be ruled out. This leaves us choosing between factitious disorder and Z code malingering. Factitious disorder would be correct if the client’s complaints existed in the absence of external rewards. Since the client is being rewarded for symptoms (unable to perform daily activities required of him), the more appropriate diagnosis is D, malingering. (Clinical Evaluation)

Answer 92

An elderly Afghani man attends the first session of therapy with his son. The son will not be part of the treatment, but is there to provide information to the therapist and provide translations if any language barriers present. What actions would a Bowenian therapist take in the initial stage of treatment? Score: 0 of 1 A. Inform the son and father that you cannot treat the client with the son present due to potential triangulation. Incorrect B. Engage the son in the therapeutic process and ask the father and son to collaboratively develop a genogram to gather a more complete understanding of the multigenerational emotional connections. C. Encourage the son to participate in family therapy and assess the level of familial differentiation. Should have chosen D. Inform the son it would be inappropriate for him to serve as translator due to confidentiality concerns. Rationale: The correct answer choice is D. The vignette clearly indicates that the son will not be part of treatment. This information allows us to eliminate answers A, B, and C. Regardless of the theoretical orientation, we must ensure ethical guidelines are being followed. In this case, the therapist must protect the client’s confidentiality, so the son should not serve as a translator. (Ethics)

Answer 93

Michael, a 17-year-old teenager was diagnosed with ADHD several years ago. He shares that he stopped taking his prescribed medication and has been using marijuana supplied by a friend. He feels the marijuana is helping and would like to get a medical marijuana card. However, he needs parental consent and doesn’t think his parents will agree to provide it. How should the therapist clinically manage the situation? Score: 0 of 1 Should have chosen A. Refer Michael back to psychiatrist to discuss medication regimen and offer the option of collateral session with parents to discuss medication options Rationale: The correct answer is A. The priority in this scenario would be a referral back to the psychiatrist since the client has changed his medication regimen without the psychiatrist’s input or knowledge. Answer C does not address the psychiatrist and can therefore be eliminated. Answer D is wrong because it disregards the client’s desire to obtain a medical marijuana card immediately. Answer B also has problems and can be eliminated. In this case, the client is expressing a desire to use marijuana as medication, not recreational use, so the conversation about risks and benefits would be more appropriate between client and psychiatrist rather than the therapist. Answer A is left as the strongest option available. The client expresses doubts about the parents consenting to a medical marijuana card, but not outright denial. Thus, it would be most appropriate to offer the collateral session with the client’s parents. (Treatment) Incorrect B. Refer Michael back to psychiatrist to discuss medication regimen and discuss the risks associated with ongoing marijuana use C. Validate Michael’s concerns regarding prescribed medications and discuss risks associated with marijuana use D. Refer Michael back to psychiatrist and encourage client to wait for 18th birthday when he can apply for his own medical marijuana card

Answer 94

A therapist is seeing Taylor, a young African-American female client with a diagnosis of Bipolar I Disorder. Taylor tells the therapist that she believes her symptoms have stabilized and she no longer wants to take medications. She hates the side effects, including weight gain and a decreased libido, which is causing a lack intimacy in her marriage. She also feels her psychiatrist is quick to prescribe medications and questions his motivations and attitude toward her because of her race. Which of the following actions should the therapist take in this case? Score: 1 of 1 Correct A. Validate Taylor’s feelings about medication side effects and acknowledge historical bias against minorities in the mental health field Rationale: The strongest answer is A. In this question, the client’s stated concerns need to be addressed. The vignette notes the client is African-American and questions her psychiatrists motivations for prescribing drugs because of her race. Therefore, the best starting point would be to acknowledge the reality of historical bias in the mental health field toward minorities. Answer B is incorrect because her stated feelings are based in fact and to jump to reality testing perpetuates the pathologizing of a normal and valid concern. Answer C is a strong answer, but the client is in the room and validating her feelings would come first. Answer D is also a possibility, but as with C, would come after the therapist validates the client’s feelings and concerns. (Treatment) B. Validate Taylor’s feelings about medication and proceed with reality testing to determine current mental status and possible paranoia C. Normalize Taylor’s feelings about medication side effects and obtain consent to speak with psychiatrist about medication management D. Normalize Taylor’s feelings about medication side effects and role play to help her confront psychiatrist regarding concerns

Answer 95

A therapist meets with a new client who recently immigrated to the United States. The client shares that he met his fiance while she was in his country doing missionary work; they fell in love and plan to marry. His wife was born in the United States and the client has concerns regarding their cultural differences and how he can fully adjust to his new life. Which of the following concerns should the therapist take into consideration when assessing the client’s level of acculturation? Score: 1 of 1 Correct A. The pace of acculturation can vary substantially from group to group and client to client. Rationale: The correct answer is A. Answer A is the only option that acknowledges diversity of experience for immigrants and acculturation. Answers B, C, and D provide sweeping generalizations about immigrants that do not allow for the unique experiences of immigrant groups and individuals. (Clinical evaluation) B. Male gendered clients are more likely to experience greater difficulties with acculturation issues than female gendered clients. C. Newly immigrated clients tend to resist rules that contradict those established in their country of origin. D. Newly immigrated clients who share religious similarities with their partners acculturate at a more rapid pace.

Answer 96

A therapist receives a request from a psychiatrist for a former client’s medical records. The therapist terminated with the client six years earlier. How should the therapist manage the legal obligations in this case? Score: 0 of 1 A. Contact the client to request an authorization for release and remittance for cost of copying records. B. Request copy of client’s authorization for release from psychiatrist and provide a summary of treatment. Should have chosen C. Contact the client to discuss psychiatrist’s request and determine what information should be shared. Rationale: The correct answer is C. In this case, the psychiatrist is requesting the entire medical record of a former client, not just a specific type of information. Therefore, the most appropriate starting point would be to contact the client to determine what the client wants to release. The therapist may not want the psychiatrist to know about certain information shared during therapy that is reflected in their records, for example, sexual history or past abuse. Once the therapist completes the actions in answer C, they could move forward with requesting the release and remittance for cost of copies in answer A. Answers B and D would only be considered if the therapist is unable to reach the client directly. (Law) Incorrect D. Request copy of client’s authorization for release from psychiatrist and provide all documents delineated in request.

Answer 97

A therapist who accepts insurance receives an inquiry from a woman who is interested in beginning couples therapy. The woman informs the therapist that she has a diagnosis of Generalized Anxiety Disorder and it is affecting her relationship. The woman also shares that she and her wife are in the process of adopting a child and though they are excited, they want to preemptively address how it could affect her anxiety symptoms. What actions should the therapist take to incorporate human diversity into the treatment plan? Score: 1 of 1 Correct A. Identify community referrals appropriate for LGBTQ families to augment therapeutic services. Rationale: The best answer to this question is A. Since the question is specifically asking about human diversity, we want to find an answer that is focused on the client’s unique experience. Answer B is incorrect because it is an assessment tool rather than an action that would incorporate human diversity into ongoing treatment. Answer C includes a component on insurance, which is in the vignette, but irrelevant to the question being asked. Answer D could be acceptable if that is the treatment modality used by the clinician, but other modalities could also be used that honor human diversity. Answer A is the best option remaining. The referral acknowledges a human diversity issue that exists and offers a referral as an adjunct to therapy. (Treatment Planning) B. Determine if the couples’ sexual orientation is affecting the presenting issue prior to incorporating it into the treatment. C. Identify community referrals to augment therapeutic services and determine what services insurance will cover. D. Incorporate a postmodern or humanistic approach that acknowledges and respects human diversity.

Answer 98

A therapist works in a hospital as a member of a multidisciplinary team and specializes in working with postpartum mood disorders. The therapist meets with a client she believes is experiencing postpartum psychosis. The woman reports a history of depression and anxiety, which was regulated prior to her pregnancy with a combination of CBT and SSRIs. The client informs the therapist that while the staff psychiatrist recommended medication, she is scared to take any because she is breastfeeding. How should the therapist manage the client’s mental health status? Score: 1 of 1 A. Validate the client’s concerns regarding medication risks while breastfeeding and offer to initiate intensive CBT. B. Refer client back to the psychiatrist since the client’s issues are outside the therapist’s scope of practice. C. Encourage client to follow the psychiatrist’s recommendations and begin medications since the benefits outweigh the risks. Correct D. Collaborate with the psychiatrist to determine the most effective way to address the client’s symptoms and risk for decompensation. Rationale: The correct answer is D. The vignette clearly indicates the therapist works in a hospital as part of a multidisciplinary team. Therefore we want to prioritize answers that include collaboration with team members. Answer A is incorrect because it excludes the psychiatrist’s recommendations outright. Answer B would be a strong answer if the therapist were in private practice, but since the therapist works as part of a team with the psychiatrist, this answer is not as appropriate as D. Answer C disregards the client’s concerns about the medications and breastfeeding, so it can also be eliminated. Answer D is the strongest option available since it takes into account the client’s stated concerns and includes the psychiatrist when considering the best options for the client. (Law)

Answer 99

A therapist is treating Josie, a 13-year-old girl who was adopted out of foster care by her parents when she was a little girl. Josie exhibits symptoms that are indicative of Reactive Attachment Disorder. Josie confides in the therapist that she does not trust her adoptive parents and feels they are emotionally abusive toward her. The parents want to develop a healthier relationship with Josie and ask to participate in therapy. How should the therapist manage the ethical responsibilities in this case? Score: 1 of 1 A. Discuss the parents’ request with Josie and honor her self-determination regarding goals and treatment unit. Correct B. Determine validity regarding accusations of emotional abuse and discuss risks and benefits of family therapy with Josie. Rationale: The correct answer is B. The only answer that acknowledges the client’s allegations of emotional abuse is answer B. It is important to assess for emotional abuse before considering how to proceed in treatment and whether or not family therapy or collateral sessions would be appropriate. Answers A, C, and D are all possible options in the future, but not until we assess for emotional abuse and how it is affecting the client. (Ethics) C. Decline the parents’ request and provide a referral for family therapy. D. Invite Josie’s parents to attend a collateral session and collaboratively determine what type of treatment is most appropriate.

Answer 100

An 11-year-old client is brought for therapy by her parents. The parents report a marked shift in their daughter’s social and academic functioning. They share she has recently avoided most social situations and her teacher shared that she appears distracted in the classroom. The therapist assesses for potential abuse and neglect, but determines it is not indicated. Which of the following goals would a Cognitive Behavioral therapist include in a treatment plan for this client? Score: 0 of 1 A. Decrease unhealthy negative thoughts linked to client’s social anxiety Improve client’s social and academic functioning Replace negative thought patterns with healthier ones B. Decrease unhealthy negative thoughts linked to client’s social anxiety Improve client’s social and academic functioning Increase communication between parents and client Should have chosen C. Increase understanding of underlying causes for behavioral changes Replace negative thought patterns with healthier ones Improve client’s social and academic functioning Rationale: The strongest answer to this question is C. Answer A and B include an assumption that the client is experiencing social anxiety. This sentiment is not clearly stated in the question stem and is therefore incorrect. It could be that the client’s behavior is a result of social anxiety, but there could be many other reasons for her behavior. We don’t want to jump to any conclusions. This brings us to choosing between answers C and D. Answer C and D are identical in the first two parts of the answers, so we are comparing “improve client’s social and academic functioning” with “Identify client’s thoughts and feelings toward friends and school.” The latter option included in answer D is an intervention, not a goal. Therefore, after eliminating answer D, the strongest option remaining is C. Answer C addresses all parts of the question asked. (Treatment Planning) Incorrect D. Increase understanding of underlying causes for behavioral changes Replace negative thought patterns with healthier ones Identify client’s thoughts and feelings toward friends and school

Answer 101

A client is referred for treatment by his psychiatrist following his recent job loss. According to his psychiatrist, the client has a history of depression, which was exacerbated by his job dismissal. The psychiatrist prescribed Zoloft for the client, which he successfully used in the past. The client meets with the therapist and reports that he has been taking his medication for over a month, but feels his symptoms are worsening. How should the therapist address the client’s deterioration? Score: 0 of 1 A. Refer client for psychological testing Refer client for vocational counseling Assess for compliance with antidepressants B. Refer client for psychological testing Refer client for vocational counseling Assess for suicidality Should have chosen C. Obtain a release to consult with the client’s psychiatrist Assess for compliance with antidepressants Continue providing psychotherapy Rationale: The correct answer is C. Answers A and B can be eliminated since the information shared in the vignette points more toward the importance of psychiatry and medication management than the need for psychological testing. In addition, the option of vocational counseling in each of the answers is not indicated. The client was laid off from his job, but there is nothing stated in the vignette that points to a lack of job skills or uncertainty regarding job aspirations. Answers C and D are both stronger options since the therapist should consult and collaborate with the referring psychiatrist to discuss client’s emotional deterioration. In addition, since the client notes prescription medication, assessing for compliance would be appropriate. Finally, when choosing between continuation of psychotherapy versus identifying support systems, the stronger option is continuation of psychotherapy. The vignette does not mention a lack of support systems in his life; so selecting this answer would require us to go to “maybeland,” by adding information that is not in vignette. It is, however, appropriate to continue with psychotherapy, making answer C the strongest option available. (Treatment Planning) Incorrect D. Obtain a release to consult with the client’s psychiatrist Assess for compliance with antidepressants Identify support systems available to client

Answer 102

A licensed therapist wants to order new business cards because he is starting a private practice. The therapist also holds a PhD in sociology and decides to include this degree next to his name on his business card. Which of the following statements best describes the therapist’s actions? Score: 1 of 1 A. His actions are legal if he also includes his license number and full MFT title Correct B. His actions are legal if he makes it clear his PhD is in sociology and includes his license number and full MFT title Rationale: The best answer to this question is B. Advertising laws exist to make sure consumers have accurate information before engaging in services. If the advertising presented is accurate and provides clear information that prevents a client from being misled, it would be legal. Answers C and D can therefore be ruled out. Answer A is incomplete; the therapist cannot include the PhD next to his name if he only includes license number and full MFT title. The therapist must make it clear by explicitly stating the PhD is unrelated to the current license. Answer B is the more accurate answer, the therapist is including the PhD, but noting it is in sociology. (Law) C. His actions are illegal because you can only include your license number and MFT title D. His actions are illegal because including PhD can mislead the public and constitutes false advertising

Answer 103

Nicho, a Chinese-American man, and his wife Quinn who is Mexican-American, are referred for couples therapy. They report that since their youngest son left for college they have been fighting a lot. Quinn shares that the fighting can become heated, especially when Nicho comes home from drinking and playing cards with friends. Nicho avoids eye contact with the therapist and says that he feels very uncomfortable airing their private information with a stranger. How should the therapist assess for the potential of domestic violence in this case? Score: 0 of 1 Should have chosen A. Meet with each member of the treatment unit separately to assess for lethality Inquire if fighting ever becomes physical Pay attention to both verbal and nonverbal communication Rationale: The strongest answer is A. The question is asking you to assess specifically for the possibility of domestic violence, so you want to find answers that assist in determining its existence. Answer B is strong, but the final part of the answer is focused more on what happens following a fight, rather than understanding the nature of the fights, which would be more helpful in determining the presence of DV. Answers C and D both assess how cultural differences affect communication, which could be important for treatment planning, but does not help with identifying presence of domestic violence. Answer A is strongest since it separates the clients to offer safety in sharing information without the influence of the partner. It also specifically asks if their fighting becomes violent. The final component of answer A is also very important; as therapists, it’s important to observe both verbal and non-verbal communication. Does either client appear scared; does their body language align with their spoken words or tell a different story? Every part of answer A directly relates back to the question being asked. (Crisis Management) Incorrect B. Meet with each member of the treatment unit separately to assess for lethality Inquire if fighting ever becomes physical Determine how the couple deescalates a fight C. Ask the couple how they reconcile following heated arguments Explore how culture differences affect the couple’s communication style Meet with each member of the treatment unit separately to assess for lethality D. Ask the couple how they reconcile following heated arguments Explore how culture differences affect the couple’s communication style Inquire if fighting ever becomes physical

Answer 104

A therapist has been working with a couple for two years. The couple initiated therapy because of communication problems, but feels their relationship has become stronger and they no longer need therapy. How should the therapist clinically manage this situation? Score: 1 of 1 Correct A. Begin the termination process and review the couple’s intended goals as well as positive changes observed by the therapist over the course of treatment. Rationale: The strongest answer is A. The couple clearly states that they no longer need therapy, so answers C and D can be eliminated because they disregard self-determination. This leaves us with answers A and B. Answer B is strong except there is no indication that adjunctive resources are necessary. Answer A is the strongest option because it provides an excellent starting point for the termination process by collaboratively reviewing goals and emphasizing what the couple achieved. (Treatment) B. Begin the termination process and review the issues that brought the couple to therapy, the potential for relapse, and provide adjunctive resources. C. Determine if the goals of therapy have been achieved prior to terminating and provide the couple with adjunctive resources to receive ongoing support in their relationship. D. Determine if the goals of therapy have been achieved to ensure termination is appropriate.

Answer 105

A therapist has been working with a family for 10 months. The family consists of two fathers, a 10-year-old daughter and a 9-year-old son. One father was diagnosed with cancer and underwent intensive treatment that resulted in his inability to work or provide care for the children. The children initially presented with symptoms of anxiety. How would a postmodern therapist determine when to terminate treatment in this case? Score: 1 of 1 A. The family members are able to express their needs to each other and the symptoms of anxiety have diminished in the children. B. The parents are able to provide an appropriate level of emotional support to their children and the outcome of the cancer treatment is known. C. The family is able to access external supports and the symptoms of anxiety have decreased in the children. Correct D. The family has identified internal and external coping strategies they can access on an ongoing basis and develop a sense of control over their presenting symptoms. Rationale: The correct answer is D. This question is asking more generally about postmodern therapy, which means the answer could include elements of Narrative and/or Solution-Focused. The question is asking how the therapist would know to terminate treatment, which means we are looking for clients achieving goals that are linked to either of these theories. Answer A is more generic and would be acceptable for most theories, and while not incorrect, it is a weaker option since it is not very specific to postmodern theories. Answer B is incorrect because the outcome of the cancer treatment is not a requirement to terminate. Answer C is incorrect because postmodern therapy would not focus on external supports only, but look at clients as capable of coping with their presenting concerns. Answer D includes language linked to postmodern therapy, by accessing internal and external coping strategies. In addition, it incorporates the strength-based approach of postmodern therapy by empowering clients to gain control over the presenting issue. (Treatment)

Answer 106

Maxine, a 16-year-old African American female is brought to therapy by her parents. Maxine attends a private school and is training to become a professional ballerina. Maxine appears to be of normal weight and according to her most recent physical is in good health. Her parents are concerned because they recently discovered that Maxine has been eating excessive amounts of fast food and vomiting afterwards. When the therapist asks Maxine how often she is engaging in this behavior, she states it occurs about twice a week, but insists it is not something she does on a daily basis. Which of the following diagnosis should the therapist consider in this case? Score: 1 of 1 Correct A. Bulimia Nervosa Rationale: The correct answer is A. Answer B can be eliminated because the vignette clearly states the client is engaging in compensatory behaviors (vomiting), which is not a feature of binge eating disorder. Answer C can be ruled out because the client is maintaining a body weight that appears to be at or above a minimally normal level. Finally, since the criteria for bulimia nervosa are met, excessive eating followed by compensatory behaviors, answer D can also be eliminated. (Clinical Evaluation) B. Binge Eating Disorder C. Anorexia Nervosa D. Unspecified Eating Disorder

Answer 107

A therapist in private practice offers supervision to an associate clinician. Unbeknownst to his supervisor, the associate entered into a sexual relationship with his long-term client. The associate/client relationship ended poorly and the client sued the associate and his supervisor for causing her harm. The supervisor met on a weekly basis with the associate and consistently provided him an opportunity to discuss his caseload. Which additional actions would demonstrate the supervisor provided supervision that met the standard of care? Score: 0 of 1 Should have chosen A. The supervisor regularly reviewed all components of associate’s client files including process notes and required associate to occasionally share video or audio recordings of sessions with clients. Rationale: The strongest answer is A. This question is asking which actions the supervisor could take to demonstrate they’ve met the standard of care. It is not asking what is legally required of the supervisor. Answer A is the only option that includes a review of associate’s client files, which would be the most important way to ensure the associate is meeting the standard of care in their treatment. In addition, while it is not required, video and audio recordings allow the supervisor to view the associate’s work and truly understand the type of care they are providing. Answers B, C, and D are inadequate and would leave the supervisor and associate vulnerable to malpractice. These answers all allow the associate to provide ongoing services with inadequate oversight and accountability. You can liken this to the court’s use of medical records as a way of evaluating treatment provided by clinicians in the course of a lawsuit--the records provide documentation that need to be explored during supervision. (Law) B. The supervisor signed the Responsibility Statement of Supervisor and provided an adequate amount of weekly supervision based on associate’s client load. C. The supervisor provided an adequate amount of supervision based on associate’s client load and encouraged associate to occasionally share recordings of sessions in supervision. Incorrect D. The supervisor signed the Responsibility Statement of Supervisor and regularly reviewed legal and ethical guidelines with the associate during supervision.

Answer 108

A son and his mother meet with a therapist for an initial session. They report the father is in the waiting room, has a history of alcohol abuse and an explosive temper that scares the son and mother. Under what circumstances should a therapist see the entire family? Score: 0 of 1 A. Agree to see the family if the father is no longer abusing alcohol and has received individual therapy. Incorrect B. Agree to see the family if the father is no longer abusing alcohol and it is determined he has never been physically abusive. C. Agree to see the entire family if the stated goals of treatment warrant family therapy and the therapist develops a safety plan with the son and mother. Should have chosen D. Agree to see the entire family if the stated goals of treatment warrant family therapy and the father takes responsibility for past actions. Rationale: The correct answer is D. The question wants you to have an understanding of when family therapy would be appropriate and when it would be contraindicated. Answer A and B are incorrect for several reasons. It is possible to provide family therapy, with the father included, even if he is still abusing alcohol. The caveat would be refusing to provide treatment if he shows up to a session under the influence. Answer A is also wrong because individual therapy for the father is not a prerequisite to providing family therapy. In fact, it could be considered an adjunctive support for the dad. Answer B is also wrong because it would still be possible to see the entire family, even if there is a history of physical abuse. Answer C is possible, but it’s not clear a safety plan is required based on the information provided. Answer D first determines if family therapy is indicated, but also assesses the level of insight the father has into his past behaviors. (Clinical evaluation)

Answer 109

A therapist who specializes in working with high conflict couples receives a subpoena. Upon reading the paperwork, the therapist realizes that the subpoena came from a member of a couple the therapist terminated treatment with two years ago. In treatment, this couple was trying to work through issues of mistrust and poor communication. At this point, it is clear they are getting a divorce. The subpoena arrived from the husband’s lawyer who is requesting the records be released as part of the divorce proceedings. What actions should the therapist take in this case? Score: 1 of 1 A. Document the receipt of the subpoena and turn over all of the records. B. Consult with therapist’s attorney and dispense with the subpoena. Correct C. Do not release records and assert privilege on behalf of both the wife and the husband. Rationale: The best answer to this question is answer C. This is a really good example of the question where none of the answers contain the ideal option. Ideally, we would contact the wife first in order to see what she would like to do, but since that option is not available, it would be best for us to assert privilege on behalf of both clients. Answer A is not correct, since we need all members of the treatment unit to waive their privilege before releasing the records. Answer B is incorrect, since it is illegal to either ignore or get rid of a subpoena. Finally, answer D is incorrect because the therapist is obligated to follow the wishes of the client when a subpoena is issued from a lawyer. (Law) D. Reach out to the wife and inform her that the therapist is obligated to comply with the subpoena.

Answer 110

A therapist works at a wellness center located in a public high school. A 10th grade student is referred for individual counseling by several of her teachers. The student is failing all of her classes and there is a shared concern among her teachers that she displays inappropriate behaviors in the classroom. According to her teachers, the student frequently speaks out of turn, argues with classmates, and often appears distracted. Which referral is most appropriate based on the information provided in this case? Score: 1 of 1 Correct A. School psychologist for special education testing Rationale: The best answer to this question is A. Answers B, C, and D may be appropriate in the future, but first we need to understand the underlying cause of symptoms. The only answer that allows us to gather additional information to determine what resources and support would be appropriate is answer A. This would be our starting point, which may or may not lead to the additional referrals included in answers B, C, and D.(Clinical Evaluation) B. School counselor evaluation team to consider a schedule change C. Tutoring to improve academic functioning D. Social skills group to address inappropriate behaviors with classmates

Answer 111

A therapist is working with a 17-year-old female client who has been in the foster care system since she was 12 years old and is planning to transition out of her group home. The client was diagnosed at age 14 with Major Depressive Disorder and Generalized Anxiety Disorder, and was prescribed psychotropic medications. As the client is moving closer to transitioning out of foster care, she’s found her symptoms of anxiety have worsened. She expresses fears of the future and wonders how she will be able to take care of herself. Which of the following adjuncts should the therapist consider to augment therapy? Score: 1 of 1 A. Job training or job placement services Psychiatrist for medication review Legal support services B. Job training or job placement services Legal support services Foster youth mentoring programs C. Community resources for stable housing Legal support services Job training or job placement services Correct D. Psychiatrist for medication review Foster youth mentoring programs Community resources for stable housing Rationale: The correct answer is D. Answers B and C can both be eliminated since it would be imperative that the psychiatrist be involved due to the prescribed psychotropic medication. In addition, answers A, B, and C all include legal support services, but it’s not clear from the vignette that this would be necessary. In addition to including the psychiatrist, answer D also includes resources for stable housing, which links back to the client’s plan to move out of her group home. Plus, it includes a mentoring program, which would be a good way to connect the client with a former foster youth who has successfully transitioned and could provide support. (Treatment Planning)

Answer 112

A therapist has been working with a client for several years. The client has a diagnosis of Major Depressive Disorder and Generalized Anxiety Disorder. How would a Psychodynamic therapist know when it is appropriate to terminate with this client? Score: 1 of 1 A. The client’s unconscious becomes conscious and their repressed emotions have come to the surface B. The client’s unconscious becomes conscious and their defense mechanisms have been identified and dealt with C. The client’s level of self-awareness has increased and the transference dynamic has been resolved. Correct D. The client’s level of self-awareness has increased and the severity of the client’s presenting symptoms have abated Rationale: The correct answer is D. Psychodynamic therapy is insight oriented, so a good time to terminate is when client’s level of self-awareness has increased. In addition, ethically a proper time to terminate is when the client’s presenting symptoms have abated. The only answer that takes the client’s symptoms into consideration is answer D, which is the best answer. Answers A, B and C touch on other goals of psychodynamic theory, however, they do not mention client’s symptoms, which we would take into account when terminating no matter what theory we are operating from. (Treatment)

Answer 113

A therapist meets with a new client who was referred by her EAP for performance issues at work. The woman is in her early-40’s, though she appears older than her stated chronological age. She is slightly overweight, her clothing is torn and messy, and she appears pale and sickly. Which of the following should be the primary focus of the therapist’s initial assessment? Score: 0 of 1 A. Assessment of client’s motivation to improve work performance due to EAP referral. Should have chosen B. Referral for medical examination due to concerns regarding physical appearance. Rationale: The best answer is B. The client is described in the stem as pale and sickly, which points to possible physical problems and the need for a medical evaluation. It would be important to first rule out any underlying medical issues before proceeding with any additional assessments. Answers A, C, and D include potential issues to assess, but not until medical issues are ruled out. (Clinical Evaluation) Incorrect C. Increasing understanding of the employment issues that triggered the EAP referral from perspective of client. D. Assessment of client’s work history including motivation, productivity, and vocational interests due to EAP referral.

Answer 114

Margaret, a single parent, attends therapy with her two children, Suzanne, age 13 and Henry, age 15. The family was referred by Child Protective Services following an investigation of the daughter’s truancy. During the assessment process the therapist learns that Suzanne refuses to attend school because of ongoing bullying, and Henry regularly sneaks out of the house at night to use marijuana and alcohol. The therapist plans to conduct in-home visits with the family for 8 weeks. Which of the following goals would a Systems therapist prioritize when providing short-term therapy? Score: 0 of 1 A. Assist the mother in reclaiming a position of authority with the children to ensure compliance with societal rules and norms. Should have chosen B. Help the mother reposition herself as the person of power and increase the children’s compliance with the family rules collaboratively established in therapy. Rationale: The correct answer is B. Systems therapy focuses on the entire family, not an identified patient. Therefore, answers C and D can be eliminated. Answer B is similar to A in reestablishing the mother’s position in the family. However, B is stronger because the second part of the answer focuses on family rules that are collaboratively established in therapy, as opposed to societal rules, which are more general and less inclusive of the family. (Treatment Planning) C. Improve Suzanne’s school attendance record since her truancy was the reason for the referral. Incorrect D. Assist the mother in developing and articulating clear consequences for misbehavior and connect Henry to substance abuse counseling.

Answer 115

Question 149 A therapist’s client was recently hospitalized due to noncompliance with his medication. When the client returns to therapy after he is released from the hospital, he reports that he no longer wants to engage in Western medicine. He tells the therapist he believes that God, not medication, will help to heal him. How should the therapist proceed in this case? Score: 0 of 1 A. Utilize motivational interviewing to help the client see that managing his illness is beyond a spiritual issue. B. Explore why the client believes God would be opposed to him taking medications if they have helped in the past. Should have chosen C. Discuss the health impacts of being noncompliant so the client can make an informed decision. Rationale: The correct answer is C. The client was just released from the hospital due to noncompliance with his medication, so it would be important to start with a discussion of the health consequences if he chooses to engage in the same behavior again. Answer A is incorrect because motivational interviewing would not try to diminish the role of spirituality, but rather focus on greater compliance with pro-health actions. Answer B inappropriately challenges the client and makes an assumption the client’s understanding of the situation is wrong. Answer D could be an option, but it would be important to first ensure the client understands the health impacts of noncompliance. (Treatment) Incorrect D. Explore the role that religion plays in the client’s overall plan of care.

Answer 116

A therapist working in a community mental health agency receives a call from a distraught 26-year-old male. The man is sobbing, making it a challenge for the therapist to understand everything he is trying to communicate. The man shares he was just assaulted by his partner. Which of the following actions should the therapist take to assess the crisis? Score: 1 of 1 Correct A. Identify current location Determine if medical attention is required Determine if client is in a safe location Rationale: The best answer to this question is A. The priority in this case is the individual on the phone. We would want to identify his current location in case he disconnects or we need to contact emergency services to help him. Answers C and D can be ruled out because they do not include identifying current location. Answers A and B share the same first two components of the answer, so you are going to compare the third part of each answer. The priority, while on the phone with the person, is to determine if he is in a safe location. Answer A addresses all of the immediate concerns. Once we have a clear sense of safety, location, and medical needs, we could move to identifying support systems in answer B. (Crisis Management) B. Identify current location Determine if medical attention is required Identify alternative support systems C. Assess location of client’s partner Determine if client is in a safe location Identify available support systems D. Assess location of client’s partner Identify available support systems Determine if medical attention is required

Answer 117

A therapist working in a community mental health agency has been meeting with a client for 6 months. The client was referred for treatment through the state’s Victims of Crime program. The therapist learns from another clinician in his agency that the client fabricated numerous aspects of the events that led to the client’s referral. Ethically, what actions should the therapist take? Score: 0 of 1 Should have chosen A. Analyze with the client the possible meaning of the lie and inform the client that Victims of Crime must be notified to avoid professional liability for fraudulent billing. Rationale: The correct answer is A. The therapist is receiving payment through Victims of Crime and must provide accurate information for billing purposes. If the therapist knowingly provides false information, their actions would be considered fraudulent and they would be legally liable. The only answer that includes this as an option is A, making it the best choice available. Answer B could be enticing, however, it only encourages the client to disclose, but does not ensure the insurance company is made aware of the false billing. (Ethics) B. Meet the client where he is and encourage client to disclose factual information to Victims of Crime. C. Attempt to uncover the motivating factors for the client’s dishonesty and maintain confidentiality. Incorrect D. Let the client know his dishonesty has been uncovered, process his reaction and maintain confidentiality.

Answer 118

A 44-year-old man is referred to therapy by his probation officer. The client spent several months in jail for auto theft and driving under the influence. Part of his probation requires substance abuse counseling, though he does not believe he has a problem, nor does he feel that counseling is necessary. Which of the following goals should be incorporated into the initial treatment plan? Score: 0 of 1 A. Help client maintain compliance with probationary requirements Decrease frequency of substance use Decrease impulsive behaviors that threaten probationary status Should have chosen B. Help client maintain compliance with probationary requirements Decrease frequency of substance use Increase awareness regarding negative consequences of substance use Rationale: The correct answer is B. This question is a little tricky because the client is denying problems with substance use. However, the client was incarcerated due to his drinking and all of the answers include addressing the substance use, so this will be part of the correct answer. Answers A and C include a goal of decreasing client’s impulsive behaviors that threaten probationary status, which is incorrect since there is nothing to indicate this is an issue. Answer D is also incorrect because it includes the development of refusal skills, which is not a concern based on information provided in the question stem. (Treatment Planning) C. Shift client from precontemplation to contemplation Increase awareness regarding negative consequences of substance use Decrease impulsive behaviors that threaten probationary status Incorrect D. Shift client from precontemplation to contemplation Increase awareness regarding negative consequences of substance use Develop refusal skills to avoid external pressures

Answer 119

Adriana, a 55-year-old Latina woman attends an intake session at a community mental health agency. Adriana was referred to the agency through the Victims of Crime program. The referral was made after she spent time in the hospital as a consequence of her husband severely beating her. She is currently separated from her husband. Adriana reports feeling constantly on edge, crying a lot, and unable to sleep or eat. Which of the following provisional diagnoses should the therapist consider in this case? Score: 0 of 1 Should have chosen A. Z-Code Spouse or Partner Violence, Physical, Confirmed Posttraumatic Stress Disorder Relationship Distress with Spouse or Intimate Partner Rationale: The correct answer to this question is A. The vignette does not include a specific time frame for symptoms so Acute Stress Disorder in answer B can be ruled out. Answer C includes adult physical abuse by a non spouse/partner, which is incorrect since the vignette clearly states the perpetrator was her husband--their current separation does not change this. Answer D includes adjustment disorder with anxiety, but the symptoms are severe enough for PTSD, so this can also be ruled out. (Clinical Evaluation) Incorrect B. Z-Code Spouse or Partner Violence, Physical, Confirmed Posttraumatic Stress Disorder Acute Stress Disorder C. Z-Code Victim of Crime Acute Stress Disorder Adult Physical Abuse by Nonspouse or Nonpartner D. Z-Code Victim of Crime Posttraumatic Stress Disorder Adjustment Disorder with Anxiety

Answer 120

A 6-year-old child is referred by his teacher to a therapist for grief and trauma counseling. The child’s mother passed away when he was a toddler and his father was recently deported. The father’s girlfriend is now the primary caretaker of the child and attends the intake session with him. What actions should the therapist take in this case? Score: 0 of 1 A. Determine if the child has any extended family in the area who would be a more appropriate caretaker for the child. Should have chosen B. Only permit girlfriend to consent if she provides documentation from father giving her authority and conduct a comprehensive assessment to develop treatment plan. Rationale: The correct answer is B. Answer A is not required, as the father is permitted to decide on the caretaker of his child. Answer C is incorrect because only familial relations are permitted by law to sign a caregiver’s authorization affidavit. Answer D is possible, but if the girlfriend were able to provide documentation from the father authorizing her to consent in his absence, this would not be required. In addition, it’s not clear that the goal at this time is reunification. Answer B is the strongest option; if the girlfriend can provide documentation from the father that gives her permission to consent, the therapist can honor this and would conduct an assessment to develop the treatment plan. (Ethics) Incorrect C. Request the girlfriend sign a caregiver’s authorization affidavit and determine if she should be involved in the therapy. D. Determine if the father is able to sign consent for the minor prior to using the caregiver’s authorization affidavit and provide legal referrals with goal of reunification between father and son.

Answer 121

A 16-year-old girl attends an intake session with both of her parents. The parents express concern for their daughter’s well-being and share that all of their efforts to help her have fallen flat. They inform the therapist that their daughter has been stealing prescription drugs, drinking to the point of blacking out, and frequently initiates fights with them. The daughter begins to cry and yells at the parents, “It’s your fault I’m so messed up. All of the drugs and alcohol come from your house.” The father responds, “We want nothing to do with therapy. We’ve done everything we can and now it’s up to her.” What initial action should the therapist take in this situation? Score: 0 of 1 A. Request that the parents participate in therapy since family dynamics are the presenting issue. Incorrect B. Meet with the parents separately and discuss harm reduction methods including removal of alcohol from home and safeguarding of medications Should have chosen C. Meet with the daughter alone to complete an assessment and develop comprehensive treatment plan Rationale: The best answer is C. This question is asking what initial action the therapist should take. This means you may have more than one answer that is correct, but you are required to put the answers in order of operation; consider where you would start. The general starting point in therapy is conducting an assessment. The only answer that includes assessment is answer C. Once the assessment is completed, the therapist may decide to include the parents, answer A; meet with the parents separately as indicated in answer B; or the therapist may determine that answer D, outpatient substance abuse treatment is most appropriate. (Clinical Evaluation) D. Refer the daughter to outpatient substance abuse treatment due to extensive drug and alcohol use.

Answer 122

A therapist working on a multidisciplinary team for the county’s public health department specializes in using Motivational Interviewing with dually diagnosed patients. The therapist is treating a client with a history of psychosis and methamphetamine use. The client complains to the therapist that he doesn’t like his psychiatrist because he finds him to be condescending and dismissive any time the client tries to convey his feelings and concerns. How should the therapist clinically manage this disclosure? Score: 1 of 1 A. Inform the psychiatrist, who is part of the multidisciplinary team, of the client’s concerns and explore ways to address the client’s concerns. B. Inform the psychiatrist who is part of the multidisciplinary team of the client’s concerns and offer to mediate a session to collaboratively address concerns. Correct C. Maintain the client’s confidentiality and explore ways the client can address his concerns directly with the psychiatrist. Rationale: The strongest answer is C. Multidisciplinary teams that are covered entities under HIPAA law are permitted by law to share information about clients. However, this question is not asking about what is legally permitted, it is asking how you would clinically manage the situation. The starting point is outlined in answer C. This answer empowers the client to address concerns, which would be a priority. If the client attempts to address concerns directly with the psychiatrist but does not feel his concerns are heard or properly addressed, the therapist could move on to answer D. Answers A and B exclude the client, which makes these answers the weakest options. (Ethics) D. Maintain the client’s confidentiality and offer to mediate a session with psychiatrist and client to collaboratively address concerns.

Answer 123

A therapist believes that a client he has been seeing for 6 months is not benefiting from therapy. Following reformulation of goals and seeking consultation, the therapist determines it is in the client’s best interest to terminate and receive a referral for a new therapist. The client agrees with the therapist’s decision and initiates treatment with a new provider. What actions should the therapist take to meet the standard of care in this case? Score: 1 of 1 A. Provide the original medical record to the new therapist after receiving a release of information from the former client. B. Provide new therapist with copies of all documentation related to the client after receiving a release of information from the former client. Correct C. Provide a summary of the treatment that includes diagnosis, safety concerns, and reason for termination after receiving a release of information from the former client. Rationale: The best answer choice is C. Answer A is incorrect because therapists should never provide original records; legally, therapists are required to retain records for seven years following termination. Answer B is incorrect because the new therapist does not need all documentation related to the client, i.e. informed consent documentation. Answer D is incorrect because the way it is worded makes it sound like the client is requesting the records for himself, which is not indicated based on the information provided in the vignette. Answer C provides the new therapist with the client’s information necessary to provide care following a release of information. (Law) D. Provide a copy of the medical record directly to client to honor self-determination.

Answer 124

A therapist working on a multidisciplinary team in a community agency meets with a new client. The client is a 31-year-old woman with a history of paranoid delusions. The therapist is collaboratively working with the staff psychiatrist and caseworker to provide wraparound services to the client. Which of the following is the priority when developing a treatment plan for this client? Score: 0 of 1 Incorrect A. Clearly articulate the roles and responsibilities of each staff member who is providing services to client. Should have chosen B. Deliberate, identify, and fully commit to an overall objective of treatment for client. Rationale: The correct answer is B. Answers A and C are very similar and will need to be completed. However, the question is asking about the priority in this case. Since a multidisciplinary team includes many different professionals, it’s important that an overall objective is created first so that everyone is working towards a common goal. Once this is achieved, then answers A, C and possibly D would occur. (Treatment Planning) C. Delineate how the various duties to assist client will be carried out. D. Discuss the methods of communication between team members to avoid triggering client’s diagnostic symptoms.

Answer 125

A therapist has been treating a middle-aged male client with a diagnosis of Posttraumatic Stress Disorder for one month. The client was robbed at gunpoint and beaten badly, warranting hospitalization. The client has frequent nightmares, is hypervigilant and does not like to leave his home when it is dark outside. His wife has attended several collateral sessions and has tried to help him cope with his symptoms. How would a Solution Focused therapist clinically manage this case? Score: 1 of 1 A. Assist the client in identifying and accessing internal strengths that existed prior to the assault Identify effective coping strategies that can assist the client in conquering the anxiety Encourage client’s wife to share positive changes she has witnessed in the client since he began therapy B. Assist the client in identifying and accessing internal strengths that existed prior to the assault Identify effective coping strategies that can assist the client in conquering the anxiety Highlight positive changes the therapist has noticed in the client since he began therapy Correct C. Ask the client to identify times he was able to have a restful night and experienced decreased levels of vigilance Identify and highlight positive actions taken by the client despite his PTSD Utilize scaling questions to highlight client’s improvements in functioning Rationale: The correct answer to this question is C. Answer A can be eliminated because the last part of the answer regarding the wife fits better with the Narrative "witness" intervention. Answer D can be ruled out for the same reason. Answer B is as a possibility, but the last part of this answer is very general. In contrast, all parts of answer C are strongly aligned with the concepts associated with Solution Focused therapy. (Treatment) D. Ask the client to identify times he was able to have a restful night and experienced decreased levels of vigilance Identify and highlight positive actions taken by the client despite his PTSD Encourage client’s wife to attend additional sessions to bare witness to client’s progress

Answer 126

A therapist meets with a 9-year-old girl who was referred by her pediatrician due to symptoms of depression. The girl’s parents are divorced and in accordance with the custody agreement, the father consented to treatment. The custody agreement includes a provision for weekly visitation with the girl’s mother. In a session, the girl tells the therapist that she “hates visiting her mom” and if her father makes her go again she would end her life by jumping off her mother’s apartment balcony. What actions should the therapist take in this case? Score: 0 of 1 Incorrect A. Initiate a 5150 to address the imminent risk of danger presented by the client’s threat to end her life. Should have chosen B. Consider the issue of confidentiality and share her threat with the father Rationale: The strongest answer to this question is B. Answer A is incorrect because initiating a 5150 is inappropriate. We initiate a 5150 if the client is in immediate danger, which is not indicated in this vignette. While her threat is very concerning, it is conditional--the threat only exists if her father makes her go to the mothers. Answer C is also too extreme based on the information shared; there are many reasons a child could hate visiting a parent and we would need to understand the reasons before jumping to child abuse. Answer D is a stronger option, but again, the threat of suicide was made clear and predicated on visiting the mother- we already know a serious risk exists and our priority is to take clear action to address the threat. Answer B has the therapist considering issues of confidentiality, but determining in this case that it is appropriate to share the daughter’s threat with her father due to safety concerns. (Crisis Management) C. File a child abuse report due to reasonable suspicion of abuse perpetrated by the girl’s mother D. Assess for level of risk of suicide and potential child abuse

Answer 127

Malcolm, a 37-year-old African-American lawyer, and Natasha, a 34-year-old Mexican-American doctor meet with a therapist for premarital counseling. The couple is excited because of their recent engagement, but also have concerns about conflicting marital expectations and how to effectively resolve them. Natasha would like to maintain her financial independence and is ambivalent regarding children. Malcolm strongly believes in joint finances and wants to have children. Which of the following goals should be included in the treatment plan? Score: 0 of 1 Should have chosen A. Increase the level of empathy provided by Malcolm and Natasha for each other and enhance their ability to effectively communicate their wishes and needs. Rationale: The best answer is A. Answers B, C and D all require the therapist to make assumptions. Answer B assumes a one size fits all approach to working with heterosexual couples and does not focus on the couple’s stated concerns. Answer C addresses communication, which is good, but is too narrowly focused on establishing a healthy financial relationship while disregarding their different views regarding children. Answer D assumes that the stated differences are due to their cultural backgrounds, which may or may not be true. Increasing empathy and improving communication are general goals that align with the couple’s stated desire to cope with conflicting marital expectations and how to effectively resolve them. (Treatment Planning) B. Increase Malcolm and Natasha’s ability to adapt to the changes that occur when heterosexual couple’s transition to marriage. Incorrect C. Improve Malcolm and Natasha’s communication skills and assist the couple in determining how to establish a healthy financial relationship. D. Improve the couple’s understanding of how their differing cultural backgrounds created conflicting outlooks on finances and children.

Answer 128

Jonathon, a 54-year-old Vietnamese man, has been working with a therapist for two years to address childhood trauma. In the past year, he has experienced new symptoms of anxiety as a consequence of events that occured at work, culminating in his termination. He is now suing his company for emotional damages and the therapist has received a request for records from the company’s lawyers. The client does not want the therapist to release information regarding his childhood trauma. How should the therapist clinically manage the legal issues presented in this case? Score: 0 of 1 A. Inform client the therapist will invoke privilege on his behalf and client should consult with an attorney. Incorrect B. Inform client the therapist can limit the scope of information shared with the company’s lawyers. Should have chosen C. Inform client this is considered an exception to privilege since he is suing for emotional damage and process his reaction. Rationale: The correct answer is C. The question is asking how we clinically manage the situation, so we are not just not looking for legal responsibilities, but clinical management as well. Answers B and D can be eliminated because they are incorrect statements; we cannot limit the scope of the release, nor will the client’s information remain confidential. You likely narrowed the answers down to A and C. Answer C is the better starting point; it is clear this is an exception to privilege and it would be important to let the client know this. In addition, the client has a history of trauma and anxiety, so clinically, it would be very important to process how this information affects him and his symptoms. The first part of answer A can be done after taking the steps outlined in answer C. The second part of answer A is not as strong; the client should already be consulting with an attorney if he is engaged in a lawsuit, and hopefully, the lawyer has already informed him of what to expect. (Law) D. Assure client that information unrelated to his lawsuit will remain confidential.

Answer 129

A therapist volunteering on a crisis hotline receives an anonymous call from someone who believes her friend is hurting herself with excessive alcohol and cocaine use. During the call, the therapist realizes the friend in question is a client of hers and has never personally disclosed information in session regarding substance use. How should the therapist manage the situation? Score: 1 of 1 A. Collect as much information from the caller as possible about the therapist’s client without disclosing information regarding the therapeutic relationship. Correct B. Suggest ways that the caller can engage the therapist’s client directly regarding the stated concerns Rationale: The correct answer is B. The therapist is working on a hotline, so she must attend to the needs of the caller. Answer B would allow the therapist to perform triage with the caller, without revealing the caller’s friend is actually the therapist’s client. Answer C would be appropriate, but only after the therapist takes steps outlined in answer B. Answer A is incorrect, because the goal is not to gather as much information about the therapist’s client, it is to provide support to the caller while also maintaining the client’s confidentiality. Answer D would be inappropriate since the caller is reaching out for crisis support. (Ethics) C. Disclose awareness of substance use to client during next session to avoid a conflict of interest. D. Terminate the call immediately to avoid a conflict of interest.

Answer 130

A 9-year-old girl meets with a school-based therapist at the request of her teacher. The teacher is concerned with the student’s social skills. She is frequently seen hugging teachers at school, including those she does not have a relationship with, as well as other adults when they are on campus. She lives with her grandmother because her father is incarcerated and her mother is in and out of rehab facilities. What diagnosis should the therapist consider? Score: 1 of 1 Correct A. Disinhibited Social Engagement Disorder Rationale: The most appropriate answer is A. The symptoms described in the vignette, indiscriminate affection toward known and unknown people, points to disinhibited social engagement disorder. Since these are the key features of this diagnosis, we can rule all other answer choices out. (Clinical Evaluation) B. Attention-Deficit/hyperactivity Disorder C. Reactive Attachment Disorder D. Autism Spectrum Disorder

Answer 131

A therapist specializes in working with children who have been diagnosed with Autism Spectrum disorder. The therapist is invited to a 7-year-old client’s birthday party by his parents. The parents believe their child has made great improvements in his social interactions and attribute these gains to their son’s work with the therapist. How should the therapist clinically manage this situation? Score: 0 of 1 Incorrect A. Discuss appropriate boundaries with the parents and inform them it would be inappropriate to attend because it would create a conflict of interest. B. Inform the couple it would be inappropriate to attend because of the client’s right to confidentiality. C. Inform the couple the therapist will attend the birthday party since it could benefit the therapeutic relationship and assist the therapist observe the client’s social interactions. Should have chosen D. Inform the couple that the therapist will need to discuss the invite with the client and determine if it would benefit or harm the therapeutic relationship. Rationale: The correct answer is D. The only answer that includes the client in the decision-making process is D. The therapist should discuss the invitation with the client and then decide how to proceed. Answers A, B, and C all exclude the client. In addition, attending a birthday party does not automatically create a conflict of interest or breach the client’s confidentiality. If the client, parents and therapist all agree it would be appropriate, boundaries and confidentiality would be discussed prior to the event. (Ethics)

Answer 132

A therapist learns that the person they have been dating for several months is the ex-spouse of a former client. The therapist terminated with the former client over two years ago after all treatment goals had been achieved. The focus of treatment was unrelated to the ex-spouse, whom the client had divorced several years prior to the start of therapy. What actions should the therapist take to address the ethical issues presented in this case? Score: 0 of 1 Incorrect A. Maintain confidentiality and continue to date the person since no conflicts of interest are indicated and more than two years have passed from time of termination. B. Maintain confidentiality and end the relationship since it is unethical to date a client or former client’s family member regardless of the amount of time that has passed following termination. Should have chosen C. Maintain confidentiality and contact former client to discuss the implications of dating their ex-spouse and determine how to proceed accordingly. Rationale: The best answer for this question is C. In this case, the therapist is in a relationship with a person who would be considered a family member of a former client, even if divorced. It is feasible to continue dating this person, but it would be important to discuss the effect on the client prior to making this determination, which is what answer C allows you to do. Answer A is incorrect because our ethical guidelines dictate that we avoid harming or exploiting our former clients, regardless of when we terminated with them. Answer B is incorrect because our ethical guidelines do not prevent us from entering relationships following termination, but only require us to avoid harm to former clients. Answer D is incorrect because it would be better to discuss this directly with the former client to understand how it would impact them. (Ethics) D. Maintain confidentiality and seek consultation to discuss the ethical implications of continuing the relationship.

Answer 133

A family presents for therapy shortly after the birth of their third child. Their two other children are significantly older, ages 10 and 12, and the couple did not plan for a third child. The couple reports the birth of their third child has placed a tremendous strain on their relationship and the family’s ability to get along. What goals would a Structural family therapist consider in this case? Score: 1 of 1 A. Strengthening the parental subsystem and increasing the couple’s ability to establish rules B. Strengthening the marital subsystem and increase the older children's participation in rule-setting C. Strengthening the parental subsystem and improving communication between family members Correct D. Strengthening the marital subsystem and developing new family rules to accommodate the newest family member Rationale: The best answer to this question is D. Answers A and B are incorrect because both answers imply there is a problem with lack of rules in the family, which is not mentioned in the vignette. Answer C is okay for Structural therapy, but the vignette does not clearly state that the family members are struggling to communicate with each other. Answer D is the strongest option because it takes into account the need for change in how the family functions to accommodate the newest family member. (Treatment Planning)

Answer 134

A therapist has met with a 10-year-old girl for an initial intake session.The girl tells the therapist that she does not want to attend therapy, does not believe she has any problems to discuss, and thinks it is a waste of her time. The girl’s parents think she is depressed and needs to talk with a therapist. Which of the following actions should the therapist take to manage ethical obligations presented in this case? Score: 1 of 1 A. Inform the parents that therapy will not be successful without the client’s desire to participate and terminate treatment B. Continue meeting with the client and work to build rapport since parents consented to treatment and believe it is necessary C. Discuss appropriateness of treatment with the client and determine whether termination is appropriate Correct D. Meet with the daughter and parents to discuss appropriateness of treatment and how to proceed Rationale: The best answer to this question is D. The question is testing your knowledge of working with minors and self-determination. The client is the daughter, but due to her age, her parents will likely be involved in treatment. The best place to start is to have the parents and their daughter in the room to collaboratively explore their concerns and the daughter’s feelings. The therapist, parents, and daughter can then determine how to proceed. This is especially important because the parents believe their daughter is depressed and the daughter is denying any problems. With everyone in the room, this discrepancy can be addressed. Answer A is possible, but due to the age of the client, and differing perspectives of client/parent, it would be better to engage everyone in a conversation. Answer B is incorrect because it disregards the client’s stated lack of interest participating in therapy, which cannot be ignored. Answer C is not as strong as D because the parents are excluded and as stated above, they should be included. (Ethics)

Answer 135

A therapist meets with a middle-aged man with a childhood history that includes physical abuse and neglect perpetrated by his father. The man is in a long-term relationship, but finds he avoids intimacy and it is taking a toll on his relationship. Which of the following long-term goals would be part of the treatment plan for a therapist grounded in Attachment Theory? Score: 1 of 1 Correct A. Increase the client’s ability to regulate and express his emotions relationally. Rationale: The correct answer is A. Answer B is incorrect because it is an intervention, not a goal. Answer D can be ruled out because it assumes the client did not have any healthy attachments, which is not clearly stated in the vignette. The client did not have a healthy relationship with his father, but we do not know about any other childhood relationships. This leaves us with answers C and A. Answer C appears strong because it connects to the stem. However, congruent communication would be a goal for Satir, not Attachment Theory. Answer A does not link directly back to information provided in the vignette, but does include generic goals associated with Attachment Theory, making it the strongest answer available. (Treatment Planning) B. Explore the client’s understanding of the link between his current attachment style and childhood relationships C. Increase congruent communication with client’s partner and resolve early childhood traumas D. Enhance communication skills and assist client in grieving desired, but unobtained early attachments

Answer 136

A therapist meets with a 35-year-old Marine, who reports that he was sexually assaulted by another Marine while serving overseas. The client tells the therapist that he informed a superior officer, but was accused of fabricating events and was not believed. He shares that since the assault, he has not been able to sleep, feels on edge, and is regularly beating himself up for not fighting back hard enough. In addition, he tells the therapist that he is questioning his manhood and wonders if he should directly confront the perpetrator to make sure he can’t hurt other Marines since no one else is willing to stop him. How should the therapist clinically manage the situation? Score: 0 of 1 Should have chosen A. Provide a referral for legal counsel Explore particulars of direct confrontation with perpetrator Assess client for presence of additional trauma due to the nature of work Rationale: The correct answer is A. The client mentions a desire to confront the perpetrator, but how he plans to do this is unclear and should be assessed since the language hints at possible physical aggression. Answer C does not address this concern and can easily be eliminated. Answer D can also be ruled out because it includes the therapist challenging the client’s cognitive distortions, which is incorrect. Therapists who focus on cognitive distortions do not directly challenge their clients, but instead help their clients to challenge their own distortions. This leaves us with answers A and B. Answer B includes determine appropriateness of systematic desensitization, which might be something the therapist considers over the course of treatment. However, this determination would come after the therapist assesses the client for the presence of additional trauma, making answer A the better option. The legal referral, included in several of the answer choices is a good option because the client shared that his superior did not take appropriate steps to address his allegation of sexual assault, thus leaving him vulnerable and exacerbating the effects of the traumatic incident (Crisis Management) Incorrect B. Provide a referral for legal counsel Explore particulars of direct confrontation with perpetrator Determine appropriateness of systematic desensitization for trauma symptoms C. Assess client for presence of additional trauma due to the nature of work Determine appropriateness of systematic desensitization for trauma symptoms Provide a referral for legal counsel D. Determine appropriateness of systematic desensitization for trauma symptoms Explore particulars of direct confrontation with perpetrator Challenge client’s cognitive distortions regarding his perceptions of manhood.

Answer 137

A therapist is starting group therapy at a local high school for children of alcoholics. The therapist determines to make it a closed group that will be comprised of 7 members, 3 girls and 4 boys. Which of the following factors should the therapist consider when developing a treatment plan for the group? Score: 0 of 1 Incorrect A. The types of relationships between members outside of the group setting Developmental level of group members Determine if group sessions will be structured or unstructured format B. The types of relationships between members outside of the group setting Developmental level of group members Understand group members’ personal experiences with alcohol or other drugs C. Group members’ understanding of how substance abuse affects their families. Understand group members’ personal experiences with alcohol or other drugs Frequency and duration of group meetings Should have chosen D. Group members’ understanding of how substance abuse affects their families. Understand group members’ personal experiences with alcohol or other drugs Presence of mental health disorders in group members Rationale: The correct answer is D. Answer A and B are both incorrect because the types of relationships between members outside of the group is irrelevant for the treatment plan. It would be relevant for issues of confidentiality, but not the treatment plan. Answer C is not a strong choice because the frequency and duration of group meetings is more about group structure than it is treatment planning. In addition, consideration of mental health disorders in group members (included in option D) is a more important consideration for the treatment plan than frequency and duration of group meetings. (Treatment Planning)

Answer 138

A 14-year-old boy, recently released from juvenile hall, attends an intake session. The client’s mother, who is wheelchair bound, consents to his treatment. The mother reports she and her son live alone. The father left the family shortly after their son was brought home from the hospital. The mother states, “I’ve always tried to be a good mother to him. I’ve tried to provide him with everything he needs, but know that my disability does not make his life easy.” What factors should the therapist take into consideration when developing a treatment plan? Score: 1 of 1 A. Referral source Unit of treatment The increased risk of child neglect and dependent abuse due to mother’s lack of mobility Correct B. Referral source Unit of treatment Additional resources available to augment therapeutic services Rationale: The correct answer is B. Every answer other than B includes “The increased risk of child neglect and dependent abuse due to mother’s lack of mobility,” which is a false notion. The mother’s lack of mobility does not increase the risk of neglect. Answer B includes referral source, which is important to understand. The treatment plan would be different if the client was, for instance, referred by probation versus self-referred. The unit of treatment is also important to consider; will the therapist provide individual therapy or family therapy? Finally, answer B includes “additional resources available to augment therapeutic services”, which is appropriate. Augment just means adding additional resources that can improve upon or supplement psychotherapy. (Treatment Planning) C. The increased risk of child neglect and dependent abuse due to mother’s lack of mobility Referral source Additional resources available to augment therapeutic services D. The increased risk of child neglect and dependent abuse due to mother’s lack of mobility Unit of treatment Minor’s involvement with probation

Answer 139

Malcolm, a 62-year-old Indonesian man, meets with a therapist on the recommendation of his Imam. Malcolm reports he was very active at his mosque, but recently he’s been feeling down, his level of motivation to engage in his community has dwindled and finds that he is spending more and more time at home. Which of the following actions should the therapist take in this case? Score: 1 of 1 A. Refer client to medical doctor and share concern that he may have hyperthyroidism. B. Complete a mental status exam to determine if client requires referrals. C. Request client signs an authorization for release for therapist to speak with referral source. Correct D. Refer client for medical examination as part of therapist’s clinical evaluation. Rationale: The correct answer is D. The client reports a shift in behavior, from active to decreased activity and lack of motivation, which could be caused by medical issues. The most appropriate step in this case is to refer the client for a medical examination to rule out any biological causes for reported symptoms. Answer A is incorrect because the therapist is providing a medical opinion, which is outside MFTs scope of practice (it could be hyperthyroidism, or a completely different medical condition). Answer B is incorrect because the mental status exam is not required prior to referring client for a medical evaluation. Answer C could be appropriate, but the priority would be to rule out medical conditions affecting mental health. (Clinical evaluation)

Answer 140

A therapist working in a community mental health agency is running an anger management group. The group consists of five members; three males and two females, all of whom are court-mandated to attend following encounters with law enforcement. In the middle of a session, one of the male group members disagrees with a statement made by a female group member. The female group member becomes upset and begins yelling at the other group member to shut up because he doesn’t understand her experience. How would an Object Relations Therapist theoretically conceptualize the female group member’s reaction? Score: 0 of 1 A. Interpret her outburst as a reflection of the broader societal power dynamics at play between males and females Incorrect B. Interpret the member’s outburst as a projection of her feelings of powerlessness toward the legal system. C. Interpret the conflict between group members as an indication that there is a lack of group cohesion and a need to restructure the group. Should have chosen D. Interpret the conflict as a consequence of intragroup transference that can be harnessed for a corrective experience Rationale: The best answer to this question is D. The question wants to test your understanding of group dynamics from an Object Relations perspective. In this question, you may find that you lack a clear understanding of Object Relations specific to the group setting. Do not let that worry you. Instead use the knowledge you have about group dynamics and what you do know about Object Relations. Answer A may hold some truth, gender differences may influence the dynamics, but it is a generalization that is not specific to this group or Object Relations. Answer B is focused too narrowly on the woman and not the group dynamics. Plus answer B assumes the woman feels powerless, which is not indicated in the question stem. Answer C is incorrect because outbursts in groups can and do occur when group cohesion exists. Answer D is appropriate for Object Relations and group dynamics, the therapist can use a difficult interaction that occurs between group members to provide a corrective experience and allow the group to grow through the process. (Treatment)

Answer 141

During the early phase of family therapy, a single father and his 16-year-old son present to a session in crisis. The son recently attempted suicide with a drug overdose, spent 3 days in the intensive care unit and a week in the psychiatric unit of the hospital. How would a Structural Family Therapist initially proceed in this case? Score: 0 of 1 Should have chosen A. Join with the father and son so they can later lead themselves out of the immediate crisis. Rationale: The correct answer is A. Answer B can be ruled out since the mother is not mentioned in the question stem. Answer C is appropriate for Structural Family Therapy, but restructuring is middle phase, not beginning phase of treatment. Answer D misuses the concept of reframing--in Structural therapy, the therapist reframes the presenting problem to avoid a member of the unit being an identified patient. In this case, however, the family is in crisis because the son attempted suicide and increasing his safety should be a focus of treatment. In answer A, the therapist joins with the father and son to win their trust and diminish any resistance to receive support. The therapist can then help them build the tools needed to lead themselves out of the crisis. In addition, it is better to provide the family with the tools to lead themselves out of the crisis as opposed to foster dependency and have the therapist lead them out of crisis. (Treatment) B. Unbalance the relationship between the father and son in order to ensure the mother takes on a position of authority. C. Attempt to restructure the family to ensure greater balance and equanimity. Incorrect D. Reframe the son’s suicide attempt so the therapist can help guide the family out of the presenting crisis.

Answer 142

Mark, a 44-year-old man initiates individual therapy with an MFT Associate who specializes in sex addiction. During the first session, Mark informs the therapist that his wife of 10 years recently discovered sexually explicit text messages on his phone and wants a divorce. Mark has two daughters, ages 7 and 5, and because of the content of his texts, his wife is threatening to seek sole legal custody and refuses to let him see his children. Mark expresses feelings of hopelessness in regards to his family and his ability to overcome his sex addiction. Which of the following actions should the therapist take to assess this client? Score: 0 of 1 Incorrect A. Explore how client’s sex addiction manifests itself Administer the Beck Depression Inventory to determine risk of suicidality Ask the client to describe what he hopes to achieve by attending therapy B. Explore how client’s sex addiction manifests itself Administer the Beck Depression Inventory to determine risk of suicidality Assess for presence of co-occurring substance abuse due to high correlation between sex and drug use C. Assess client’s relationship with his daughters and other minors Explore the types of sexual behavior client is engaging in Determine client’s interest in keeping family intact Should have chosen D. Assess client’s relationship with his daughters and other minors Explore the types of sexual behavior client is engaging in Assess client’s level of risk for self-harm Rationale: The correct answer is D. There are several red flags raised in this vignette that require immediate assessment. The client states that the discovery of the sexually explicit content of his phone resulted in his wife seeking sole custody and prohibiting him from seeing his children. This statement requires further assessment about the client’s relationship with his daughters and other minors--assessing for inappropriate relationships and potential child abuse. Answers A and B do not address this and can therefore be eliminated. Answer C includes an assessment of client’s interest in keeping family intact. This may be something the therapist assesses after addressing immediate risks, but it is not a priority based on information shared. Answer D addresses client’s relationship with daughters and minors, information regarding types of sexual behavior, and an assessment of self-harm, which is a priority since the client expressed feelings of hopelessness. (Clinical Evaluation)

Answer 143

A 32-year-old male client initiates therapy after he is laid off from his job. During the assessment the client reports feelings of anxiety and lack of interest in spending time with friends. He informs the therapist that since his layoff he has not been sleeping as well as usual. He presents as slow to respond to the therapist’s questions and his eyes appear bloodshot. Which of the following provisional diagnoses should the therapist consider in this case? Score: 0 of 1 A. Adjustment Disorder with Depressed Mood Cannabis Intoxication Z-Code Other Problem Related to Employment Should have chosen B. Adjustment Disorder with mixed anxiety and depressed mood Cannabis Intoxication Insomnia Disorder Rationale: The correct answer is B. The client is exhibiting signs of both depression and anxiety. Answer A does not include anxiety and answer D excludes depression, which allows us to rule out each of these answer options. Answer C includes adjustment disorder with disturbance of conduct, which would be pointing more to disruptive behaviors rather than those described by the client. Answer B properly addresses the symptoms of anxiety and depression, and the client’s presentation during session could be linked to either cannabis intoxication or insomnia. (Clinical evaluation) C. Adjustment Disorder with disturbance of conduct Insomnia Disorder Z-Code Other Problem Related to Employment Incorrect D. Adjustment Disorder with anxiety Cannabis Intoxication Z-Code Other Problem Related to Employment

Answer 144

Victoria, a 45-year-old Japanese-American woman attends her first session of therapy in a community mental health agency. She is unemployed and does not have health insurance. During the assessment, Victoria discloses a history of depression and anxiety. She also tells the therapist that she attempted suicide approximately 10 years earlier when she and her long-term girlfriend ended their relationship. Which of the following actions should the therapist take to assess the client’s current level of lethality? Score: 1 of 1 Correct A. Identify current level of depression and anxiety Ask client if she has thoughts of harming herself Inquire about current support system Rationale: The correct answer is A. The question is looking for answers that can help the therapist understand the client’s current risk for suicide (lethality). Answer B can easily be eliminated since it does not ask about suicide or self-harm, which would be a priority in response to this question. Answers C and D include the phrase, “emotional functioning,” which is not as focused as “identify current level of depression and anxiety.” The vignette clearly states the client is experiencing anxiety and depression, so the answer choices that include assessing the current levels of each is stronger. This leaves us with answer A, since we already eliminated B. Answer A specifically assesses severity of client’s described symptoms, asks specifically about thoughts of suicide, and assesses for supports. All components of answer A would help the therapist determine the client’s current level of risk. (Crisis Management) B. Identify current level of depression and anxiety Identify current stressors Inquire about familial relationships C. Determine current level of emotional functioning Ask client if she has thoughts of suicide Inquire about current support system D. Determine current level of emotional functioning Ask client if she has thoughts of harming herself Identify current stressors

Answer 145

A therapist is providing individual therapy to two separate clients and learns they are romantically involved. During the course of treatment one of the clients decides that many of her concerns center around the relationship. She eventually requests couples therapy. What actions should the therapist take to manage ethical responsibilities in this case? Score: 1 of 1 A. Continue meeting with them individually and refer out for couples therapy. B. Explain this would constitute a conflict of interest, continue meeting with one client and refer the other out for individual therapy. Correct C. Neither confirm nor deny the other person is your client and provide referrals for couples counseling Rationale: The correct answer is C. Answer A is not wrong, but it is incomplete. It does not take into account the importance of maintaining confidentiality in a complicated situation. Answer B breaks confidentiality by acknowledging the conflict of interest. Answer D is inappropriate because the therapist already provides individual therapy to each partner and it would be problematic to also provide couples counseling. The strongest answer takes into account the importance of maintaining confidentiality and properly provides referrals for couples counseling. (Ethics) D. Offer to see the clients individually and provide couples therapy.

Answer 146

A therapist receives a phone call from a former client who terminated two years prior. The woman states on the call that she is in crisis and didn’t know who else to call for help. The woman tells the therapist that her husband attacked her the night before, in front of their daughter, and then stormed out of the house. She has her 10-year-old daughter at home with her and is scared for their safety. She reports the daughter has been hysterically crying and hiding in her room since the incident. Which of the following actions should the therapist take to address the crisis? Score: 0 of 1 A. Direct the woman to leave the house immediately and file a child abuse report. Incorrect B. Direct the woman to leave the house immediately and encourage her to call law enforcement. C. Assist the woman in identifying support systems that can help and encourage her to call law enforcement. Should have chosen D. Assess if the client or daughter sustained injury and refer to a domestic violence shelter. Rationale: The correct answer is D. We do not have enough information to file a child abuse report--it’s unclear what the daughter witnessed and the client seems to be taking protective steps by reaching out help. Answers B and C are premature--we would want to assess first to determine the types of support the client and daughter need. It’s unclear if they need immediate medical support or if it would be more appropriate to have law enforcement intervene. Answer D allows for the assessment, which would guide next steps. In addition, answer D includes the referral to a domestic violence shelter, which is a strong answer since the client is describing domestic violence. (Crisis Management)