Final Mock II Flashcards

Question

A 45-year-old gay man seeks therapy because of a long history of depression. He states that “in most areas of my life things are fine, but I have never had an emotional relationship that felt intimate.” He is estranged from his family, most of whom live in a different state and has few friends. He also reports being distanced from the gay community because he is not political and “after all, it is no different from being straight, except I have sex with guys.” Which of the following actions should the therapist take in this situation? A. Conduct a comprehensive assessment to develop a treatment plan and determine need for referrals. B. Explore the client’s estrangement from family, disconnection from the gay community and provide referrals C. Conduct a comprehensive assessment and refer to psychiatrist for a medication evaluation to address depression. D. Normalize client’s feelings and provide referrals for medication evaluation and support group.

Answer 1

A 45-year-old gay man seeks therapy because of a long history of depression. He states that “in most areas of my life things are fine, but I have never had an emotional relationship that felt intimate.” He is estranged from his family, most of whom live in a different state and has few friends. He also reports being distanced from the gay community because he is not political and “after all, it is no different from being straight, except I have sex with guys.” Which of the following actions should the therapist take in this situation? Score: 0 of 1 Marked Should have chosen A. Conduct a comprehensive assessment to develop a treatment plan and determine need for referrals. Rationale: A comprehensive assessment (A) is the next step in this situation, before any kinds of explorations, referrals, or suggestions would be made. The therapist needs to have a comprehensive understanding of the presenting complaint prior to making treatment interventions. Answer (B) would be pieces of the comprehensive assessment, making A a better answer. Both (C) and (D) might happen after the assessment is complete, but we do not have enough information to warrant these referrals with the information currently provided in the vignette. (Clinical Evaluation) Incorrect B. Explore the client’s estrangement from family, disconnection from the gay community and provide referrals C. Conduct a comprehensive assessment and refer to psychiatrist for a medication evaluation to address depression. D. Normalize client’s feelings and provide referrals for medication evaluation and support group.

Answer 2

A couple brings in their 13-year-old daughter to see a therapist in private practice. During the first session the mother tells the therapist that they have been wanting to bring the daughter in to see someone for a couple of years now, but she has been refusing to come to therapy until now. The parents complain their daughter is moody, irritable, and she reports no one at school likes her. Although these things have been going on for some time, it is the daughter’s recent demands that made the parents decide the situation was intolerable and brought the family to therapy. About two weeks ago she told her parents she wants to quit some of her extracurricular activities, as well as change schools. What would be the goal of an initial assessment for a Cognitive Behavioral Therapist versus a Solution Focused Therapist? Score: 1 of 1 A. The CBT therapist would collaborate with the client to identify the cognitive distortions; the solution focused therapist would collaborate with the client to identify reasons she believes no one likes her B. The CBT therapist would identify the problems confronting the client and collaborate to develop treatment plan; the solution focused therapist would ask the client how they will know things are better C. The CBT therapist would collaborate with client to identify the symptoms; the solution focused therapist would ask the client how they would know things are better Correct D. The CBT therapist would collaborate with the client to define the problem; the solution focused therapist would ask the client how she would know things were better Rationale: Answers (A) is out because identifying cognitive distortions is not a goal of initial assessments for CBT and solution focused does not focus on the problem. Answer B is incorrect because the therapist would not identify the problem and developing the treatment plan is not an initial goal of assessment. That leaves answers C and D. (D) is a better answer because the first part of the answer for CBT gives a fuller picture of the issue than just the identifying the symptoms. In CBT, it is called a functional analysis when the therapist understands when and where someone has symptoms so that the therapist can really understand and “define the problem.” (Treatment Planning)

Answer 3

A client presents to therapy with symptoms of fearfulness to leave the house, an avoidance of buses, and anxiety around other people. She adds that while she’s struggled with these issues her whole adult life it has gotten worse since her mother died five months ago. Which DSM 5 diagnoses should be considered in this case? Score: 1 of 1 Correct A. Agoraphobia; Generalized Anxiety Disorder; V. Uncomplicated Bereavement Rationale: Agoraphobia is our top answer here because she is afraid to go out. It is in (A) and (C). Both (B) and (D) have Panic Disorder and there is no indication of panic attacks so those are out. (C) has Separation Anxiety, which mainly happens with children and is not indicated here. Answer (A) also has Generalized Anxiety Disorder, which is possible with the anxiety around other people and V. Uncomplicated Bereavement is also possible with the death of her mother. So (A) is the best answer. (Clinical Evaluation) B. Panic Disorder; Separation Anxiety; Adjustment Disorder C. Agoraphobia; Separation Anxiety; Adjustment Disorder D. Panic Disorder; Generalized Anxiety Disorder; V. Uncomplicated Bereavement

Answer 4

An African-American couple brings in their adult daughter, age 24, to therapy. The daughter has been living with them since she graduated from college a few years ago. The couple reports their daughter has been experiencing episodes of decompensation. In formatting an initial treatment plan, what would be the initial goals for treatment in this case? Score: 1 of 1 Correct A. An improvement in symptoms; increased ability to adapt to stress; ability to engage in everyday activities. Rationale: Episodes of decompensation include: a temporary worsening of symptoms, a loss of the ability to adapt to normal changes and stress, and difficulty with normal activities of life. In short, an episode of decompensation refers to a time when you experience an increase in symptoms and a loss of function. With this definition in mind the best answer is (A). Even without knowing the definition, (B) would be knocked out because of the medication compliance; we don’t know if she’s on medication. (C) and (D) are out because there’s nothing about her being afraid, so “Ability to articulate fears” doesn’t make sense. (Treatment Planning) B. An improvement in symptoms; maintenance of social relationships; medication compliance. C. Ability to articulate fears; willingness to leave the home; openness to trying new things. D. Ability to articulate fears; reduction in cognitive distortions; increased socialization.

Answer 5

A Middle Eastern family consisting of father Abir, mother Narin, mother’s sister Gulnar, 12-year-old Nadina, and her little brother Arman seek family therapy. They state that recently Nadina’s behavior has been a bit strange. She has become withdrawn, uninterested in things she used to love, and almost completely disengaged in family activities. “We decided to try family therapy this time, since last time, when Nadina was in therapy by herself it seemed to have made matters worse,” said Abir. When the therapist turns her attention to Nadina, she appears very shy and uncomfortable talking in front of her entire family. The therapist suggests an individual assessment during the first half of the next session. During that time, Nadina tells the therapist that her previous therapist used to masturbate in front of her. “He also said that I should also play with myself in front of him in order to loosen up and know my body better. So I did that a few times and now I feel completely ashamed of myself.” What action should the therapist take? Score: 0 of 1 Incorrect A. Inform Nadina that her parents must be told about the incident immediately. Should have chosen B. Contact protective authorities. Rationale: The best answer is (B). The client is a minor and the therapist exposed himself to her. This constitutes a mandated report. (A) is wrong because the parents don’t HAVE to be informed, though the therapist may do it. (C) would be fine if the client were not a minor. And (D) is wrong because this is a case that qualifies as a mandated report. (Law) C. Provide the brochure from the BBS and discuss the option of reporting the previous therapist to the licensing board. D. Maintain confidentiality and deal with this as a clinical issue only.

Answer 6

44-year-old Angela comes to therapy with her 47-year-old husband, Ron, and their 14-year-old son. The wife has a bruise on her cheekbone and further questioning reveals presence of domestic violence in the family. The son comments, “My parents have been fighting ever since I was little. They hit each other but never hurt me or anything.” As the session progresses, Ron becomes more and more agitated and begins to yell at Angela while she is describing her view of the situation. The best course of action clinically would be: Score: 0 of 1 Should have chosen A. interrupt current discussion; conduct separate individual assessments with each family member; refer the parents to individual therapists. Rationale: When there is a history of DV and the situation becomes heated in the session, the first thing a therapist can do to clinically manage the situation is to call a time out and interrupt current discussion. Since this is still an assessment stage, the presence of DV calls for separating family members and conducting individual assessment. Couples therapy is not recommended with couples that experience DV. Thus, answer (A) contains all of correct options. There is not enough information to suspect child abuse, thus (D) is wrong. A child witnessing DV is not enough to make a CPS report. The stem needs to indicate that the child is suffering as a result of witnessing DV. For instance, they are now depressed or suicidal. Treating the couple conjointly is not recommended, thus (C) is out. Opening the door would only be necessary if the time out technique did not work. Thus (B) is out as well. (Crisis Management) Incorrect B. get up and open the door of the office; refer the wife to anger management group; refer the husband to a support group for batterers. C. interrupt current discussion; refer the son to a support group for victims of DV; treat the couple conjointly. D. get up and open the door of the office; refer parents to individual therapists; make a child protective services report.

Answer 7

A 32-year-old male with an extensive criminal history has been in therapy for several months. His probation officer strongly encouraged him to receive therapy because of ongoing anger management and impulse control issues. The client informed the therapist at the onset of treatment that he was concerned about sharing information that could be used against him with his probation officer. In a session, he reveals the fact that he robbed a store 3 days ago. Legally, the therapist should: Score: 1 of 1 A. Determine if the client physically threatened anyone and consider making a police report. B. Inform the client that his probation officer must be informed since it is a violation of his probation. C. Maintain confidentiality and process the consequences of the client’s criminal activity. Correct D. Maintain confidentiality and process the incident with the client. Rationale: Making a police report, even if someone was harmed (A) or informing the probation officer (B) would break the client’s confidentiality that we are legally required to maintain. A would only be true if the stem indicated the client harmed someone and that victim were a minor/elder or dependent. Answer C is incorrect because we would want to more generally process the incident with the client rather than focus on the specific consequences. Therapists are not legally required to break confidentiality and report past acts of violence, thus answer option (D) is correct. (Law)

Answer 8

57-year-old Nolan and 54-year-old Luisa seek treatment due to marital discord. Luisa complains “Nolan is always quiet when he gets home from work. It’s as if we have nothing to talk about, nothing in common.” Nolan utters “Ever since the kids went off to college, all Luisa does is rearrange their rooms and tries to rent them out on Airbnb. She is bored and disinterested with me.” How should the therapist proceed during the first session? Score: 1 of 1 A. Conduct an inventory of the couple’s attachment style; ask the couple what brought them together; figure out what conflict looks like between the two of them Correct B. Conduct an inventory of the couple’s attachment style; provide psychoeducation to the couple about the life stages; discuss their relational history Rationale: The first thing for the therapist to do when the couple presents with a life stage issue is to provide psychoeducation, normalize their feelings, and conduct a comprehensive assessment (B). Answer (A) describes various assessment questions that we might use, but it does not address the issue of the life stages, which makes (B) a better answer. The first part of answer (C) is not going to be something we do right away. This might be an intervention we use during later sessions. The first part of answer (D) is unnecessary since the only time we would have to separate the couple would be if we suspect DV or abuse. Neither of those are indicated in the stem, thus we will not separate Nolan and Luisa. (Clinical Evaluation) C. Ask the couple to each put themselves into the shoes of their partner and describe their experience; figure out what conflict looks like between the two of them; conduct an inventory of the couple’s attachment style D. Schedule individual sessions with each member of the couple; provide psychoeducation to the couple about the life stages; ask the couple what brought them together

Answer 9

Nathan, age 5, is brought to therapy by his mother Linda because he has been acting out at kindergarten. The school told Linda that Nathan won’t stay in his seat, frequently interrupts the class, and has been aggressive with his peers. Linda shares that the family recently moved across country to live with Linda’s parents because Nathan’s father was physically abusive toward both her and Nathan. Linda starts to cry and says, “I know why he’s acting this way.” After informing Linda that a child abuse report must be filed, how should the therapist proceed in this case? Score: 1 of 1 A. Process her feelings about the report and refer her to a domestic violence support group. B. Explore the nature of the abuse and obtain a release to speak to the school. C. Explore the nature of the abuse and observe how Linda interacts with her son. Correct D. Process her feelings about the report and instill hope that therapy can help her son process the trauma he has experienced. Rationale: The best answer is (D). You would want to start by processing the client’s feelings and then instill hope that you can help her son. All the other components in the other answers could be done at some point, but instilling hope would be important in this case. It’s important to note that the answer is not claiming the therapist can make everything better, but is just saying that the son will have a place where he can process what has happened. (Treatment)

Answer 10

A therapist is treating a client who is 5 months pregnant. The woman experienced postpartum depression after the birth of her first child and fears she is likely to experience it again once her second child is born. She recently informed her employer that she was pregnant and planning to take maternity leave following the birth of the child. Shortly after sharing her intentions, she received written notice of termination from employment due to “personnel conflicts.” What action should the therapist take in this case? Score: 1 of 1 A. Encourage the client to request disability insurance and refer to psychiatrist to address risk of postpartum depression. B. Explore what coping skills helped the client after birth of first child and refer to psychiatrist Correct C. Refer client to legal services regarding termination and explore appropriate support for postpartum depression. Rationale: The client has presented a legal issue to the therapist, which is outside the therapist’s scope of practice. Therefore, the therapist would best serve the client by encouraging her to seek legal advice by someone qualified to provide those services. Answer C addresses both the legal needs and postpartum depression making it the best answer. Encouraging the client to request disability insurance does not address the potential legal issues that arise in this case and the psychiatrist may or may not be appropriate at this time (B). Confronting the manager could be detrimental to the client if she is to pursue legal action (D). (Ethics) D. Encourage her to confront the manager about her termination and refer for legal services.

Answer 11

Rosaria, a 70-year-old woman, is referred by her doctor. On the phone with the therapist, Rosaria discloses that for some time now she has been experiencing trouble recalling recent events or recognizing people and places. “I cannot remember what I ate yesterday or where I put my keys for the life of me. I am so frustrated all the time. And I am really terrified that there will come a day when I will not recognize my husband or my kids. What is going to happen to me?!” she exclaims with tears in her voice. The doctor gave her the diagnosis of dementia. Rosaria is upset and scared. She says that she wants to involve her entire family in therapy with the therapist. What should the therapist do first? Score: 0 of 1 A. Conduct research on dementia in order to gain knowledge of the disease; make an initial appointment just for Rosaria; consult with her doctor regarding the best course of treatment Incorrect B. Obtain a release to speak with her doctor and determine the stage of her disease; make an initial appointment for Rosaria’s entire family; make sure that this case is within the therapist’s scope of competence Should have chosen C. Make an initial appointment just for Rosaria; make sure that this case is within the therapist’s scope of competence; obtain a release to speak with her doctor during the initial appointment Rationale: Meeting just with the client (C) would be what the therapist should do first in order to complete assessment and come up with a treatment plan. It would also be important to make sure that the therapist has experience working with someone with such a diagnosis. Since there is another provider involved, it is best practice to obtain a release right away to coordinate care. Both answers (B) and (D) will be out since we are going to meet with our client first before involving her family. She was not referred for family therapy, so we will see her individually first, build rapport, conduct assessment and then determine the best way and time to involve the family--she does not specify how she wants the family involved so this does not interfere with self-determination. Answer (A) is not the best here, since we will initially meet with Rosaria, conduct our own assessment, and only then consult with her doctor. Plus the option of having Rosaria sign a release that is present in (C) is better than the option of speaking with her doctor right away. One would come before the other. (Clinical Evaluation) D. Make an initial appointment for Rosaria’s entire family; obtain a release to speak with Rosaria’s doctor; conduct research on dementia in order to gain knowledge of the disease

Answer 12

A therapist is conducting an intake interview with Athena, a 48-year-old woman. Athena has experienced episodes of depression throughout her life. When she was 6 year old her older brother died in a car accident. According to her, this event completely pulled her family apart and she was lost between her mother’s grief and her father’s depression. At the end of the session she asks, “How would I know when therapy is over?” How would a Cognitive Behavioral Therapist respond to this inquiry? Score: 1 of 1 A. You will tell me what your goals for therapy are, and when you reach those goals we will terminate. B. We will collaborate on formulating our treatment goals, and I will tell you when it is time to terminate. C. I will determine what the treatment goals are based on what you told me, and once you feel that you have reached them we will terminate. Correct D. We will collaborate on formulating the treatment goals and once we’ve determined you are close to reaching your goals we will discuss maintaining progress and begin termination. Rationale: One of the tenets of CBT therapy is a collaborative stance. Answer (D) reflects such collaboration and includes proper protocol for termination, which is spreading out the sessions. Answers (A), (B), and (C) do not suggest collaboration and give either client or the therapist too much control. (Treatment)

Answer 13

A therapist is meeting with a 37-year-old computer programmer. The client was encouraged to attend therapy by his brother who is seeing another therapist in the same counseling center. The client tells the therapist that he is very content at his job and actually is in charge of a big project at his firm. “The improvement I am working on would reinvent the entire system of how we do things at the company. This is a huge responsibility and people are looking to me to develop the best way to move forward. So I have been working around the clock.” During an intake interview a therapist also learns that the client has 6-7 alcoholic beverages a night. In addition, client tells the therapist that he has been experiencing headaches and blurry vision. Which of the following referrals is most important in this case? What should be the therapist’s first referral for the client? Score: 1 of 1 A. Alcoholics Anonymous because the client is abusing alcohol regularly and is not indicating any level of denial. Correct B. A general medical practitioner because the client is abusing alcohol and is experiencing physical symptoms. Rationale: AA might be an appropriate referral after dealing with the physical issues (A). The client’s symptoms require immediate medical attention and most likely in-patient detox so (C) is out. If the client had bizarre symptoms, such as smelling a tangerine all the time, then we would refer him to the neurologist, but he is not having those symptoms so (D) is out. Thus, the correct answer is (B), which will include sending the client to an emergency room if he does not have a regular doctor. The main thing is for him to see a doctor due to the symptoms of headaches and blurry vision. (Crisis Management) C. An outpatient substance abuse treatment facility because the client is abusing alcohol, but is functional at work. D. A neurologist to assess for head trauma because the physical symptoms listed are commonly linked to head trauma injuries.

Answer 14

Natalia, a 47-year-old, and Igor, a 49-year-old, come in with their 16-year-old daughter Olga. They are referred by Olga’s school. The initial assessment indicates that Olga has all the symptoms of anorexia. Natalia complains that all their attention is focused on Olga. Who should the therapist’s unit of treatment be? Score: 0 of 1 Marked A. The parents to strengthen their relationship in light of the mother’s expressed concern about the family dynamics. Incorrect B. The daughter alone since the assessment indicates she has symptoms of anorexia that must be addressed. Should have chosen C. The entire family in light of the mother’s expressed concern about the family dynamics. Rationale: One of the best ways to determine the unit of treatment is to see who is in the room with you. Since the whole family is here right now, and one of the presenting complaints is that the family’s complete focus is on the daughter, it is safe to say that the entire family should be the unit of treatment. Seeing the daughter (B), the mother (D), or the parents (A) alone will not help the family deal with the complaint that was brought up. (Clinical Evaluation) D. The mother alone in light of her expressed concern about the family dynamics.

Answer 15

A therapist received a phone call from a concerned mother regarding her 15-year-old son. She states that he is withdrawn and is exhibiting bizarre symptoms like staying up all night, not eating, and grinding his teeth constantly. What is the most likely diagnosis? Score: 1 of 1 A. Bipolar II Correct B. Amphetamine abuse Rationale: The combination of indicated symptoms, particularly grinding teeth, point to Amphetamine abuse (B). There are no symptoms, such as impaired coordination, or sensation of slowed time to indicate Cannabis use (D). There are not enough symptoms to indicate hypomania, thus (A) is out. One might consider a Depression NOS diagnosis (C), due to impaired sleeping and eating, but teeth grinding would point towards Amphetamine use. (Clinical Evaluation) C. Unspecified Depressive Disorder D. Cannabis abuse

Answer 16

A therapist is working with Gregory, an 82-year-old Irish American man, who now lives in assisted living housing. When the therapist first approached the client he was resistant and unwilling to talk. “You are so much younger than me. What is it that you have to offer me?” he asks the therapist. During the third session, when the therapist asked Gregory to look back at his life and share any highlights that come to mind, the client suddenly perked up and willingly shared a number of stories. In working with the elderly, what is the objective of employing a Life Review as an intervention? Score: 1 of 1 Correct A. Provide clients with an opportunity for closure; communicate a sense of respect; and help clients recognize the sense of meaning developed over the course of for their lives. Rationale: A Life Review is a supportive tool for client’s mental health. It is an opportunity to communicate a sense of respect and reverence to the clients regarding their past accomplishments and sorrows. It provides clients with a possibility to gain closure. Thus (A) is the correct answer. A Life Review is not used as an assessment tool, thus (B) and (D) are out. Goals for treatment (C) might come out of the Life Review, but that is not the main function of such an intervention. (Treatment) B. Help clients recognize the meaning developed over the course of their lives; assess clients for possible signs of dementia; provide clients with an opportunity for closure. C. Develop appropriate goals for treatment; provide clients with an opportunity for closure; communicate a sense of respect D. Communicate a sense of respect; review client’s movement through various developmental stages; help clients recognize the meaning developed over the course of their lives

Answer 17

Sally, a 66-year-old widow who lost her husband five months ago, is self-referred. Sally recently retired from her job at the post office. Lately, she has lost her appetite and has been having trouble sleeping and concentrating. She reports that the only thing she enjoys anymore is spending time with her 8-year-old granddaughter. She takes her to school and to ballet practice. Otherwise, Sally just feels useless and is concerned that she will become a burden to her daughter’s family. She tears up when she says, “I’m having a hard time getting old. I hate being alone. I still pretend my husband is just at work. I keep praying that he’ll come back. I now know why my husband used to refer to his drink as ‘old faithful.’” What initial interventions should the therapist consider in the case provided in the vignette? Score: 1 of 1 Correct A. Acknowledge the changes that have occurred in her life and assess her safety. Rationale: Answer (A) is the best answer. You’d want to start by acknowledging what she’s been through and finding out if she has any thoughts of harming herself. (B) is jumping too quickly to having her volunteer. Psychoeducation about life stages could be done, but acknowledging the changes would come first (C). Determining her level of social support is more of an assessment activity than an intervention (D). (Crisis Management) B. Identify potential volunteer opportunities and assess her level of alcohol use. C. Provide psychoeducation about life stages and assess her safety. D. Determine her level of social support and provide psychoeducation about grief and loss.

Answer 18

Maria, a Mexican American, brings her 58-year-old mother, Ana, in for therapy. Maria says that she is very concerned about her mother, because she has not been the same since her husband died four weeks ago. Maria relays that her mother hasn’t been able to get out of bed. Ana reports seeing and hearing her husband everywhere. According to Maria, her mother never had any type of psychological symptoms previously. What is the therapist’s priority in this case? Score: 1 of 1 A. Refer Ana to a general medical practitioner for a physical and medical evaluation. B. Refer Ana to a psychiatrist for evaluation due to symptoms of delusional disorder. Correct C. Explore the family’s cultural views about grief and dying. Rationale: A complete assessment is the first thing that the therapist should do. Exploring family’s cultural views about grief and dying (C) should be part of the assessment process. If communicating with the spirit of the dead is a normal part of the culture, then referring Ana to an M.D. (A) or a psychiatrist (B) would not be necessary and we risk pathologizing behavior that is normal in the cultural context. The therapist might refer Ana to an M.D. (D) if the symptoms are persistent and abnormal for the client but only after completing comprehensive assessment. (Clinical Evaluation) D. Refer Ana to a psychiatrist if symptoms persist after two months.

Answer 19

Elizabeth, a 19-year-old college student, comes to therapy complaining of body image issues. She is average weight, which makes her unhappy and she wishes she were skinnier. “I am constantly on a diet,” she states “and once a week I feel so bad about eating even a little bit of food that I have to throw up to feel better.” Elizabeth’s likely diagnosis is: Score: 1 of 1 A. Anorexia nervosa B. Bulimia nervosa Correct C. Unspecified eating disorder Rationale: Since Elizabeth is of average weight, the diagnosis of anorexia nervosa is out (A). Elizabeth does not meet full criteria for bulimia nervosa (B) because for such diagnosis to be present one must engage in binging and compensatory behaviors at least once a week for three months. Thus, the correct answer is (C). (D) is out because her symptoms are better accounted for by the diagnosis of unspecified eating disorder. (Clinical Evaluation) D. Body dysmorphic disorder

Answer 20

Justin is referred to therapy by his EAP for 6 sessions to work on issues of social isolation and poor job performance. Initial assessment indicates the fact that Justin will need more than 6 sessions to deal with his chief complaints. After contacting Justin’s EAP provider and advocating for additional sessions, the therapist learns that they will still only allow 6 sessions. How should the therapist proceed? Score: 0 of 1 A. Focus on the underlying causes of behavior during 6 sessions then refer out or discuss payment options if continued support is indicated. B. Explain the EAP’s restrictions to the client and provide client with referrals to a different therapist. Should have chosen C. Explain the EAP’s restrictions to the client and collaboratively identify appropriate treatment goals for short-term therapy. Rationale: (A) would not be the way to proceed because we would want expectations to be clear at onset of therapy, not following the completion of 6 sessions. Answer (B) is incorrect because it would still leave him with the same amount of sessions with just a different therapist. Answer (D) is not as strong as the correct answer because we are just processing the limitations with the client rather than working within the clearly defined parameters noted in the vignette. Thus, talking to Justin and developing goals that are of appropriate depth and length (C) is the most optimal solution to the situation. (Ethics) Incorrect D. Explain the EAP’s restrictions and process referral limitations with client.

Answer 21

A therapist has been treating a client with schizophrenia who lives in a group home for those with severe mental illness. In one session, he states, “I feel like my conservator controls all of my life and financial decisions and I don’t like that; he is stealing my money.” How should the therapist proceed? Score: 1 of 1 A. Maintain confidentiality and process with your client how he can no longer be under the control of the conservator. B. Call the conservator and express your concern about how he manages your client’s financial matters. Correct C. Become familiar with parties involved and their respective rights and responsibilities as ordered by the court. Rationale: (C) is the best answer. When working with a client who is a conservatee, you will need to work with both the conservator and conservatee. It is good to know what powers the conservator was granted by the court, as this can vary on a case-by-case basis. (A) is out because it isn’t the client’s choice to have a conservator or not. (B) is breaking your client’s confidentiality (a client with a conservator still has the right to confidentiality). (D) is out because there is no way we would not want to dismiss the claim outright without first receiving additional information. (Law and Ethics) D. Ensure your client that his conservator is not stealing his money and practice reality testing techniques.

Answer 22

A therapist is meeting with a gender non-conforming teen. The teen tells the therapist that things have been tough for her recently. Even though she has a good group of friends at school, her parents at home just do not understand what she is all about. They want her to stop dying and cutting her hair and grow it out. They keep pressuring her to dress in a more traditional manner and do not allow her to be active in any of the LGBTQ community affairs. Meanwhile, she is trying to figure out her own sexual identity and gender preferences. “Having my family’s voice be so loud, drowns out my own,” she shares. What should a Solution Focused therapist do in formulating treatment goals? Score: 0 of 1 A. Define the problem; break down the goals into small steps to focus on each week; identify client strengths. B. Challenge the client’s definition of the problem; compliment client competencies; visualize client’s future Incorrect C. Ask how the client has coped in the past and help relocate the resources; compliment client competencies; visualize client’s future Should have chosen D. Clarify achievable goals with the client; identify client strengths; compliment client competencies. Rationale: In the early stage of therapy, a Solution Focused therapist works with the client to clarify achievable goals and identifies the client strengths. Complimenting a client is a classic SF intervention (D). Solution focused therapists generally do not focus on client problems (A) or (B). Asking clients how they have coped in past and identifying resources (C) is a middle stage intervention. (Treatment Planning)

Answer 23

A therapist in private practice is conducting a weekly support group for postpartum mothers. During a group discussion about the challenges new mothers confront, one of the mothers begins to sob and says she is struggling to get through each day. She notes that she has lost interest in daily activities, spends most of the day in bed and feels disconnected from her husband and baby. How should the therapist clinically manage the client’s disclosure? Score: 0 of 1 Incorrect A. Provide psychoeducation to group about postpartum blues; explore if other group members feel the same; refer to individual therapy. Should have chosen B. Meet with client after group: assess for suicide; refer to individual therapy. Rationale: What can we eliminate? (A) and (D) are out because this is more than “blues.” That leaves (B) and (C). (B) is the best because it meets with the client privately, assesses for risk, and refers her to individual therapy which is indicated. (C) is problematic because it normalizes something that, while common, is not “normal.” It also invites others to say if they have the same thing and there is a good chance that no one else is feeling as bad as this; so it could increase the client’s shame. (B) is the better option as it responds to the severity of the woman’s complaint. (Crisis Management) C. Normalize the client’s experience; explore if other group members feel the same; refer to individual therapy. D. Provide psychoeducation to group about postpartum blues; help client identify supports; explore ways to improve connection to family.

Answer 24

A 24-year-old Asian-American woman is referred to a therapist by her doctor. She tearfully reports that six months ago she was diagnosed with Lupus. She shares that her boyfriend of two years broke up with her a few months ago because he couldn’t deal with the news and that she has been having a hard time getting out of bed to get to work. She recently moved in with her parents and states, “My parents say that I am depressed but my doctor says it is part of the disease.” She appears clean but disheveled. What action should the therapist take first: Score: 1 of 1 A. Provide the client with psychoeducation about how Lupus causes depression. B. Obtain a signed release of information to consult with the referring doctor. Correct C. Ask how the client views the impact of Lupus on her mental health. Rationale: The client has indicated that her parents and her doctor have different views of her symptoms. The best place to start would be asking her views on the problem (C). The client has had a lot of changes in the past few months that are likely to affect her mental health in addition to the Lupus. Answer (A) sides with the doctor without taking in to account the other issues. (B) could be done as some point, but not when the therapist is initially connecting with the client. (D) could also be done at some point once the therapist is cleared on how the client views her situation. (Clinical Evaluation) D. Explore how Lupus is viewed in Asian-American culture.

Answer 25

A six-year-old child lives with a foster family. His father is in prison and his mother is in residential treatment for alcohol dependence. The child is small for his age, often has temper outbursts, and has difficulty completing schoolwork. The therapist notes that his speech is immature. What interventions should the therapist consider? Score: 0 of 1 A. Request the child’s file from the social worker; work with the foster parents on a behavior modification plan; obtain a release to speak to the teacher Incorrect B. Suggest that the child’s teacher refer him for special education placement; have the parents sign a release authorizing the therapist to speak to a social worker; obtain a release to speak to the teacher Should have chosen C. Refer the child for assessment for fetal alcohol syndrome; gather child’s history; request the child’s file from the social worker Rationale: Proper assessment is going to inform the treatment plan developed by the therapist. The child’s mother is in treatment for alcohol dependence and the child is exhibiting symptoms that might be accounted for by Fetal Alcohol syndrome. Therefore, the best first step would be to refer the child for assessment to rule out such disorder, gather history and get a hold of the child’s file. Thus, answer (C) is correct. Answer (A) jumps to creating a behavior modification plan, but we do not yet know what is going on with the child, so we cannot determine what plan he needs. Answer (B) ignores the therapist’s responsibility for proper assessment given the child’s presenting symptoms. Answer (D) is not indicated, since it is not stated in the stem that his biological mother wants reunification. (Clinical Evaluation) D. Refer the child for assessment for fetal alcohol syndrome; work with the child’s biological mother toward reunification; suggest that the child’s teacher refer him for special education placement

Answer 26

Maricel, a 37-year-old single woman, is referred by her mother’s doctor. Maricel is a high school math teacher. She was born in the Philippines but moved to the United States when she was two. Recently, her elderly mother suffered a stroke and is currently in a coma on life support. Maricel has been the primary caregiver for her mother since her father died two years ago. Maricel has decided that she wants to terminate life support. However, her uncle, who is her mother’s brother, is against it. Tearfully, Maricel shares, “In front of the doctor, he says that I have the final say, but in private he is against me doing it. I’m sure that all his siblings are going to take his side in this matter. He doesn’t care that this is what my mom wanted.” She adds, “I just can’t concentrate at work; I’m snapping at my co-workers and friends and then I feel awful about it. I’m crying all the time, not sleeping, and I’m tense. I just don’t know what to do. I don’t want to get out of bed in the morning.” Which of the following human diversity issues should the therapist consider when developing the comprehensive treatment plan in the case presented in the vignette? Score: 1 of 1 A. Maricel’s cultural and religious views of death and dying and the impact of being a single woman and sole caregiver of mother. Correct B. Maricel’s spiritual beliefs regarding end-of-life issues and the influence her Filipino culture plays in this situation. Rationale: When developing a treatment plan, it is important to take into consideration matters that are both relevant to the presenting issues and that address diversity issues, making (B) the best answer. Maricel’s spiritual beliefs regarding end-of-life issues are important to take into consideration, since the presenting complaint is her mom’s dying wishes. In addition, what sets this case apart from other similar cases is the fact that Maricel is heavily influenced by her culture and her Filipino family in making this decision. Answer (A) is not the best answer because we do not see evidence of Maricel’s religious views in the stem or that her being a single woman is somehow impacting her decision making process in this case. Answer (C) is out since there is no evidence in the stem that Maricel has departed from traditional Filipino roles. There are no indicators of answer (D) in the stem either, as there is no mention of Filipino attitudes towards Western medicine or the role of religion in Maricel’s caregiving. (Treatment) C. Maricel’s departure from traditional Filipino roles and the impact of being a single woman and sole caregiver of mother. D. Filipino attitudes towards Western medicine and the role of religion and spirituality in Maricel’s family.

Answer 27

A therapist meets with a client who describes feelings of depression that began soon after her partner moved into the home. The client replies with a flat “fine” when asked about the new arrangement, but also mentions offhandedly that she has to go straight home after the session because the partner monitors the car mileage and time spent away from home. The client seems tense. Which of the following actions should the therapist take to address the relational dynamics discussed in the vignette? Score: 1 of 1 A. Explore the possibility of a joint session to address the recent changes in the couple’s relationship. Correct B. Explore how the couple has dealt with conflict over the course of their relationship. Rationale: The therapist’s best course of action would be to start by exploring how the couple deals with conflict (B). This would allow the therapist to gather additional information to determine if domestic violence is present in the relationship. The therapist should not suggest a joint session (A) or role play how to be more assertive with partner (C) if there is a likelihood of domestic violence. The therapist might want to collaboratively develop a safety plan (D), but only after determining it is appropriate for the client. (Crisis Management) C. Role-play with client to enhance her ability to set boundaries with her partner and assert her needs. D. Explore how the couple deals with conflict and develop a safety plan.

Answer 28

A therapist conducts an intake interview with a 19-year-old woman who was driven to the session by her father. During the interview she discloses her battle with depression, as well as her reservations regarding taking antidepressant medication. She also talks about her deeply rooted anger, which stems from her parents’ divorce when she was 7 years old. She says that she was caught completely off guard when her parents announced their divorce, since she has never seen them fight in front of her. Her mother left the state shortly after and they have barely seen each other since. At the end of the session, the client’s father enters the office and demands to see the therapist’s notes on the interview. What should the therapist do? Score: 1 of 1 A. Schedule a joint meeting to discuss client’s wishes with regards to her records. B. Ask the father to submit his request in writing since he is the one paying for the sessions. Correct C. Inform the father of the requirements associated with such disclosure. Rationale: The therapist must protect the adult client’s confidentiality and would need consent from the client prior to sharing information with the father (C). The therapist would be breaking confidentiality by scheduling a meeting with the father (A) or releasing records based on the father’s written request (B). Explaining that the records are the property of the agency (D) does not directly address the request. (Law) D. Explain that records are the property of the agency and refer him to speak to the agency’s clinical director.

Answer 29

A therapist is working with a family consisting of a mother, father, and 15-year-old daughter. The mother and daughter are arguing with each other about her curfew while the father sits in silence. The daughter says, "Every time I come home a little bit late, my mom yells at me. I can't take it anymore." The dad says to the therapist, "See what I have to deal with?" Which of the following questions demonstrates the Systems theory concept of circular causality? Score: 1 of 1 A. To the mother, “What feelings arise for you when your daughter yells at you?” B. To the daughter, “When you arrive late, what happens after your mother yells at you?” Correct C. To the father, “How do you respond when your wife yells at your daughter?” Rationale: Circular causality, an intervention used in family therapy, tries to determine patterns in family dynamics. By asking the father how he responds to the wife yelling at the daughter (C), the therapist is able to understand how the entire system functions together. Asking the mother what it feels like when her daughter yells (A), asking the daughter what happens when she comes home late (B), or asking the mother how her yelling affects the father (D), does not allow the therapist to understand how the different parts of the system work together.(Treatment) D. To the mother, “How do you think your yelling affects your husband?”

Answer 30

A 34-year-old woman seeks treatment for increasing symptoms of anxiety. She is the single mother of a 4-year-old girl, after having divorced from her daughter’s father 3 months ago. She reports that their separation was mutual and they continue to be friends, but she states that her feelings of anxiety are increasing. She is increasingly concerned about her ability to be a single parent and has recently been considering sending her daughter to live with the father. She reports feeling disconnected from her daughter and unsure of how to “get things back to normal.” Which of the following interventions should the therapist consider when addressing the client’s anxiety? Score: 1 of 1 A. Encourage the client to discuss the benefits of psychotropic medications with medical doctor. B. Offer a joint session with the client’s ex-husband to identify co-parenting techniques that would address client’s concerns. C. Assign the client to read psychoeducational books on divorce and co-parenting. Correct D. Teach the client calming skills and ways to better discriminate between a relaxed versus tense state of being. Rationale: This question is asking for interventions that directly address the client’s anxiety, so we want to find an answer that specifically focuses on this issue--the more focused specifically on anxiety, the better. Answer (A) is incorrect because it's not clear psychotropic medicine is appropriate and the way it is worded is not quite right, as it only encourages the client to discuss benefits, without providing a balanced approach. Answer (B) may or may not help the client’s anxiety, so while it may be something the therapist could do, it’s not a very strong option. Answer (C) is similar to (B), it could help, but does not specifically address anxiety. Answer (D) is the strongest option because it most directly addresses the client’s anxiety, which is what the question is asking about. (Treatment)

Answer 31

Jose, a 32–year-old accountant, is referred to therapy by his EAP. He is approved for 8 treatment sessions. The referral from the EAP states that Jose has poor time management skills and recently had issues with his productivity. Jose shares that his boyfriend was recently transferred to another city for work and it has caused a strain on their relationship and his overall health. He shares that he likes his job but just can’t concentrate like he used to. What action would a Solution Focused therapist take in the final phase of treatment? Score: 0 of 1 Incorrect A. Process Jose’s feelings about termination and compliment his progress and growth. B. Identify Jose’s resources and strengths as well as identify possible setbacks and ways to stay on track. C. Identify what “productive employment” would look like for Jose and compliment his progress and growth. Should have chosen D. Compare Jose’s scale of current functioning to the initial scale and identify possible setbacks and ways to stay on track. Rationale: Answer (A) is a good answer, yet it is not specific to Solution Focused theory, and since that is what the question is asking, the ideal answer will include elements from the theory (if that option did not exist, this could be an acceptable option). Answer (B) is not the best answer since identifying strengths and resources are indicative of the middle stage of this theory. Answer (C) includes an intervention (“Identify what ‘productive’ would look like”) that would be better fitting in the beginning stage of treatment. Answer (D) is the best answer since, as a Solution Focused therapist, we would utilize scaling and compare how the client is doing now as compared to how he was doing when the treatment began. The second half of the answer is also a fitting Solution Focused final stage intervention. (Treatment)

Answer 32

Immediately following a group psychotherapy session, a group member, Clara, returned to the office of the therapist to privately discuss an incident that had occurred during the session. The client reported that another member, Mandy, had broken a group rule by being disrespectful. Clara complained, "I know at the very beginning we talked about not forming cliques in the group. Well Mandy sure did not hear this rule. She was openly talking about Clarissa and her weight to others and I know Clarissa could hear her. Then she invited some of the group members to her house for a party, but did not invite the rest of us. She is so rude! I want you to properly deal with this matter." Which of the following would be the most appropriate therapeutic response? Score: 1 of 1 A. Explore the client’s feelings about observing the group member’s disrespect individually with Clara and inquire if other group members shared this experience when the group meets next. B. Separately process the client’s reasoning for not addressing the situation immediately in group and revisit group rules to ensure a safe environment during the next group meeting. C. Assure the client that it is acceptable to privately report such concerns and maintain the client’s confidentiality. Correct D. Acknowledge client’s concerns and suggest the client consider bringing up this incident for discussion in the next group session. Rationale: When a group member expresses concerns about group dynamics, it is always important to deal with the issue with the group as a whole (D). Answers (A) through (C) do not provide an opportunity for the group as a whole to deal with the issue so we would prioritize the answer that brings it back to the group. (Treatment)

Answer 33

A therapist meets with Claire, a client who has recently lost her husband. The client’s sister, Catherine, has been staying with the client during the month since the loss. Catherine telephones the therapist expressing concern about the client’s open expression of grief. She presses the therapist to learn whether the client has discussed these grief reactions. Which of the following actions should the therapist take in this case? Score: 1 of 1 A. Provide psychoeducation on the grief process to address the sister’s concerns about the client’s grief reactions. Correct B. Explain that information cannot be disclosed without a client’s consent. Rationale: The therapist must protect the confidentiality of her client and the only answer that does so is (B), explaining that information cannot be disclosed without client’s consent. Engaging in conversation with the sister (A) would breach client confidentiality. The therapist could discuss the sister’s concerns in the next session (C) or set up a joint meeting with the sisters (D) in the future (though safety concerns are not indicated), if the client expresses interest; however, these answers overlook the legal requirement of how the therapist should proceed. (Law) C. Discuss the sister’s concerns with the client at the next session. D. Set up a joint meeting with the sister and the client to address the sister’s concerns about client’s safety.

Answer 34

During an initial session, a mother tells a therapist that her three year-old son is stubborn, self-centered, doesn’t listen, and refuses to help her until she starts doing something, and then he wants to help. He tantrums when she tries to show him how to do things properly and insists on doing it his way. Which would be the most appropriate initial response to the client’s concerns? Score: 1 of 1 Correct A. Acknowledge and explore the mother’s feelings around parenting struggles and educate the mother about child development. Rationale: The therapist’s best response would be to acknowledge and explore the mother’s feelings and provide the mother with education about normal development (A) since the symptoms described appear to be signs of normal child development. If, after receiving information regarding normal development, the mother continues to express concern or identifies behavior outside the norm, it could be appropriate for the therapist to schedule an evaluation (B), review behavioral techniques (C), or provide play therapy (D). (Treatment) B. Schedule a biopsychosocial evaluation of the child and refer mom to a parenting group for parents of children with behavioral issues. C. Review behavior modification techniques and examine the mother’s expectations of parenting. D. Provide play therapy for the child and joint play therapy for mother and child.

Answer 35

A therapist receives a call from his individual male client who is panicking after learning that he is HIV+. His girlfriend is scheduled to come in for a session but he says he does not want to tell her for fear of being abandoned. He asks his therapist not to share this information. The therapist knows the couple is trying to get pregnant. How should the therapist respond to the client’s disclosure? Score: 1 of 1 A. Recommend he tell her in the session and offer to process the information. Correct B. Assure him that confidentiality will be maintained and encourage him to tell his partner. Rationale: As therapists, our duty is to protect the client’s confidentiality, and the girlfriend is not the client. We are also not mandated to break confidentiality when it comes to the client’s HIV status, thus (B) is the right answer. Answer (A) is only partially correct, since it omits the part about confidentiality. Answers (C) and (D) are wrong since “no secrets” policy does not apply in this case and neither do limits of confidentiality or mandates. (Law) C. Validate the client’s fears, but remind him of the “no secrets” policy. D. Remind client of the limits of confidentiality and your mandate to protect the girlfriend and the possible unborn fetus.

Answer 36

Kevin, a 48-year-old male, is in treatment for issues of depression. At the end of the sixth session, Kevin angrily states that his 18-year-old stepson is getting on his nerves and it is time Kevin showed him “who is the man in the house.” Two days after the session, the therapist receives a phone call from Kevin’s wife. She is concerned because Kevin left to go meet her son at the cabin in the woods for a “stern talking to.” His wife states that Kevin was very irritable when he left the house. The therapist’s responsibility is to: Score: 1 of 1 Marked A. Encourage Kevin’s wife to call 9-1-1. Correct B. Maintain confidentiality. Rationale: The therapist’s responsibility in this case is to maintain confidentiality of the client. Kevin’s wife is not giving us enough information to substantiate Tarasoff. Therefore, on the phone with her, we are going to maintain confidentiality and not even acknowledge to her that Kevin is our client (B). Based on the information provided in the stem, the threat of harm is unclear. Encouraging the wife to call 911 (A), calling the police and warning Kevin’s stepson (C), or contacting Kevin to find out whether he has means of hurting step son (D) are overreactions based on the information provided. (Crisis Management / Law) C. Call the police and warn Kevin’s stepson. D. Contact Kevin and find out whether he has any means of hurting his stepson.

Answer 37

Francisco, a 32-year-old construction worker, is referred by his EAP because of troubles at work. Francisco tells that therapist that co-workers are constantly conspiring against him. He is convinced they are discussing the most profitable projects behind his back and intentionally leaving him out of important meetings. “I do not trust anyone in that company; they are just like my family. They are out to get me,” says Francisco at the end of the first session. His most likely diagnosis is: Score: 1 of 1 A. Delusional Disorder Correct B. Paranoid Personality Disorder Rationale: According to the DSM 5, Paranoid Personality Disorder (B) is characterized by a pervasive distrust and suspicion of others such that their motives are malevolent. Since the symptoms appear to be pervasive (“they are just like my family”), the symptoms better describe Paranoid Personality Disorder rather than Delusional Disorder (A). The client is not exhibiting any psychotic symptoms; ruling out Schizophrenia (C) and the symptoms do not appear to be developing in conjunction with another individual, ruling out Shared Psychotic Disorder (D). (Clinical Evaluation) C. Schizophrenia D. Shared Psychotic Disorder

Answer 38

Molly, a 23 year-old college student, comes to treatment complaining of constant and frequent mood swings. During the assessment phase, the therapist learns that Molly has been diagnosed with diabetes but has not been getting proper treatment for it. She exclaims, “If I monitor what I eat and maintain a proper diet, I am OK. I do not have health insurance and it is too expensive to pay for doctor’s visits out of pocket. Could you just help me figure out the number of sugar calories that I consume?” What would the treatment goals be during the initial stages of treatment for a Narrative therapist? Score: 1 of 1 A. Separate the client from the problem; explore the story she is telling herself around her illness; assess client's motivation for treatment Correct B. Explain that you are not trained to help her with managing her diabetes; assist the client in finding medical resources; identify ways in which Molly’s problem with diabetes impacts her life Rationale: The symptoms being described and the goals of the client are outside the scope of practice for a therapist. The client requires medical services and the therapist’s initial goal would be to connect the client with those services. In addition the answer is appropriate because a Narrative therapist would initially focus on gathering a problem-saturated story from a client (B) . Although externalizing the problem is part of Narrative Therapy (A), it is not an appropriate intervention, because it does not address the client’s medical needs. Providing the client with tools to help her monitor diet (C) and identifying factors that enhance the problem (D) are outside the scope of practice of the therapist. (Treatment Planning) C. Identify ways in which Molly’s problem with diabetes impacts her life; provide the client with specific tools that can help Molly monitor her diet; record progress of the client throughout treatment D. Identify factors that enhance the problem; help client reduce harm inducing behaviors; talk about ways the diabetes tricks Molly into not maintaining a proper diet

Answer 39

A Structural Family therapist is in the middle phase of treatment with a family that has been in therapy for three months. The family sought therapy after the 36-year-old daughter and her 14-year-old son moved back home with her 66-year-old father and 65-year-old mother. The daughter had lost her job due to issues with alcohol and moved in after completing a treatment program. At the start of the session, the mother reports that three days ago the daughter relapsed and became violent when they confronted her. What action should the therapist take first? Score: 0 of 1 A. Explore each family members perspective of the incident and create a safety plan. Should have chosen B. Remind the family that the therapist is a mandated reporter and obtain more details about the violent episode. Rationale: The code of ethics states that therapists must inform the clients of the limits of confidentiality at the start of treatment and then remind them throughout the course of treatment when necessary. We are never going to trap the client into telling us the information that later can be used to make a report. So we are going to tell the client: "I am going to stop you right there and remind you that I am a mandated reporter.” Doing so goes in accordance with the code of ethics. In this scenario, there are two elders and a minor. If the violent episode were directed at one of them, a report would be required. So the best answer is (B) remind them of reporting duties then further assess. Neither (A) nor (C) acknowledge the possibility of reporting. (D) has only APS and it could be CPS. (Ethics) C. Recommend that the daughter seek alcohol treatment immediately and create a safety plan. Incorrect D. Obtain more details about the nature of the violent episode and file an APS report if necessary.

Answer 40

Silvia, age 16, is referred by her probation officer for court-mandated therapy. She has been arrested three times for assault, stealing, and drug possession. She was recently released from a juvenile correction camp where she spent six months. She is currently residing in a group home. Silvia states, “Don’t expect me to share stuff with you. The only people I trust are my homies; my gang is my family.” Silvia has a history of marijuana, crystal meth, and alcohol abuse. She adds, “Can you help me sleep? I can’t shut my brain off at night. I just think of all the people who have wronged me and what I want to do to them. There’s a girl trying to get with my man and if she does, I’m going to cut her.” She is currently enrolled in a GED program but reports that she’s never been good at school and just can’t focus in class. She jumps in her seat when the office phone rings. What additional information would help the therapist decide the course of treatment in this case? Score: 1 of 1 A. Silvia’s arrest history and her family substance use history. B. Silvia’s trauma history and past substance use. C. Sylvia’s arrest history and current substance use. Correct D. Silvia’s trauma history and current substance use. Rationale: In order to decide on the course of treatment we need to identify this client’s diagnosis and any crisis issues that we might be dealing with. Answer (A) includes Silvia’s arrest history and we already know how many times and what she was arrested for, so there is no need to get more information about it. Plus, we are much more interested in her personal substance use history, as opposed to her family’s, since she is the client. The first part in answer (B) is correct – it is important to know client’s history of trauma in order to determine her diagnosis and appropriate treatment plan. We see that the client jumps when the phone rings, has history of violence, and has been involved in a gang, all of which point to a possible trauma history. The second part of Answer (B) is not as relevant as the second part of answer (D), since we would want to find out how much and what she is currently using; we already know her history with meth, alcohol, and marijuana. Answer (C) has the current substance use, but the first half, as discussed, is already known. Answer (D) is the best answer as it prompts us to find out more about her history of trauma and her current substance use, both of which while help in determining the course of treatment. (Clinical Evaluation)

Answer 41

A structural family therapist has been working with a family of six for several weeks. In the most recent session, Stephanie, the second to youngest member of the family tells the therapist about the “blow out” that happened the night before. Apparently two of the siblings got into a fight and the mom was trying to help them resolve it while bathing the youngest child and helping Stephanie with her homework. In the meantime, the dad was downstairs watching the football game. The therapist asked the family to replay the scenario from last night and encouraged the dad to participate in the management of the fight more actively. What was the purpose behind such intervention? Score: 1 of 1 Correct A. To help the family modify the problematic interaction and see it through to a satisfying completion. Rationale: The intervention described in the stem is re-enactment. It is frequently used by structural family therapists in order to help the family change problematic behaviors and experience a different, more effective outcome (A). Answer (B) describes a Systems family therapy intervention. Answer (C) describes a Gestalt intervention. Answer (D) does not fit because, even though challenging the definition of the problem is an early stage structural therapy intervention, in this case the therapist did not challenge the family’s definition of the problem but asked them to re-enact the problem instead. (Treatment) B. To observe circular causality and communication patterns. C. To increase “here-and-now” awareness. D. To challenge family’s definition of the problem.

Answer 42

Nicholas, a 36-year-old lawyer, and his partner Gary, a 43-year-old accountant, are self-referred for couple’s therapy. The intake interview reveals that both Nicholas and Gary are in long-term recovery for cocaine addiction. They report having frequent arguments and misunderstandings with each other. “Every single conversation seems to turn into a fight,” said Nicholas. “Gary has been tremendously defensive lately,” he adds. “Oh it is all on me, isn’t it?” retorts Gary. “How about you? You have been completely absent lately. I cannot connect with you at all.” As part of the initial intervention the therapist should: Score: 1 of 1 A. Teach the couple communication skills; examine relational history; discuss recent stressors Correct B. Discuss recent stressors; assess for relapse in either partner; teach the couple how to be empathetic with each other Rationale: Given the fact that substance abuse history is present in both clients, assessing whether either partner has relapsed is the most appropriate intervention to start with. Increased distance in the relationship and frequent arguments may be signs that one partner has relapsed, putting stress on the relationship. The only answer that includes assessment for relapse is answer B. The rest of the interventions are also good to do at some point, but checking for relapse would need to be part of the right answer. (Treatment) C. Assign the couple intimacy exercises as homework; teach the couple how to be empathetic with each other; discuss recent stressors D. Teach the couple how to be empathetic with each other; examine relational history; discuss recent stressors

Answer 43

A 24-year-old young man walks into a therapist’s office wearing a colorful headband, long purple scarf, and a fur coat. He states that he is happy with who he is, but he would like to better understand personal messages he receives from the newspaper and magazine articles. He adds that his strongly developed telepathic skills allow him to know what other people are thinking about him; thus he warns the therapist about the consequences of lying to him. What diagnosis should be considered initially? Score: 0 of 1 A. Schizoid Personality Disorder Should have chosen B. Schizotypal Personality Disorder Rationale: This client is exhibiting odd, eccentric behavior, ideas of reference, and magical thinking. In addition, he is happy with who he is, which points to egosyntonic nature of the disorder. All of these symptoms are best accounted for by answer (B). Neither Schizoid PD, nor Histrionic PD have magical thinking or ideas of reference as their symptoms. Thus (A) and (D) are out. Since his behaviors are present across all aspects of his life and are egosyntonic, it cannot be Delusional Disorder (C). (Clinical Evaluation) C. Delusional Disorder Incorrect D. Histrionic Personality Disorder

Answer 44

A frail 91-year-old female nursing home resident has begun to refuse some meals. A medical evaluation determined the need for a gastric feeding tube. Although her son is in favor of having the feeding tube placed, the resident refuses. The son demands that the therapist working in the hospital should get the doctor to put in a feeding tube. What initial step should the therapist take in this case? Score: 0 of 1 Marked A. Refer the son for treatment to cope with his mother’s refusal to eat. Incorrect B. Process the son’s feelings of powerlessness. C. Explain to the son that his mother cannot be force-fed. Should have chosen D. Refer the resident for a competency evaluation. Rationale: Each client has the right to self-determination, unless it is determined that he/she lacks competency to make decisions for themselves. In working with the elderly, one of the appropriate early stage interventions is to refer the client for competency evaluation (D), particularly since there is a reasonable suspicion that competency might be compromised. Referring the son for treatment (A), processing his feelings (B), or educating him (C) will not deal with the critical and potentially dangerous situation at hand. (Crisis Management / Ethics)

Answer 45

A 52-year-old female client is in therapy with a male therapist for help with her relationships with her grown sons. The therapist perceives that a good working relationship has been established, but in the eighth session, the client announces that she wants a new therapist. She states that the therapist is too young and inexperienced to help with her particular problem. The therapist should: Score: 1 of 1 Correct A. Encourage the client to discuss her feelings about their relationship. Rationales: The most appropriate intervention to do when the client expresses resistance or a sudden desire to leave therapy is to discuss the situation directly with the client and clarify the client’s feelings and concerns (A). Reassuring the client of the therapist’s experience (B), referring the client out (D), or differentiating between the therapist and client’s sons (C) are all “fix-it” interventions that will miss the opportunity to deepen the client’s understanding of self in working with her transference. (Ethics) B. Review his professional experience to reassure the client. C. Help the client to differentiate the therapist from her grown sons. D. Validate the client’s feelings and offer a list of older therapists.

Answer 46

An unemployed, pregnant, single woman who was recently hospitalized for observation after a car accident is referred to a community mental health clinic. She tells the therapist that she has not had any prenatal care, has not changed her diet, which she describes as basically “fast food,” and doesn’t want to exercise because it is “tiring.” She also states that she enjoys going out with friends and drinking alcohol, but only on the weekends. What issues should the therapist focus on during the assessment phase of treatment? Score: 1 of 1 Correct A. Client’s feelings about being pregnant; determining client’s intentions for therapy; understanding client’s perception of herself and her self-worth. Rationale: As therapists, we do not make CPS reports regarding fetal abuse/neglect, thus (D) is out. Answers B and C both include providing referrals, which is something we might do in future treatments, but it’s not clear at this time what services would be appropriate or if they are necessary. Plus, in answer B, the inclusion of assessing for risk of suicide is not indicated, ruling this answer out. Answer C is also a weak answer because exploring the mother’s future plans for the baby might also be what we do in future treatment, but not indicated at this time. At this point, meeting the client where she is and understanding her presenting issues and goals for therapy will be the priority (A). Her lack of self care might be pointing to a low view of self, and/or to her potentially feeling resentful of being pregnant, so we would want to inquire about these issues. Assessing her motivation given her lack of desire to care for self is also a good step to take, to make sure that she actually wants the help she is being offered. (Clinical Evaluation) B. Providing referrals to community services; assessing for risk of suicidality; understanding client’s perception of herself and her self-worth. C. Exploring the client’s plans for her baby following delivery; Client’s feelings about being pregnant; providing referrals to community services D. A need to make a report to Child Protection Services; assessing for risk of suicidality; exploring the client’s plans for her baby following delivery

Answer 47

William, age 59, brings his daughter Terrie, age 15, for therapy. William says, “Terrie has been cutting for a year, cries in her bedroom, and worries about everything.” William's wife, Florence, age 58, is a Scientologist and against psychotherapy. She’s been treating Terrie with homeopathic supplements and exercise. Terrie shares that she thinks about death and tried to hang herself a few years ago. She shows you the scars and fresh cuts on her right forearm. Terrie says, “I show my parents these and they do nothing about it, even when the cuts are deep and bleeding really badly.” Terrie begins to cry and says to her dad angrily, “I don’t want to be homeschooled! You guys shouldn’t have adopted us. All you care about is your business.” William shakes his head and says, “I’m too old to deal with this. How much is this all going to cost?” How would a Systems therapist incorporate human diversity into the treatment plan based on the case presented in the vignette? Score: 1 of 1 Correct A. Ask William and Terrie to tell you how Florence’s religious beliefs impact their family; explore how being older parents impacts the different family members; explore their experience of being an adoptive family and how it affects their understanding of the situation Rationale: The right answer for this question needs to respond to the issues presented, be consistent with the concepts of Systems theory, and include issues of human diversity that are playing out in this case and are unique to this family. Answer (A) includes all of these components. The parts of the answer are geared towards all family members and include words like “explore” and “ask”, which is consistent with System’s theory. Florence’s religious beliefs are certainly influential in this case as they are rather specific. Being older parents as well as an adoptive family has its own set of influences that not all families are dealing with. Answer (B) is wrong since a System’s therapist is not going to confront Florence’s religious beliefs. Doing so will not help to remove Terri’s position of an IP. The second part of answer (B) only addresses Terry and a System’s therapist would address the dynamic of the whole family. Answer (C) is not the best answer, since it has the therapist educating the family on the impact of being an adoptive family, as opposed to exploring their view on how it is impacting the situation. The family is going to know more about their experience than the therapist would. Answer (D) is not fitting since the first half deals only with William and leaves the rest of the family out. The second half of answer (D) targets Terrie as an IP, something a Systems therapist would avoid doing. In addition, the therapist is not going to determine whether homeschooling is the best option; that would be imposing the therapist’s views onto the family. (Treatment Planning) B. Remove Terrie’s position of the identified patient by confronting Florence’s religious beliefs; evaluate the validity of Terrie’s beliefs that her parents do not care about her; explore their experience of being an adoptive family and how it affects their understanding of the situation C. Educate them on how being an adoptive family may affect their understanding of the situation; Explore Florence’s religious beliefs and how they affect Terrie’s treatment; discuss how the other family members are impacted by Terrie’s problems D. Explore how being older parents affects William’s view of the family’s issues; ask William and Terrie to tell you how Florence’s religious beliefs impact Terrie’s illness; determine whether homeschooling is the best option for Terrie

Answer 48

A therapist is hired in a consulting capacity to evaluate current company productivity and offer solutions that might improve the morale amongst the staff. As part of the evaluation the therapist conducts an in-depth assessment of the company. Such assessment includes an interview with each employee about their experiences with the company and possible suggestions they might have regarding improvements. The therapist was assigned an immediate supervisor who is not a therapist. The supervisor asks the therapist to disclose the particulars of employee interviews, specifically wondering about what was said by the administrative staff. How should the therapist proceed? Score: 1 of 1 A. Operate under the new supervisor’s code of ethics and share some generic information revealed by the employees. B. Rely on the company’s internal policies for guidance. C. Ask to be reassigned to work under another supervisor since such a request violates the therapist’s professional code of ethics. Correct D. Base professional actions on the profession’s code of ethics and provide the supervisor with a summary of all interviews keeping the particulars of what each person shared confidential. Rationale: The guiding principles behind every therapist’s actions are the ethical and legal standards of our profession. Thus operating under the supervisor’s code of ethics (A) or under the company’s guidelines (B) would be unethical if such guidelines violate therapist’s code of ethics. The therapist might ask to switch supervisors (C); however such option might not be available or might take time to complete. Besides, (C) does not answer the question posed by the supervisor. In the meantime, the therapist is to follow one’s own professional code of ethics in performing actions and submit a summary or the overview of the interviews, highlighting general themes, as opposed to the specifics of what people shared. (Ethics)

Answer 49

A 5-year-old child is referred to a therapist for an assessment as part of a custody hearing. The custodial parent has been accused of coaching the child to describe physical abuse by the non-custodial parent. Which of the following scenarios is likely to indicate the child has been coached? Score: 1 of 1 A. The child cannot get the time and day correct when describing the events. B. The child acts out repetitive violent acts and horror scenes in play therapy. Correct C. The child exhibits no fear or anxiety when describing the abuse. Rationale: The correct answer is (C) because the disconnect between the emotion and the information shared is the biggest red flag of all the options presented. In addition, one can train the child how to play, what to say, and how to say it; however, it is difficult to teach the child to emote. (Crisis Management) D. The child’s story is consistent when retold to the therapist.

Answer 50

A therapist is working with Jhumpa, 42 and his wife Keiko, 38. They immigrated to the United States over twenty years ago from Japan. During the assessment, Jhumpa explains that they live under the same roof as their children and Keiko’s mother. “My mom is having trouble sleeping. We think she might be depressed,” Keiko notes. The wife and her husband are experiencing ongoing conflict about whether or not to move the mother into a nursing home. What issues should the therapist initially consider when working with this couple? Score: 1 of 1 A. The decreased risk of suicide among elderly parents living with their children and Keiko’s mother level of depression. Correct B. The couple’s values and beliefs about caring for elderly family members and ways in which the couple handles their disagreements. Rationale: Answer (B) is correct because the therapist should begin by understanding the values and beliefs around the issues and understanding how the couple handles conflict. (A) is incorrect because there is not enough information to determine if there is risk of suicide, and Keiko’s mother is not part of the treatment unit. There is also no indication of elder abuse, so (C) is incorrect. (D) could certainly be considered, but is not why the couple is seeking help. (Clinical Evaluation) C. Keiko’s mother’s level of depression and the increased risk of elder abuse due to conflict between the couple. D. The couple’s cultural beliefs regarding the appropriate treatment of the mother’s depression and ways in which the couple handles their disagreements.

Answer 51

At the end of the second session with a new client, the client hugs the therapist and tells him that she is so happy to finally find a therapist who knows what he’s doing and is helping her to feel better. Between sessions, the client leaves multiple messages on the therapist’s voice mail with updates. Which of the following actions should the therapist take in this case? Score: 0 of 1 Incorrect A. Document all interactions in the client’s psychotherapy notes; tell the client that, due to ethical concerns, such behavior is problematic; set appropriate boundaries for the therapeutic relationship at the next session B. Recognize the client’s need for positive affirmation to establish trust with the therapist; adjust the treatment plan to account for such need; record personal feelings and interpretations as part of the psychotherapy notes Should have chosen C. Document all interactions in the client’s medical record; set appropriate boundaries for the therapeutic relationship at the next session; record personal feelings and interpretations as part of the psychotherapy notes Rationale: Based on the behaviors presented in the stem, it is likely that the client has Borderline Personality Disorder. Establishing boundaries (C), particularly with clients with BPD, is an important therapeutic intervention. In addition it is important to write down factual information about the client’s behavior in the medical records and therapist’s personal interpretations in a separate psychotherapy note. Enabling the poor boundaries by casting the behavior as a way to establish trust (B) or an example of client’s comfort (D) would be detrimental to the client’s treatment. There is no need to state that such behavior is unethical, since that could be perceived as authoritative and/or judgmental (A). Plus the documentation of client - therapist interaction belongs in the medical record. (Ethics) D. Interpret the hug and messages as an indications of the client’s comfort with the therapist; record personal feelings and interpretations as part of the psychotherapy notes; document all interactions in the client’s medical record

Answer 52

A therapist meets with a client who recently retired and reports feelings of “loneliness and a lack of purpose.” As a successful doctor, the client looked forward to retirement and to spending time with family and pursuing new hobbies. “I have been working for over 40 years,” the client states, “I was so looking forward to picking up golfing and playing with my grandchildren.” However, the client reports spending most of the time sleeping and watching television. Which of the following actions should the therapist take to assess this client? Score: 1 of 1 A. Inquire about the client’s AOD use; discuss civic clubs or organizations the client could join; refer the client for a medical evaluation Correct B. Ask the client to fill out a Beck Depression Inventory; inquire about the client’s cognitive functioning, sleeping patterns and levels of motivation; investigate types of support systems available to the client Rationale: The client is indicating some symptoms of depression, and additional investigation of depressive symptoms (such as sleeping, motivation, and cognitive functioning) should be done first. Beck Depression Inventory is a good assessment tool for someone who is exhibiting signs of depression. Since the client reports feelings of loneliness, identifying types of support available would be part of the initial assessment (B). Option (A) is out, since there is no indication of drug or alcohol use (AOD). A discussion about various organizations the client could join is a possibility, but it is more problem solving than assessing. Talking about general support systems is more applicable in this case. (C) is out since investigating the effect of losing part of identity would come after a thorough assessment of depression. (D) is out since AOD use is not indicated and we will conduct our own assessment of the client first before talking to any collateral sources of information. (Clinical Evaluation) C. Investigate the effects of losing part of the client’s identity as doctor and opportunities to be productive; ask the client to fill out a Beck Depression Inventory; refer the client for a medical evaluation D. Investigate types of support systems available to the client; ask the client to sign a release allowing the therapist to speak with collateral sources of information; inquire about the client’s AOD use.

Answer 53

A therapist is working with a client who has a history of substance abuse. He informs the therapist that although he has been through several treatment programs, he has continuously relapsed. He says that nothing has worked for him and he doesn’t think anything can help him. The client thinks he will become just like his father, who has a long history of substance abuse. When determining how to intervene, what should the therapist do first? Score: 1 of 1 A. Ask client about his experiences in the different treatment programs. Correct B. Assess the client’s current use and his motivation to change his behavior. Rationale: In working with any client, it is important to begin the work with assessment. Motivation on the part of the client to change the addictive behaviors is the most important factor to consider when assessing probable effectiveness of substance abuse treatment. Answer (B) includes both of these important components. It is after such steps are complete that the therapist might decide to involve the client’s family (C), refer the client for a medical evaluation (D), or ask about previous experiences (A). (Clinical Evaluation) C. Explore the client’s willingness to involve his family in his recovery. D. Refer the client for a medical evaluation.

Answer 54

Sandra, a 54-year-old self-employed accountant, is referred to therapy by a close friend. Sandra has been feeling tense and nervous since her elderly mother moved in five months ago. Tearfully, she explains, “I just can’t keep up with Mom’s round-the-clock needs on my own. It’s overwhelming. The medications are so confusing; sometimes I just skip them for a couple days and then double up. I can’t afford to hire a caregiver and I won’t put her in a home. I don’t know what to do. I can’t take this much longer!” Sandra confesses that she has been taking her mother’s muscle relaxant medication frequently to cope with stress. She appears fatigued and occasionally loses focus during the session. What interventions should a Psychodynamic therapist use in the middle stage of therapy if Sandra is unable to recognize the unhealthy defense mechanisms she is employing? Score: 1 of 1 A. Interpret Sandra’s current need to take care of her mother as a response to unresolved issues stemming from early childhood; Assist Sandra in identifying times when she has been able to take care of her mother. B. Ask Sandra to invite her mother for a session to explore alternative living arrangements; Interpret Sandra’s substance use as a way to avoid dealing with her anger toward her mother for being a burden. Correct C. Monitor Sandra’s safety and the safety of her mother; Interpret Sandra’s current need to take care of her mother as a response to unresolved issues stemming from early childhood. Rationale: The first part of answer (A) is both consistent with a Psychodynamic perspective that takes into consideration early childhood experiences, and acts as an appropriate intervention for a middle stage of this theory. The second half of answer (A) is more fitting for a Solution Focused therapist rather than a Psychodynamic one, which means (A) is out. Answer (B) is wrong since the first part has us inviting Sandra’s mother into the room and at this point, such intervention is not indicated. The second half of answer (B) is plausible, but the first half rules it out. Answer (C) is the best answer since monitoring both Sandra’s and her mother’s safety is something we are going to do throughout this case due to Sandra’s hopelessness, drug use, and poor medication management of her mother. The second half of this answer has already been discussed as part of answer (A). Answer (D) is incorrect because it is assuming a particular emotion (anger), which may or may not be accurate and it's unclear if a referral to NA is appropriate at this time. (Crisis Management) D. Interpret Sandra’s substance use as a way to avoid dealing with her anger toward her mother for being a burden; Provide referral to Narcotics Anonymous.

Answer 55

Question 79 Melanie, a 60-year old widow seeks out therapy at the suggestion of her daughter. She reports that her husband passed away approximately a year ago and since that time, she has been unable to work due to ongoing health problems. In addition she reports feelings of frustration and disappointment. She does not want to talk to her friends or to her daughter about her feelings since she does not want to bring anyone down along with her. “I keep busy during the day, but evenings are hard. That is when my husband and I used to sit down and watch television together. I can still see him sitting there in his spot on the couch. I miss his satirical remarks.” In creating a treatment plan the therapist should first consider: Score: 1 of 1 A. The client’s need for bereavement counseling; if the client has an adequate support system; client’s ability to pay for services B. The client’s level of depression; the client’s need for bereavement counseling; if the client has an adequate support system Correct C. The client’s need for bereavement counseling; the nature and severity of her health problems; if the client has an adequate support system Rationale: In determining any client’s treatment plan, it is important to rule out substance abuse and any medical issues. In this stem, it is indicated that the client is experiencing health problems; thus the first thing to consider is the nature and the severity of such concerns (C). After ruling out medical conditions, and thus any possibility of health risks, the therapist can move on to evaluating client’s support system and ability to pay (A), level of depression (B), and/or the need for bereavement counseling (D). (Treatment Planning) D. The client’s level of depression; the client’s need for bereavement counseling; client’s ability to pay for services

Answer 56

Filip, a 27-year old real estate agent seeks treatment for persistent anxiety. In the initial interview he tells the therapist that he worries about everything. “It is like a constant tape playing in my head. I worry that the sale is not going to go through. I worry that I will not have enough money to pay my rent. I worry that I will never find a mate. And then I worry about missing being single if I do find someone.” He has agreed to complete thought records in between sessions with the therapist. The next two sessions the client says, “I didn’t get it done.” How should a Cognitive Behavioral therapist respond to the client’s lack of follow through? Score: 1 of 1 A. Interpret behavior as a sign of resistance and explore client’s motivation for treatment. Correct B. Ask the client what interferes with completion of homework and identify strategies to address barriers. Rationale: Meeting the client where they are in a neutral, curious way and working to address the barriers identified is the most appropriate way to approach this situation (B). Interpreting client’s behavior as resistance is a little bit premature, so (A) is incorrect. Reminding the client of the importance of homework and limits of CBT as a consequence might come across as authoritative and even judgmental, so (C) is out. Acknowledging that homework can be burdensome and restructuring assignments (D) does not make sense since the client never said that the reason they did not complete it was because it was burdensome and we can’t restructure without first understanding barriers. (Treatment) C. Remind the client of the importance of homework and discuss limitations of CBT without client’s completion of assignments. D. Acknowledge that homework can be burdensome and restructure assignment to make it easier to complete.

Answer 57

The parents of a 15-year-old boy consult with an employee assistance program therapist regarding their child’s shift in behavior since entering high school. During the past year his grades have dropped dramatically, and he was recently placed on juvenile probation after being caught attempting to steal alcohol from a grocery store. He was adopted when he was two years old after he had been in several foster homes. Before this last year his behavior and development had progressed normally. What actions should the therapist take to address the chief complaint? Score: 1 of 1 Correct A. Refer the entire family for a comprehensive assessment and treatment. Rationale: Some of the behavior described in the stem are extreme and do not reflect normal adolescent development (C). The appropriateness of brief therapy (B) could only be considered after an assessment is conducted. There is not enough information in the stem to suspect abuse or neglect (D), since sudden shift in behavior can be accounted for by substance use or a medical issue. Thus, due to severity of the boy’s behaviors, further assessment and appropriate treatment are indicated (A). (Clinical Evaluation) B. Meet with the adolescent and his family for brief therapy. C. Provide psychoeducation on the normal stages of adolescent development and accompanying behaviors. D. Assess the son for potential abuse or neglect due to marked change in behavior.

Answer 58

A therapist has been working with Kathleen for over 8 months. Kathleen initiated treatment when she was in the middle of a divorce. Her ex-husband was physically and emotionally abusive toward her for several years. It took Kathleen four attempts before she finally left him. As a result of being emotionally abused over many years, Kathleen is exhibiting signs of low self-esteem. She constantly expresses self-defeating thoughts regarding her inability to leave her ex sooner and struggles to move beyond the feeling that she wasted so much of her life on such a poor relationship. She reports feeling depressed, overwhelmed, and hopeless about the future. The therapist should do all of the following except: Score: 1 of 1 A. Collaborate with the client to develop goals for behavior change. B. Address client’s dysfunctional thinking patterns. Correct C. Accept the client’s views of self and circumstances. Rationale: Accepting the client’s view of hopelessness would not be appropriate (C). Collaborating with the client on goal development (A), addressing dysfunctional thinking patterns leading to the client’s view (B), and identifying client’s strengths (D) would all be fitting interventions. (Treatment) D. Ask questions to identify client strengths and successes.

Answer 59

A woman explains to the therapist that her family recently survived a major car accident. She is worried because every time there is a loud noise, her six-year old daughter becomes terrified and hides in the closet. The daughter looks frightened as she clings to her mother. How will the therapist know it is time to terminate with the child? Score: 1 of 1 A. The child is able to express her feelings related to the car accident. B. The child is able to ride in cars without becoming scared. Correct C. The child no longer becomes terrified when hearing loud noises. Rationale: One of the ways to determine that it is time to terminate is when the client is symptom free. Since this client’s presenting complaint is around loud noises, once the little girl is no longer terrified of them, it would be time to terminate (C). (Treatment Planning) D. The child is able to reenact the accident through play therapy without becoming aroused.

Answer 60

A family of three is referred for therapy by their minister. Maria, 36, and her husband Enrique, 37 report that they have found their 14-year-old son, Mario, drunk on two occasions. “One time I walked in on him drinking alone in his room,” Maria states, “and another time he came home smelling of alcohol after his baseball practice.” “This is unacceptable to us,” adds Enrique. The son responds, “I hate school, I get bullied every day. You guys don’t care; you just pray.” Which interventions should the therapist consider in this case? Score: 1 of 1 A. Refer for substance abuse treatment; obtain a release to speak to school; obtain a release to speak to the referring minister. B. Assess for suicide risk; refer to MD; refer for substance abuse assessment. Correct C. Assess for suicide risk; refer for substance abuse assessment; explore how he is bullied. Rationale: Since there are a few pressing issues presented, speaking to the minister might become relevant at some point, but it is not a priority, thus (A) and (D) are out. There are no indications of any medical issues, thus (B) is incorrect. Answer (C) addresses all of the critical issues presented in the stem, making it the right answer. (Crisis Management) D. Explore how he is bullied; refer for substance abuse assessment; obtain release to speak to the referring minister.

Answer 61

Jill, age 45, and John, age 47, are referred by Jill’s therapist for therapy to help with their blended family. The couple recently married and Jill’s children, Tammy, age 13, and Jake, age 10, moved in with John and his daughter, Blair, age 5. John complains, “Tammy is such a handful. She doesn’t listen to anyone. We really need help with her.” Jill adds, “The transition has been hard on everyone. It doesn’t help that I have been working a lot and the kids spend a lot of time with sitters.” What ethical responsibilities does the therapist have based on the case provided in the vignette? Score: 1 of 1 A. Manage countertransference issues that may arise; Obtain a release from Jill to consult with her therapist; Maintain appropriate boundaries with the family. Correct B. Clarify the unit of treatment; Manage issues of confidentiality if seeing members of the family alone; Discuss their expectations of treatment. Rationale: Answer (A) is ruled out since the first part is not relevant to the vignette. There is no indication in the stem that the therapist is having issues with countertransference. The second half is a legal responsibility, not an ethical one, and the third part is also not indicated in the stem. Answer (B) has all parts that are ethical in nature and that are relevant to the case. It would be important to identify the unit of treatment, to discuss their expectations, and to manage confidentiality if members of the family are seen alone. Answer (C) is out since the first half is not as relevant to the case presented, as we would need the answer to be, and the third part is legal in nature. Answer (D) has a good first half, but the second part, as discussed, is not relevant to the case. The third part only addresses the parents and the transition has been hard on the whole family. (Ethics) C. Maintain appropriate boundaries with the family; Discuss their expectations of treatment; Obtain informed consent from the family. D. Clarify the unit of treatment; Maintain appropriate boundaries with the family; Provide a referral for parenting classes.

Answer 62

Shana, an overweight 31-year-old financial analyst, is referred to therapy by her EAP due to problems at work. She has been coming in late, leaving early, not completing paperwork on time, and being absent-minded in the meetings. She shares that lately she feels like she is on a rollercoaster with her moods, particularly when she gets hungry. She adds “On the bright side, I’ve lost 10 pounds this month without even trying." What initial interventions should the therapist consider in this case? Score: 1 of 1 A. Complete psychological testing; Provide a referral for Shana to see a psychiatrist; Identify irrational beliefs regarding body size. Correct B. Complete biopsychosocial assessment; Provide a referral for Shana to see an MD; Assign the client to keep a journal of activities, thoughts, and feelings. Rationale: Answer (A) is incorrect since there is no indication for psych testing for this client, her symptoms of quick weight loss and hunger-related mood swings point to the need for her to see a doctor, not necessarily a psychiatrist. And there is no indication of irrational beliefs about her body size in the stem. Answer (B) contains good initial stage interventions that are also relevant to the case. A biopsychosocial assessment should be completed, she should be referred to an MD, and a journal assignment to keep track of her feelings, thoughts, and activities is a good way of helping the client gain awareness about what might be causing her presenting issues. Answer (C) has a good first part, but the second part is not appropriate since it is not clear that it is work stress that is the matter here. Answer (D) has us referring Shana to a nutritionist and that is a bit premature. We would first need to know that it is diet that is causing her weight loss and mood swings. (Clinical Evaluation) C. Complete assessment interview; Provide a referral for Shana to attend a Work Stress Support Group; Assign the client to keep a journal of activities, thoughts, and feelings. D. Complete biopsychosocial assessment; Provide a referral for Shana to see a nutritionist; Identify irrational beliefs regarding body size.

Answer 63

Eileen comes to therapy at the suggestion of her co-worker who spoke very highly of CBT therapy. In an initial interview the client reveals feelings of tension and trouble concentrating. “I always anticipate the worst in every situation,” she states. She also mentions having guilt and hopelessness about the future. “Nothing will ever work out for me as it does for others,” she notes. “I am not meant to be happy.” The initial diagnostic impression of generalized anxiety disorder is reached. The client further relates that she frequently gets angry with her boyfriend for no reason. After an initial medication evaluation, a Cognitive Behavioral therapist would most likely focus treatment on: Score: 1 of 1 A. Assisting the client in identifying the historical origin of feelings of anxiety; utilizing self-report symptoms measure to identify baseline functioning; orienting Eileen to CBT B. Identifying precipitating events that compound client’s difficulties; teaching relaxation skills; utilizing self-report symptoms measure to identify baseline functioning Correct C. Exploring her underlying thoughts and beliefs about herself and others; orienting Eileen to CBT; identifying precipitating events that compound client’s difficulties Rationale: Answer (A) is wrong since a Cognitive therapist does not care about the historical origin of feelings. Answer (B) is out since relaxation skills training is more of a middle stage intervention. Answer (C) is the best answer amongst the ones provided, since a Cognitive therapist would orient client to CBT, would focus on client’s underlying thoughts and beliefs about herself and others, and it is consistent with an initial assessment stage of treatment. Identifying events that trigger client’s struggles would also be an appropriate Cognitive intervention. Answer (D) is an intervention appropriate for a Psychodynamic therapist and not a CBT one, since CBT therapists do not care about defense mechanisms. (Treatment Planning) D. Orienting Eileen to CBT; identifying the defense mechanisms she uses to cope with her anxiety; exploring her underlying thoughts and beliefs about herself and others

Answer 64

A couple in their 70s, Elise and Jim, come to therapy due to conflict over their 26- year-old granddaughter, Jessica. A year ago, after suffering a near-fatal car accident, Jessica, along with her unemployed husband Matt, age 25, moved in with them. Jim complains, “Jessica lays around doing nothing all day, even though she recovered from her injuries months ago. They should both be out looking for work. They can’t stay with us forever!” Elise appears upset and states, “My grandbaby can stay with us as long as she needs to! I just thank God that she’s alive and in one piece.” Jim says he suspects his grandson-in-law is an alcoholic. He reports that he heard the couple fighting violently last night in their room but was afraid to intervene “after what happened last time.” What interventions would an Object Relations therapist use in the initial treatment plan in the case described in the vignette? Score: 1 of 1 A. Create the space in which the couple can share their anxieties regarding the current situation and serve as a transitional object for Jim and Elise as they move towards differentiation. B. Interpret the mental representations of Jessica and her husband that Jim and Elise each hold and enable the couple to act as if they are on the same page about their multigenerational household. Correct C. Create the space in which the couple can share their anxieties regarding the current situation and interpret and explore the mental representations of Jessica and her husband that Jim and Elise each hold. Rationale: An Object Relations therapist would indeed create the space in which the couple can share their anxieties regarding the current situation in the initial stage of treatment. So the first half of answer (A) is good. The second half, however, is a mumbo jumbo combination of both Bowenian and Object Relations terms. Besides, Jim and Elise have not indicted the desire to differentiate. The first half in answer (B) is a good initial stage Object Relations intervention, but the second half talks about a multigenerational household, which is a Bowenian term. Plus “acting as if” is an intervention appropriate for Adlerian therapist. Answer (C) is correct since both parts are good initial stage Object Relations interventions. Answer (D) is out due to the second half that has been discussed in (B). (Treatment) D. Facilitate a dialogue between Jim and Elise about the impact of Jessica’s car accident on their family and enable the couple to act as if they are on the same page about their multigenerational household

Answer 65

A therapist attends an intensive two-day workshop on treating sexual disorders. Besides this workshop, the therapist has no other training or background in sexual disorders. After attending the workshop, the therapist lists Treating Sexual Disorders as an expertise on his website. This action is: Score: 1 of 1 A. Legal since it falls within scope of practice, but unethical due to misrepresentation of scope of competence. Correct B. Illegal and unethical due to misrepresentation of scope of competence. Rationale: The actions taken by the therapist are both illegal and unethical (B), as they violate laws and ethical guidelines for advertising by misleading potential clients of the therapist’s scope of competence. The actions are neither ethical nor legal (A) or (C). It is not sufficient for the therapist to cite his specific training (D); regardless, it is unacceptable to list false expertise. (Law and Ethics) C. Legal since it falls within scope of practice and ethical since the client attended an intensive training to treat sexual disorders. D. Legal and ethical as long as he cites the specific training he attended.

Answer 66

A 34-year-old single man seeks therapy for conflict at work and with his family. During the assessment, he shares that he becomes easily agitated with colleagues, frequently explodes at the smallest slights and “ isn’t sure where the anger is coming from.” He tells the therapist that he’s gotten a verbal warning at work after the last incident where he snapped at his co-worker during a staff meeting. “And my brother and I have not spoken in weeks. He is upset with me after I yelled at him in front of the whole family,” states the client. After carefully listening to the client’s presenting complaints, a Psychodynamic therapist would? Score: 0 of 1 A. Explain the process of therapy; explore the client’s feelings about his week and the intensity of emotions; offer interpretation of the client’s anger as it relates to conflicts from the past. Should have chosen B. Determine if the client has a certain level of psychological sophistication to engage in a therapeutic process; explain the process of therapy; wait silently and attentively for the client to relate whatever comes to his mind. Rationale: The question is asking about the way in which a Psychodynamic would proceed. Psychodynamic therapists are insight oriented, so they make sure that the client is psychologically minded and sophisticated enough to gain insight from therapy. Psychodynamic therapists are also neutral and non-directive, so they will not initiate the conversation but wait for the client to start once they describe the way therapy works. Thus (B) is the best answer. The therapist’s actions in answers (A) and (C) are too direct and involved for them to be attributed to a Psychodynamic therapist. Answer (D) might happen during the later stages, but the therapist is not going to start with inquiring about early childhood. (Treatment) C. Explain the process of therapy; remind the client of his treatment goals and ask what he’d like to address first; observe the client’s characteristic defense mechanisms. Incorrect D. Determine if the client has a certain level of psychological sophistication to engage in a therapeutic process; explain the process of therapy; inquire about the client’s early childhood relationship.

Answer 67

A school-based therapist is leading a small ongoing group for high school students with conduct problems. The goal of their weekly meetings is empathy development. In addition, the therapist attempts to aid the students in advancing a sense of responsibility for their actions. The group has now been meeting for 5 consecutive weeks and it is clear that one of the students is an informal group leader. He tends to intimidate the others and tries to control the discussion by glorifying his past crimes. Each week he comes in boasting about things he has done without any consequences. How should the therapist address the group dynamic? Score: 1 of 1 A. Remain in the observing role without getting involved and allow the group to work out the issues of power and control. Correct B. Assume a leadership role and ask the group how they feel about this student’s stories and comments. Rationale: A group member who takes over the leadership of a therapy group destroys the therapeutic process. The therapist can best re-assert professional leadership by providing a safe environment for the other members to express their feelings (B).(A) is not the best answer since the group has been dealing with it for 5 weeks now and they have not yet been able to confront the situation. So they need help and modeling to deal with this situation. (C) is not the best answer since it would be empowering this student in the wrong way and letting the group work through this situation. (D) is not a good answer since we need to help the group express the impact this student's behavior has had on them, instead of giving more air time to the student. He needs to be able to hear what it was like for them to have him in the group, since the goal of this group is to develop empathy and a sense of responsibility. (Treatment) C. Maintain a neutral stance and model a trusting relationship by listening to the leader. D. Demonstrate the concept of therapeutic confrontation, by talking to the student leader about his past and current behavior.

Answer 68

After working together for several months, a therapist discovers that she attends the same church as her client. The client, a 76-year-old recent widow with ongoing health issues, asks the therapist to accompany her to weekly church services. The client explains to the therapist that it is difficult for her to get around and she does not have any support nearby. What interventions should the therapist consider? Score: 1 of 1 A. Deny the client’s request; clarify the concept of dual relationships; document the interaction; empower client to build a support network. B. Deny the client’s request; discuss professional boundaries; address issues of dependency with client; empower client to build a support network. C. Deny the client’s request; clarify the concept of dual relationships; document the interaction; refer client to a support group for widows. Correct D. Deny the client’s request; discuss professional boundaries; process the client’s reaction; empower client to build a support network. Rationale: This question is asking what interventions the therapist should consider. We are going to put the answers in order. Since there are a lot of repetitive answers we are going to compare the elements that are different. The first goal of the therapist should be to deny the request, discuss boundaries and process the client's reaction since such rejection might be painful for the client. We would also attempt to help the client find an alternative support network (D). (A) is not a good answer since documenting the interaction would come after processing the client's reaction. (B) is not a good answer since the client does not exhibit issues of dependency. (C) is missing an important element of processing the client’s reaction, which would be an important step in this case. (Ethics)

Answer 69

A therapist meets with a 30-year-old man who is having relationship problems. He reports that he’s been dating a woman for almost a year and is feeling conflicted over the direction of the relationship. He found the therapist through his insurance panel and would like to use his insurance to pay for his sessions. After completing an assessment, the therapist informs the client that his presenting issues will not be covered by his insurance. The man becomes upset, tells the therapist he has to use insurance or he cannot afford therapy, and asks the therapist to help him make it work. What ethical and legal obligations does the therapist have in this case? Score: 1 of 1 A. Discuss treatment options and encourage him to find a low or no fee clinic. B. Diagnose the client with adjustment disorder and submit claim to insurance. Correct C. Explain why insurance cannot be used and offer him a list of low fee providers. Rationale: Since the client is insisting on using his insurance, we have to respond to the client’s request. So we are going to do (C) first. (A) can be done after such explanation. (B) would constitute fraud since it is illegal to make up a diagnosis simply due to reimbursement needs. (D) can also be done, but only after the explanation regarding insurance has been given. (Law and Ethics) D. Offer a sliding scale fee to client based on his ability to pay.

Answer 70

A recent Chinese immigrant is seen in a hospital emergency room after several panic attacks. He is referred to a therapist but declines mental health treatment. All of the following are likely explanations for this refusal except: Score: 1 of 1 Correct A. High incidence of anxiety disorder within the Chinese culture. Rationale: The correct answer is (A) since there is no evidence to support the fact that anxiety is highly prevalent in Chinese culture. Even if it is, it would not provide an adequate explanation as to why the client is refusing treatment, versus options (B), (C) and (D), which are all possible explanations for such refusal. (Clinical Evaluation) B. Possible language barriers. C. Alternative treatments available in the culture. D. Cultural stigmas associated with treatment.

Answer 71

An adolescent client is mandated to receive counseling for anger management by her juvenile probation officer. Although the client is 14-years-old, her parents consented to treatment. The therapist has met with the client for three sessions and believes the client is finally beginning to trust him. In the fourth session, the client is coherent and cooperative, but the therapist believes she smells alcohol and notices the client is slurring some of her words. Which of the following actions should the therapist take in this case? Score: 0 of 1 A. Contact the parents since they consented to treatment and address safety concerns with them. Incorrect B. Confront client about suspicions and postpone the session. C. Inform the client you must notify the probation officer since she is a mandated client and has violated probation conditions. Should have chosen D. Confront the client about suspicions and proceed accordingly Rationale: Answer D is the strongest answer based on the information provided in the vignette. The vignette notes the therapist believes the client has been drinking, but belief is different from certainty. The only answers that directly address the therapist’s uncertainty are B and D. The only reason we would postpone/reschedule the session is if the client is truly under the influence and since we do not yet know that, answer B is incorrect. Following the confrontation, the therapist may choose to use the interventions noted in answers (A), (B), or (C). (Crisis Management)

Answer 72

A 38-year-old medical doctor seeks treatment for depression. The client states that her whole life she had worked to become a doctor and now that she was finally practicing independently she was miserable. She shares that she recently broke up with her boyfriend and says she’s afraid she’ll never meet someone who can measure up to her expectations. In the initial phase of treatment, what interventions would an Adlerian therapist utilize compared to a Cognitive Behavioral therapist? Score: 1 of 1 Correct A. An Adlerian therapist would explore the client’s style of life and early recollections; a Cognitive Behavioral therapist would help the client identify her problematic beliefs. Rationale: Both parts of answer (A) correlate with the theories in question and both are initial stage interventions that are relevant to this case. The first half of answer (B) is descriptive of a Solution Focused theory, so (B) is out. Answer (C) is wrong since exploring the client’s level of social involvement is going to be part of exploring client’s style of life, and exploring the client’s early recollection is crucial for Adlerian therapy, so the first part of answer (A) is more comprehensive. The second part of answer (D) rules it out, since CBT therapists do not explore the origins of problematic beliefs. (Treatment) B. An Adlerian therapist would explore what kind of life the client would like to have; a Cognitive Behavioral therapist would provide psychoeducation about CBT. C. An Adlerian therapist would explore the client’s level of social involvement; a Cognitive Behavioral therapist would help the client identify her problematic belief. D. An Adlerian therapist would complete a family constellation; a Cognitive Behavioral therapist would explore the origins of the client’s problematic beliefs.

Answer 73

Addison, a single mother of two, seeks treatment at a community clinic following the death of her aunt. She tells the therapist that her aunt died very suddenly of a brain aneurysm. “She was there one day and gone the next,” Addison states tearfully. “She used to take care of my boys,” adds Addison, “they absolutely loved her. She would take them to the library and to the playground. And now I have to take a leave from my job in order to take care of them. That is going to cost me a pretty penny, but there is no one else I can leave them with.” The client complains that she is always tired and feels she no longer has time for herself. In creating a treatment plan which of the following action should the therapist prioritize? Score: 0 of 1 A. Providing the client with grief counseling as her aunt’s death seems to be the underlying determinant of her chief complaint. B. Referring the client for a medical evaluation since she is tired all the time and it is important to rule out any possible medical issues according to the standard of care. Should have chosen C. Assisting the client in identifying her immediate needs due to the diverse nature of the issues she is presenting with. Rationale: Based on the information provided in the stem, the immediate needs of the client are unclear and the therapist should therefore assist the client in identifying her immediate goals (C). Once the client’s needs are identified, the therapist might find it appropriate to provide grief counseling (A), refer the client for medical evaluation (B), or refer her to childcare services (D). (Treatment Planning) Incorrect D. Referring her to childcare services in order to help the client feel less overwhelmed and better supported.

Answer 74

A lesbian couple seeks pre-marital counseling. The women, one a 36-year old African American high school teacher and the other a 34-year-old Caucasian graphic design artist, have been dating for three years and living together for the past year. When the therapist inquires about their reasons for seeking therapy, the teacher shares in a frustrated tone that their only issue is that the other woman smokes marijuana daily and refuses to quit despite promising to do so. In response to this, the other woman groans and says, “I don’t understand why this is such an issue for you.” Which of the following actions should the therapist initially take? Score: 1 of 1 Correct A. Ask the woman who uses marijuana to tell the therapist about the role marijuana plays in her life. Rationale: The best answer is (A). Answers (B) and (C) both focus on the marijuana use as a “problem” instead of exploring it from a neutral stance. One client does not see it as a problem, so using that wording can be harmful to the therapeutic relationship. This would make the therapist seem to be siding with the teacher. Answer (D) could be done at some point but doesn’t address the main presenting problem. Answer (A) is a technique from motivational interviewing that explores the role the substance plays in the person’s life instead of pushing them to see it as a problem. (Clinical Evaluation) B. Explore with the woman who uses marijuana when the problem with marijuana started and her views on how it has impacted their relationship. C. Reflect back to the teacher that marijuana seems to be causing them a lot of problems. D. Determine whether the teacher has ever used marijuana and how her use or non-use impacts their situation.

Answer 75

A five-year-old child is brought into therapy after she started wetting the bed again. During the initial assessment, the mother explains that this behavior started soon after she gave birth to her third child. Which of the following interventions should the therapist first take? Score: 1 of 1 A. Begin a course of play therapy to address the regressive behaviors being exhibited by the child. B. Assess for potential sexual abuse due to enuresis being a common sign of abuse. C. Refer the child for a medical evaluation to rule out any underlying biological causes. Correct D. Provide psychoeducation on normal child development and possibility of regressive behaviors being linked to recent changes in the family. Rationale: Children will often revert to an earlier developmental stage when attempting to cope with stress. It is important for the mother to understand normal child development and to discuss the recent changes(D). Following the provision of psychoeducation, the therapist might receive additional information that would indicate the need to begin play therapy (A), to assess for sexual abuse (B), or to refer the child for a medical evaluation (C). However, based on the information provided, taking any of these steps prior to psychoeducation would be overreactions. (Treatment)

Answer 76

A therapist sees a 13-year-old child for therapy and suspects the mother is physically abusing the child. The therapist had difficulty building rapport with the child who, until recently, was unwilling to participate in sessions. The therapist is concerned that if a report is made to the child protection agency, the therapeutic relationship will be damaged. What actions should the therapist take to manage the legal and ethical issues presented in this case? Score: 0 of 1 Marked Incorrect A. Meet with the child individually to discuss concerns regarding safety and to assess for abuse. B. Refer the child for a medical evaluation to assess the client’s physical well-being and potential effects of physical abuse. Should have chosen C. Report the suspected abuse and process the report with the child. Rationale: Legally, therapists are mandated to immediately file a child abuse report if they suspect abuse and should process the need to report with the client(C), once we have reasonable suspicion, we must report regardless of the effect on the therapeutic relationship. Answer (A) is incorrect because we do not need to assess further once we suspect the abuse. Following the report, we may choose to refer the child for a medical evaluation (B). Our obligation is to process the report with our client, it’s not clear how involved the mother is in treatment or if it would be appropriate to discuss with her as well, so (D) is not as strong as answer (C).D. Report the suspected abuse and process the report with the child and mother. (Law and Ethics) D. Report the suspected abuse and process the report with the child and mother..

Answer 77

A therapist working on a multidisciplinary team meets with a young adult male who is hospitalized following a failed suicide attempt. The client is agitated and complains that too many staff members know the details of what led to his attempt. He tells the therapist that he is tired of being asked the same questions over and over again. He acknowledges that he “lost it” with a staff member but defended his action as a response to being belittled in front of other patients. After acknowledging the client’s feelings, how should the therapist proceed? Score: 1 of 1 A. Reassure the client that the staff understands the client’s frustration and can deal with his anger. B. Suggest ways the client can better manage his anger. Correct C. Explore how the client thinks the therapist can help with the situation. Rationale: The client is expressing frustration regarding lack of control in his hospitalization, and exploring how the therapist can help (C) allows the client to feel some sense of control. Reassuring the client of the staff’s understanding and ability to deal with his anger (A) could be misleading and gives the client permission to continue acting inappropriately with staff. Suggesting anger management techniques (B) does not address the underlying reason for the client’s behavior and telling the client that his feelings will be discussed with staff (D) would perpetuate the client feeling a lack of control. (Clinical Evaluation) D. Tell the client that his feelings will be discussed at the next staff meeting

Answer 78

A therapist is providing crisis counseling to second graders at a local elementary school. A classmate was recently hit by a car and killed on the way to school. The students report feeling scared to come to school and anxious that something bad might happen to them. When meeting with students, the therapist should first: Score: 0 of 1 Should have chosen A. Reassure students that their feelings are normal and meet with students individually to assess severity of symptoms. Rationale: The correct answer is (A) because the first thing to do is to let the students know that feeling scared is completely normal and to be expected. This way the students do not have to worry that something is wrong with them. We would also want to assess the varying needs of students, as type of support needed will vary. It is only after completing this step that the therapist might choose to follow through on options (B), (C), or (D). It’s important to note that students’ needs will vary, so the different options available in answers (B-D) could be appropriate for one subset of students, but not all. (Crisis Management) B. Develop a student support group to provide a safe space for classmates to process their grief and to normalize their feelings of fear. Incorrect C. Provide students and their parents with education on how cope with Acute Stress Disorder and grief. D. Develop a list of referrals for grief counseling and encourage parents to link students with mental health treatment.

Answer 79

A 54-year-old man seeks therapy for feelings of emptiness. His wife encouraged him to “talk to someone.” He shares that he is a partner at a large law firm but finds his work meaningless. He has been married for almost thirty years but doesn’t feel attracted to his wife. His two children are in college and he says he doesn’t have a great relationship with them because he was always working. How would a Reality Therapist proceed initially in this case? Score: 0 of 1 Should have chosen A. Assist the client in defining what he wants for his life and from therapy. Rationale: Answer (A) describes perfectly an initial stage in Reality therapy. Answer (B) is out since Reality therapy does not focus on the past but on present choices. Answer (C) is out since a Reality therapist is going to focus on what the client is currently doing, not on what was done. Answer (D) is not indicative of Reality therapy either, since Reality therapists do not concern themselves with feelings as much and would rather focus on present choices, than provide psychoeducation. (Treatment Planning) B. Explore how the client’s problems first developed. C. Find out what solutions the client has already tried to alleviate his feelings or emptiness. Incorrect D. Provide psychoeducation about how the choices we make affect how we feel.

Answer 80

A therapist working in a mental health hospital sees a 67-year-old involuntary client who is being held due to the risk of self-harm. The client has heart disease and a history of cocaine abuse. The client does not feel she needs to be in the hospital and requests the therapist transfer her to an outpatient program. How should the therapist initially respond? Score: 1 of 1 Correct A. Remind the client that hospitalization is not voluntary. Rationale: Clients who are involuntary hospitalized are not able to determine when they are to be released and should be reminded of this if attempting to receive alternative treatment (A). The therapist does not have the authority to discharge the client (B) and (D) nor determine when the client will be released (C). (Law) B. Assist the client in efforts to be discharged and locate outpatient program. C. Explain that the client will be released after 72 hours. D. Refer the client for an outpatient evaluation.

Answer 81

A therapist receives a phone message from a client’s psychiatrist who has been providing medication monitoring for the client’s depression. The psychiatrist informs the therapist that the client gave him permission to contact you and he would like to discuss concerns about the client’s diagnosis and treatment. What should the therapist do first? Score: 0 of 1 A. Call the psychiatrist to inform him that you will request the client sign a release in the next session. Should have chosen B. Call the psychiatrist and request a faxed copy of his release before acknowledging you see the client. Rationale: Legally we are allowed to speak to another health care provider without a release for the purpose of treatment and diagnosis, however, it is always best practice to secure a release from the client and have it on file. For instance if the conversation with another provider moves away from those two topics and into client’s history, as it often does, we are covered. Thus (B) is the best answer here. Calling the client and receiving a verbal consent would not be sufficient, thus (C) is incorrect. You could do (A); however it is time consuming. (D) is incorrect since the therapist would be breaking the client’s confidentiality without having a written release in hand. (Law) Incorrect C. Call the client to request permission to speak with the psychiatrist. D. Call the psychiatrist to discuss concerns regarding the client’s case since the client has signed release.

Answer 82

A 15-year-old, who has a diagnosis of childhood diabetes, is brought in to therapy by her parents who were sent by her MD. Recently, she has been fighting with her siblings and parents. Although she continues to receive good grades, she demonstrates an increasing need to be in control at home and is rebelling against family rules and her required diet. Which of the following conclusions should the therapist make based on this assessment information? Score: 0 of 1 A. The symptoms are a result of mood fluctuations caused by possible misuse of prescribed medication. Should have chosen B. The symptoms are a result normal adolescent behavior. Rationale: The child’s behaviors may represent a common response in children who feel they are lacking control in certain aspects of his/her life (D); however because they are recent, the behaviors are more likely representative of normal adolescent behavior (B). There is no indication that she is misusing her prescribed medication (A). There is a possibility that her diet is causing fluctuations in her mood (C), but the behaviors can be better explained by adolescence. (Clinical Evaluation) C. The symptoms are a result of an irregular diet causing fluctuations in her mood and behavior. Incorrect D. The symptoms are a result of her need to control whatever parts of her life she can.

Answer 83

Carol, a recently divorced 40-year-old accountant, and her 14-year-old daughter, Cindy, are self-referred. Carol complains that since the divorce, Cindy is always talking back, stays out past curfew, and “sneaks” her 17-year-old boyfriend into the house. Carol states, “It’s tough enough to raise a daughter alone. I can’t even get her to go to school.” Cindy says, “You and your religion make a big deal out of everything. I hate being home when you’re always running those bible study groups. Just back off!” After the session, Cindy calls the therapist and reports that she is two months pregnant and is considering having an abortion. Cindy asks that her mother not be told about the pregnancy. Consider Cindy and Carol as the unit of treatment. Which of the following actions would a Solution Focused therapist take when developing a treatment plan in this case? Score: 1 of 1 A. Instruct them to describe what their relationship would be like if they were getting along; identify their automatic thoughts about one another. B. Ask them to identify a time when they were getting along; draw a family map to understand their roles. Correct C. Utilize scaling questions to clarify the nature of their situation; ask them to identify a time when they were getting along. Rationale: The best answer is (C). Both scaling questions and asking to describe a time when they got along are in line with Solution Focused therapy. (A) is out because of the automatic thoughts. In (B), drawing a family map is used in Bowen. And in (D), telling them to resist getting better is a Strategic Intervention. (Treatment Planning) D. Tell them to resist getting better; ask them to identify a time when they were getting along.

Answer 84

A therapist at a community mental health center has been working with a family from El Salvador to address issues with their teenage children. At the beginning of the final session, the mother gives the therapist a gift card and expresses her appreciation to the therapist for continued support of the family. How should the therapist address the gift with the client? Score: 0 of 1 Should have chosen A. Acknowledge the expressed gratitude and inform the client that you cannot accept gift cards. Rationale: Gift cards are equivalent to cash and that would be an inappropriate gift to accept, so the best answer is A. You don’t need to find out the value or consult with a colleague. (Ethics) Incorrect B. Determine the value of the gift prior to accepting it. C. Consult with a colleague who is knowledgeable about El Salvadorian culture. D. Explain to the family that it is your agency’s policy not to accept gifts from clients.

Answer 85

A therapist meets with a 48-year-old male with a chief complaint of depressive symptoms, including lethargy and a lack of interest in usual activities. The client reports a history of regular recreational cocaine use, although he reports refraining from use for several days and has a desire to maintain sobriety. What initial action should the therapist take in this case? Score: 0 of 1 A. Refer client to psychiatrist to evaluate severity of depressive symptoms and to determine appropriateness of an SSRI. Incorrect B. Encourage the client to attend Narcotics Anonymous since he is in the action stage and recommend he participate in individual therapy to address depressive symptoms. Should have chosen C. Provide client with psychoeducation regarding common withdrawal symptoms linked to cocaine withdrawal, including depressive symptoms. Rationale: The correct answer is (C) because prior to referring the client to NA (B) or for a psychiatric evaluation (A), and affirming the client’s motivation to maintain sobriety (D), the therapist should first educate the client on the nature of his/her symptoms. Understanding that repeated use of cocaine depletes the brain of the neurotransmitters necessary to sustain normal mood resulting in depression will help the client grasp and deal with the reality of the situation. (Treatment) D. Affirm client’s desire to maintain sobriety and help identify support systems to assist client with stated goal.

Answer 86

During a session with a therapist, a woman complains about ongoing conflict with her husband regarding their finances. She reports that two days ago, after a heated argument about a credit card bill, her husband slapped her. She informs the therapist that this was not the first time a fight became physical. She is feeling more optimistic because he bought her flowers and offered to start couples therapy with her. The client informs the therapist she would like the husband to join in future sessions. How should the therapist initially proceed to address the physical violence presented in the case? Score: 1 of 1 A. Acknowledge client’s hope for change; encourage client to develop a safety plan; inform client that couples counseling is contraindicated in cases of domestic violence. Correct B. Acknowledge client’s hope for change; provide the client with psychoeducation regarding the cycle of violence; develop a safety plan with client. Rationale: Answer (B) is the strongest answer available. We want to start where the client is, so acknowledging the client’s hope for change is a good place to start. We would also want the client to be aware of the cycle of violence since the vignette clearly indicates they are in the honeymoon stage. In addition, developing a safety plan with our client is essential to address potential future risk. Answer A highlights the importance of paying close attention to the wording--we would want to collaboratively develop a safety plan with the client, not encourage the client to develop one. This wording makes answer A incorrect. Answer C is not as strong as (B) because our priority is focusing on our client, not resources for the husband. Answer (D) is not as strong as (B) because the referral to a DV support group is not as important as safety planning. (Crisis Management) C. Provide the client with psychoeducation regarding the cycle of violence; refer husband to attend anger management group; develop safety plan with client. D. Provide client with referral to domestic violence support group; provide psychoeducation regarding the cycle of violence; inform client that couples counseling is contraindicated in cases of domestic violence.

Answer 87

Allison is a 35-year-old, woman who is referred by her EAP. She states that she’s been having a hard time since she changed departments because she doesn’t get along with her new boss. She says angrily, “She’s always checking on me. It drives me crazy. I’m not going to put up with her attitude for much longer.” When the therapist asks why the client was referred she replies, “Because she caught me drinking in the bathroom during lunch.” What ethical responsibilities does the therapist have in this case? Score: 1 of 1 A. Review options for payment of fees; Practice within scope of competence; Obtain signed consent for treatment. Correct B. Practice within scope of competence; Manage confidentiality in contact with workplace; Monitor countertransference throughout course of treatment. Rationale: Since the question is about ethical responsibilities, we are going to rule out the answers that contain legal responsibilities. Thus, answers (A), (C), and (D) are out because reviewing options for payment of fees, obtaining signed consent for treatment, and acting within scope of practice are all legal responsibilities. (Ethics) C. Practice within scope of competence; Review options for payment of fees; Manage countertransference throughout course of treatment. D. Discuss risks and benefits of treatment; Limit services to permissible scope of practice; Manage confidentiality in contact with workplace.

Answer 88

A new client who is self-referred tells a therapist during the initial intake that he is dissatisfied with his current job and is interested in finding a new one. He shares that he has worked at his current company for several years and needs assistance in deciding upon a new career. He reports there are no other issues he is interested in addressing at this time. What should the therapist do next? Score: 1 of 1 A. Start therapy by helping client develop short and long-term goals. B. Start therapy by initially focusing on client’s career concerns and explore other issues as they arise. Correct C. Refer client to a career counselor. Rationale: In order to do career counseling, you would want to make sure you have the proper training. This is the only issue the client is presenting with, so he would be better served by seeing someone who specializes in this area. Thus, the correct answer is (C). Answers (A) and (B) would be inappropriate, since his goals are clear and would be better addressed by a career counselor. There is no indication of the fact that the client might be depressed, thus answer (D) is not relevant. (Ethics) D. Assess client for possible depression.

Answer 89

A 75-year-old woman is referred to therapy by her pastor following the loss of her spouse of 35 years, as well as the loss of her sister. In the initial interview, the client reports she is experiencing recent difficulties with memory loss and confusion, aches in her body, sadness, feelings of loneliness, and a lack of purpose. As an initial intervention, the therapist should: Score: 1 of 1 A. Refer the client for a medical evaluation to address memory loss, and other biological complaints. B. Provide psychoeducation on the grief process and ask the client to share memories of her spouse and sister. Correct C. Assess the client for depression and suicide risk due to symptoms and increased risk factors. Rationale: Based on the multiple losses, the client’s age, and her own reports, an evaluation for depression and suicide is the therapist’s first course of action (C). A medical evaluation (A) may be appropriate, but not the therapist’s first action. An exploration of memories (B) does not adequately address the immediate problems. Referring the client to a support group (D) may be appropriate, but like (A), not the therapist’s first action. (Crisis Management / Clinical Evaluation) D. Provide psychoeducation on the grief process and refer the client to a support group for recent widowers.

Answer 90

A therapist working at a community clinic is meeting with a 16-year-old girl for the first time. The girl reveals that she has been depressed for most of the past year. To help her cope, she has been buying sleeping pills off her classmates and friends. During the session the therapist determines that it is necessary to initiate a 5150 because the client presents as a serious danger to herself. After informing the client of the need to initiate a 5150, she becomes upset stating that such a step is not necessary. She demands that her mother who is in the waiting room be included. The mother becomes hysterical. How should the therapist proceed? Score: 1 of 1 A. Acknowledge the intensity of the situation; create a safety plan for mother and daughter; determine if there is another family member available for support B. Validate the client's fear; assess further to see if the client has a plan and how many pills she has available; invite a colleague into the room to help manage the situation C. Validate the client's fear; determine if there is another family member available for support; discuss the possibility of voluntary hospitalization. Correct D. Acknowledge the intensity of the situation; contact the PET team and initiate a 5150; process with mother and daughter. Rationale: The best answer is D. The therapist already determined a need for a 5150, so there is clear reason to move forward with that despite the mother and daughter being upset. Since the daughter stated that hospitalization is not necessary, an option of voluntary hospitalization is no longer viable. So (C) is out. The stem states that the therapist has already determined the need for 5150; therefore further assessment is not indicated. So (B) is not the best answer. Answer (A) could be done later, but at this point we need to address the need for hospitalization. (Crisis Management)

Answer 91

A therapist is providing ongoing therapy for a 13-year-old girl who was molested by her mother’s ex-boyfriend. In assessing the impact the abuse has had on the client, the therapist should be most concerned with the client’s: Score: 1 of 1 A. Physical health B. Family relationships C. Coping skills Correct D. Psychosocial functioning Rationale: In assessing the impact of a traumatic experience the therapist is most concerned with client’s psychosocial functioning (D), which is an encompassing term that includes both coping skills (C), and client’s relationships (B). As therapists, it is outside our scope of practice to assess physical health (A) and for that we would refer the client to an M.D. (Clinical Evaluation)

Answer 92

Ana, a Mexican-American 39-year-old single mother of two young children, is referred by her minister. Ana shares that she has been very overwhelmed lately. Her parents were visiting for three months but recently went back to Mexico. She says, “They really helped me with the kids. Childcare is so expensive and my kids are in different schools now. My boss at work is getting irritated that I have been late a lot. I am worried I am going to lose my job.” She adds that she’s been having difficulty sleeping and bad headaches. What human diversity issues should the therapist consider when developing an initial treatment plan in this case? Score: 1 of 1 A. Ana’s health concerns; Her low socioeconomic status; Being a single mother. Correct B. Ana’s spiritual beliefs; Her experience as a Mexican-American; Being a single mother. Rationale: In answering this question we need to think about this client’s unique life circumstances that are shaping her presenting issues. In the stem we see that she is a Mexican-American, is a single mother, and she was referred by her minister. All three of these things set her aside from other people with similar presenting issues, thus (B) is the best answer. Answer (A) is out since lots of people share similar health concerns and that is not a human diversity issue. Plus, we would be making an assumption if we were to state that her low socioeconomic status is at play, since the stem doesn’t explicitly state that she has a low socioeconomic status. Answer (C) is also out due to the assumptions regarding her low socioeconomic status. And (D) is wrong because we do not know her sexual orientation. (Treatment Planning) C. Ana’s spiritual beliefs; Her low socioeconomic status; Being a single mother. D. Ana’s sexual orientation; Being a single mother; Her experience as a Mexican-American.

Answer 93

Tasha, age 63, is referred to therapy by her doctor. Tasha was recently in a car accident that resulted in her losing her left leg. In the first session she appears clean but disheveled and has a hard time maneuvering her wheelchair. She tells the therapist, “I am too old for this. I don’t want to be a burden on my family. Now I can’t even take care of my grandkids.” What actions should the therapist take to address the legal obligations presented by this case? Score: 1 of 1 A. Assess Tasha’s potential for self-harm; Consult with physician regarding in-home support needs; Obtain written consent to collaborate with medical providers. Correct B. Assess Tasha’s potential for self-harm; Disclose fees for professional services; Obtain written consent to collaborate with medical providers. Rationale: The correct answer is going to focus on legal responsibilities that are relevant to the case; thus, we will eliminate all answers that contain ethical obligations. Answer (B) is the only one that describes all legal obligations. Answers (A) and (D) are out since they contain ethical elements, such as consulting with physician and maintaining privacy. Answer (C) is ruled out since initiating a “No Harm” contract is too premature and, even if the client was considered suicidal, is not considered an effective intervention. (Law) C. Initiate a “No Harm” contract; Disclose fees for professional services; Limit services to permissible scope of practice. D. Obtain Tasha’s informed consent for treatment; Explore her expectations of therapy; Maintain privacy and security of client records.

Answer 94

A teacher consults with a school-based therapist regarding a six-year-old student who has repeatedly come to school with the same injuries. The student tells the teacher the injuries are a result of playing with the family’s dog and participating in outdoor sports. The teacher reports the student is increasingly distracted during class, spending more time alone, being aggressive with classmates, and is reluctant to leave the classroom at the end of the day. What should the therapist do next? Score: 0 of 1 A. Discuss the client’s injuries with the school nurse. Should have chosen B. Explain to the teacher the need to report abuse. Rationale: The information provided in the stem is enough to reasonably suspect child abuse. It is the responsibility of a mandated reporter to notify the appropriate authorities when abuse is suspected (B). Both the teacher and the therapist would not need to make a report. In this case, the teacher would make a report, since he/she has witnessed the child’s behavior first hand and the therapist would document that such report was made. It is the responsibility of the appropriate authorities to investigate whether abuse exists. So (A), (C), and (D) are out. (Crisis Management) Incorrect C. Contact the parents to inquire about the child’s unusual behaviors. D. Meet with the student to complete an assessment.

Answer 95

A therapist sees a college-aged client who was raised in a family with an alcoholic mother who was abusive toward the client and her siblings. The client tells the therapist that she and her siblings regularly avoid getting angry or upset around her mother, because they are afraid of how she will react. The client also says she tries to keep her mother happy and that she feels this is the only way to do so. Which of the following short-term goals should the therapist consider in this case? Score: 0 of 1 Should have chosen A. Help the client understand characteristics of codependency in order to help free her from a burdensome relational dynamic with her mother. Rationale: The stem describes a codependent situation, so the therapist needs to first help the client understand this behavior (A). Assisting the client in expressing her feelings (B) or helping the client access and express her anger (C) address only one element of the broader issue. Family therapy (D) is not a realistic option at this point. (Treatment Planning) B. Assist client in expressing her feelings to her mother in an attempt to reinstate a parent - child hierarchy. Incorrect C. Help client access and express her anger since doing so can be cathartic for the client. D. Prepare the client for family therapy in order to facilitate an honest conversation between all family members where the children can express the impact of mother’s behavior on them.

Answer 96

A 33-year old client seeks therapy for depression. During the assessment she tells the therapist that she has been taking prescription painkillers daily and has been unable to stop despite past efforts. She admits to the therapist she’s resistant to quitting because she has tried before and the physical and psychological effects were “torturous.” What is the best ethical course of action for the therapist to take in this case? Score: 1 of 1 A. Refer her to a psychiatrist for a medication evaluation to treat her depression and collaborate with the psychiatrist on treatment goals. Correct B. Provide psychoeducation about the effects of painkillers on mood and refer her to a substance abuse treatment center. Rationale: The best answer is B because it acknowledges the impact of the drug use and provides an appropriate referral. D and A ignore the drug use and C denies the client treatment. (Ethics) C. Provide psychoeducation on the stages of change and inform client that treatment won’t be effective until she is ready to deal with the addiction. D. Develop treatment goals to address the client’s depressive symptoms and deal with the addiction once depressive symptoms are reduced

Answer 97

A therapist working in the psychiatric hospital is asked to complete a mental status exam of a newly admitted patient. The 54-year-old woman was admitted to the hospital in the middle of the night under WIC Section 5150 after the police received an anonymous call due to safety concerns. When the therapist meets with the woman, she presents as confused and unable to provide intake information. Which of the following actions should the therapist take to manage the legal and ethical issues involved in this case? Score: 0 of 1 Should have chosen A. Seek permission from the client to contact relatives; continue working with client to gather information; collaborate with medical team. Rationale: People are admitted to the hospital for serious reasons: they might have tried to attempt suicide by taking some substance or might be a danger to self or other in some other way. If the client is unable to provide intake information, the next best source of information could be family or significant others (A). Seeking permission to make these contacts would be an appropriate and ethical thing to do. The client might not be in the clear enough state of mind in order to give us a release to talk to the relatives, but that does not mean that we wouldn't try. In addition, we could continue our efforts to work with the client and it would be important to collaborate with the medical team to understand any underlying biological concerns. Answer B is not as strong because it’s premature to recommend psychological testing and it’s not clear how long it would take for the client to stabilize. Answer C is incorrect because we would focus our attentions on the medical needs rather than the officers or psychological assessment. Answer D has similar components to B and C also making it incorrect. (Law and Ethics) B. Recommend psychological testing for the client; collaborate with the medical team; wait for the woman to stabilize before completing the report. Incorrect C. Refer for psychological testing; follow up with officers who invoked 5150; gather as much information from client as possible. D. Seek permission from client to contact relatives; follow-up with officers who invoked 5150; wait for the woman to stabilize before completing the report.

Answer 98

A therapist is seeing a family of four, including the 15-year-old daughter and 12-year-old son. The stated goal of therapy is to decrease ongoing conflict between the siblings and improve communication. The mother, who has history of trauma, has developed a positive relationship with the therapist and requests to concurrently meet with the therapist for individual therapy. Which of the following actions should the therapist take to manage the ethical issues involved in this case? Score: 1 of 1 A. Provide the mother with referrals to other therapists because it would be unethical to provide individual and family therapy concurrently. B. Continue family therapy and meet with mother individually and clarify boundaries. C. Consider referring the family to another therapist because of severity of symptoms for mother and level of rapport. Correct D. Consider the implications of concurrent individual therapy for family and discuss them with the client. Rationale: Some family therapists decide to work with family members individually and some decide to refer family members out for individual work. It would be important to discuss the implication of such a request and how it would affect the family before deciding how to proceed, answer D. Answer A is incorrect because providing concurrent therapy is not always unethical. Whether the therapist and the mother decide to work together (B) or provide referrals (A) and (C), it would be important to first discuss the implication of such request to family therapy (D) and consider the full clinical picture. (Ethics)

Answer 99

A therapist meets with an older couple, Stefan and Mila. The couple reports they are experiencing increased arguments and distance between them. “I have to poke and prod him all day in order to get anything out of him,” says Mila. “It is like living with a wall,” she adds while her husband is looking down at his feet. During one session, the husband finally tells the wife that the reason he is so shut down is because a few weeks ago, when he told her that he was getting depressed, she told him to talk to the therapist instead. “It was clear that telling you about my depression was just a burden for you. So I figured I would not bother you anymore,” he says. What formulation would an EFT therapist offer to this couple? Score: 1 of 1 A. This distance you have been experiencing is a pretty powerful problem you are dealing with. How have you managed to keep the distance from getting even bigger between you? B. Stefan, it sounds like you believe that Mila does not want to hear about anything you are going through since she did not want to hear about your depression, is that right? C. Have you ever had an issue with communication or feeling distant with one another in the past? How were you able to resolve it? What would you need to do to get that to happen again? Correct D. Mila, it sounds like you miss your husband and to regain a sense of connection are poking and prodding Stefan to try reaching him. Stefan, you want to know that your pain matters to Mila, and when you thought you were a burden, you decided it would be safer to stop being vulnerable. Rationale: The answer that reflects the attachment perspective of EFT is (D). Answer (A) is reflective of a Narrative theory approach. Answer (B) describes an example of overgeneralization, which is a cognitive distortion. This is something a Cognitive therapist would say. Answer (C) is an example of Solution-Focused questioning. (Treatment)

Answer 100

A therapist is currently treating a 13-year-old child who has a diagnosis of PTSD. His 20-year-old brother, who has a history of substance abuse, physically abused the client. The child informs the therapist that the older sibling recently moved back into the house after losing a job. The parents assure the therapist that they informed social services of the plan and received approval for him to move back into the home. Which of the following actions should the therapist take to manage the client’s safety concerns in this case? Score: 1 of 1 A. Schedule a joint session with the entire family to assist in the transition and safety plan with the child. B. Contract with the client to report any further abuse and continuously assess for signs of abuse. Correct C. Develop a safety plan with the child and continuously assess for signs of abuse. Rationale: Safety is the main objective for the child; thus the development of a safety plan should take priority (C). Answer (A) is out because it is contraindicated to have a victim and a perpetrator in the same session. Options (B) and (D) could be done, but safety is foremost. D. Appeal the decision made by social services and request removal of the perpetrator from the house due to client’s diagnosis of PTSD.

Answer 101

Betty, a 66-year-old woman, is referred for therapy by her Employee Assistance Program (EAP). She has been written up for poor job performance, multiple absences, and tardiness. She has recently been diagnosed with liver cancer. She tearfully states that she’s been feeling really down and has not been sleeping or eating well lately. Betty grumbles that her husband is unsupportive and demanding. She affirms that she has been sober for the last 6 years and says, “Although, lately, I have been thinking of how good a glass of red wine would taste right about now. I have a great AA sponsor and she helps me with my sobriety. So you do not have to worry about that. I just want you to help me deal with cancer from all angles.” How should the therapist clinically manage therapeutic implications of the fact that Betty was referred for treatment by EAP? Score: 1 of 1 A. Help the client prioritize the issues she is dealing with; Notify the client’s employer when she has met her goals; Establish goals that are objective; Obtain a release to speak to Betty’s boss B. Obtain a full family history; Establish a clear target date for achievement of goals; Establish goals based on the client’s priorities; Explain what information will be shared with the EAP C. Ask the client to clarify what she means by “I just want you to help me deal with cancer from all angles”; Establish goals that are incremental; Provide all the information requested by the client’s employer; Refer client to a psychiatrist for a medication evaluation Correct D. Inform the client that treatment is going to be short-term and problem-resolution focused; Establish goals that are attainable and measurable; Review progress and provide necessary referrals; Explain what information will be shared with the EAP Rationale: In order to answer this question correctly it is important to keep in mind the specifics of working with EAP as it relates to this case. Answer (A) is wrong for many reasons. We will not be notifying the employer just when the goals have been met, we will be notifying the employer all along the way. It is not so much that we are after objective goals, but rather we would aim to create attainable and measurable goals. We would not need to obtain a release to speak with client’s boss, since the client already agreed to us talking with her boss by agreeing to EAP treatment. Answer (B) is wrong since we will not be obtaining family history as part of short term and problem-resolution focused EAP treatment. Answer (C) is out since not all parts relate to EAP treatment. Plus we might not be providing all of the information that is requested by the employer, only that information which is agreed upon in the EAP contract. All parts in answer (D) pertain to working as an EAP provider; thus it is the best answer. (Treatment Planning)

Answer 102

A therapist in private practice is on three different insurance panels. The therapist receives notification that one of the insurance companies is conducting an audit and they request six clients’ records. How should the therapist respond? Score: 0 of 1 A. Contact an insurance company representative to determine the reason for the audit and advocate to only release a limited scope of information Should have chosen B. Pull each of the requested files to make sure each file has an authorization and submit the records. Rationale: The best answer is B. Audits are treated as part of the federal HIPAA exception permitting access to health records for treatment, payment, and health care operations (TPO) activities without an authorization from the client. If you are on an insurance panel, you have agreed to allow your records to be audited. The clients, when they agree to utilize their insurance and sign HIPAA forms, also agree in advance to release records for insurance audits. However, the therapist should verify the authorization is signed and in the client’s record before releasing the file. (Law) C. Request written authorization for each file and inform clients about information released. Incorrect D. Verify request with the insurance company to make sure that this is a bona fide request and provide copies of the records.

Answer 103

A 22-year-old client initiates therapy with complaints of anxiety and hopelessness. The client currently lives with her stepsister, is unemployed, and is attempting community college. She discloses that her father left her family when she was a baby and her mother died of an overdose two years ago. The client has a much older boyfriend who travels a lot for work and she thinks he is cheating. Which of the following areas should the therapist inquire after in order to complete a comprehensive assessment for this client? Score: 1 of 1 A. Gather family history; determine client’s strengths; identify coping mechanisms. B. Explore suicide risk; determine somatic symptoms; identify familial coping patterns. C. Explore substance use; determine somatic symptoms; identify familial coping mechanisms. Correct D. Explore suicide risk; determine client’s strengths; identify coping patterns. Rationale: The client expressed hopelessness so suicide risk is essential and it narrows it down to B and D right away. D is more specific to the client and thus a stronger answer. (Clinical Evaluation)

Answer 104

A therapist is seeing a client with a diagnosis of Major Depressive Disorder. In discussing the treatment plan, the therapist suggests certain goals and interventions. The client quickly agrees, stating, “I’ll try anything. I just want to feel better.” The client reports a history of failed counseling experiences. In developing a realistic treatment plan, how should the therapist initially proceed? Score: 0 of 1 A. Empower the client to take the lead in developing treatment goals to counter lack of motivation among clients experiencing depressive symptoms. B. Explore effective treatment protocols for depression by consulting with colleagues and peer reviewed journals. Should have chosen C. Identify obstacles that hindered earlier treatment efforts since client has an awareness of what was ineffective in the past. Rationale: Past barriers to reaching treatment goals must be identified first so that the therapist and client can be successful moving ahead (C). The rest of the options listed may be appropriate actions to take but will not be effective until the therapist understands what past treatment was like and what hindered progress in the past. Also, answer A is weak because it would be best for the client and therapist to collaborate on treatment goals, not have one of the other do them on their own. (Treatment Planning) Incorrect D. Clarify the client’s understanding of the treatment process to ascertain client’s expectations and identify appropriate interventions.

Answer 105

Eric, a 38-year-old Caucasian, and Naomi, a 31-year-old Asian-American, are referred by Naomi’s minister. In order to keep his job, Eric recently completed a 30-day drug and alcohol residential treatment program. Naomi states that while Eric was away, she felt safe for the first time in years. She was able to attend church and see her friends. Her situation has changed since Eric returned home. She appears nervous in session and complains of insomnia, nightmares, and difficulty concentrating at work. She fears that they both might lose their jobs. Eric states, “I don’t know why I’m here. I don’t need any more therapy. I’m done drinking! What’s the problem? Naomi should just see you alone.” Using Cognitive-Behavioral Therapy, which of the following interventions would achieve Naomi’s goal of increasing her self-care skills based on the case provided in the vignette? Score: 1 of 1 Correct A. Teach Naomi relaxation techniques to use when she awakens from a nightmare; test Naomi’s assumptions that she might lose her job Rationale: The question is specifically focusing on Naomi’s goal of self-care, as well as CBT therapy. Both parts in (A) address that goal and are appropriate CBT interventions. Answer (B) talks about the origins of her thoughts, but CBT does not pay attention to the origins. Plus the therapist will not teach the client how to extinguish her fears, as that is not an existing intervention. Answer (C) is out since CBT therapists would not be enabling the client to challenge isolation, rather thoughts that are resulting in isolation. And teaching the client ways to stop thinking about her husband’s drinking is not an appropriate intervention. If he drinks, she should be thinking about it. Answer (D) talks about the origins of her thoughts and CBT does not pay attention to the origins. (Treatment) B. Enable Naomi to identify the origins of her self-defeating thoughts; teach Naomi to extinguish her fears about seeing her friends C. Enable Naomi to challenge her isolation as a result of not seeing friends; teach Naomi thought-stopping techniques regarding Eric’s drinking D. Encourage Naomi to monitor her thoughts when she is feeling nervous; enable Naomi to identify the origins of her self-defeating thoughts

Answer 106

A 33-year-old man who lost custodial rights with his two children following a CPS case is court ordered to receive individual therapy as a condition for him to have visitation rights with his children reinstated. In the first two sessions with the therapist, the client presents as guarded and distrustful of the therapist. He misses the next two sessions. What actions should the therapist take to address the client’s missed sessions and court requirements? Score: 1 of 1 A. Close client’s file and provide a written report to the court documenting the client’s number of sessions attended and termination due to lack of attendance. B. Call client to reschedule appointments and inform him of the cancellation policy as well as amount owed for missed session fees. C. Close client’s file and provide him with a written report that he can share with court regarding number of sessions attended and date of termination. Correct D. Contact the client to discuss the consequences of missed appointments and explore client’s feelings regarding therapy. Rationale: By calling to discuss the consequences of the missed appointments and exploring the client’s feelings toward therapy, the therapist can work to build rapport and ensure the client understands what would happen if he did not comply with the order (D). This may or may not lead to termination. Assessing the client’s motivation to continue and potentially rescheduling appointments (B) can be part of such phone call. If after such conversation the client continues to miss, the therapist might provide a report to the client or court (A) as well as terminate therapy with the client (B). (Treatment)

Answer 107

A therapist sees a client who is concerned about excessive Internet use. The client worries about not being able to control online activity and feels it is harming interpersonal relationships outside of the Internet. In order to assess the impact of the client’s Internet use, the therapist should determine: Score: 0 of 1 Should have chosen A. The degree to which the client’s life is affected. Rationale: The therapist would need a complete picture of the client’s presenting problem and its impact on the client’s life, which must include an evaluation of how Internet use affects the client’s life (A). Options (B), (C), or (D) would be done after the therapist has an understanding of the extent of the problem. (Clinical Evaluation) Incorrect B. The duration of time spent online each day. C. How many online relationships the client has. D. What kind of websites the client is visiting.

Answer 108

A therapist receives a phone call from a 58-year-old married woman who is distressed by her husband’s recent inability to sustain an erection. She reports that her husband has suffered from depression and was recently prescribed Paxil. She says the physician has explained how SSRIs can cause this problem but she tells the therapist, “It’s not because of the medicine, it’s because he no longer loves me.” What interventions would the therapist consider in creating a treatment plan in this case? Score: 1 of 1 A. Offer individual therapy to the client; add a comment in client’s psychotherapy notes reminding the therapist to assess client’s attachment history; work to address the client’s distorted beliefs and assumptions B. Offer individual therapy to the client; refer the client to NAMI to help her learn about the effects of SSRIs and depression on libido; prioritize addressing the client’s beliefs and fears about the way her husband feels about her. C. Offer conjoint sessions to the client and her husband; suggest that the husband seek a second opinion; refer the client to NAMI to help her learn about the effects of SSRIs and depression on libido Correct D. Offer conjoint sessions to the client and her husband; work collaboratively with the husband’s prescribing health care provider if seeing them together; add a comment in client’s psychotherapy notes reminding the therapist to assess client’s attachment history Rationale: The woman is struggling with changes to her marital relationship; therefore, conjoint therapy (D) would allow both the husband and wife to explore their feelings. In addition according to the standard of care it is best practice to collaborate with other healthcare providers involved in the case. The client’s comment at the end is possibly pointing to attachment wounding, thus gathering client’s attachment history would be an important part of creating a treatment plan. Individual therapy (A) would only address one partner in a shared issue, plus there is no evidence of client’s distorted beliefs and assumptions in the stem. The woman has already received education from the doctor regarding SSRIs, so sending her to the National Alliance for Mental Illness (an organization that provides resources to individuals with mental health disorders and their families) would not be effective (B). Suggesting the husband seek a second opinion (C) is unnecessary and premature. (Treatment Planning)

Answer 109

An unmarried couple, Howard, an Asian American age 39, and Kate, a Caucasian age 24, are referred by Howard’s health insurance panel. They share that they recently moved in together. Kate tearfully tells of Howard’s lack of affection over the past five months. According to her, he can’t control the amount of time he spends on the Internet at work and at home. Howard avoids eye contact and nervously states, “I don’t know what I’ll do if my boss ﬁnds out about my problem.” Kate’s voice breaks as she says, “I can’t live like this! He is spending all our money on porn sites. We can’t pay our bills, and today we can’t even pay our $10 co-pay. Can we defer that until you cure Howard?” How would Cognitive Behavioral Therapy be used in the case presented in the vignette? Score: 1 of 1 A. Explore Howard’s early sexual experiences; Assign homework on active listening to improve communication; Clarify Howard and Kate’s sexual needs and how they communicate those needs to each other. B. Explore Howard’s needs for emotional gratification; Discuss Howard’s and Kate’s beliefs about their body images; Explore the underlying assumptions that come from Howard’s parents. Correct C. Assign homework on active listening to improve communication; Explore Howard’s belief system about sexual addiction relating to shame; Learn what automatic thoughts are triggered by those underlying assumptions. Rationale: Answer (A) is immediately ruled since CBT theory does not dive into early experiences. Answer (B) is also out since a CBT therapist will not be exploring the needs for emotional gratification or assumptions that come from client’s parents. There is no indication in the stem that Howard and Kate are having body image issues. Answer (C) is a perfect answer since assigning homework, exploring a belief system, and learning more about automatic thoughts are all interventions a CBT therapist would do. Answer (D) is out since it starts with an intervention that is more fitting for a Solution Focused therapist. (Treatment) D. Ask the couple to describe what their relationship would be like without this problem; Explore the underlying assumptions that come from Howard’s parents; Explore Howard’s belief system about sexual addiction relating to shame.

Answer 110

A 16-year-old client is referred by her teacher and is brought to treatment by her mother who complains that her daughter frequently skips school and has been found drinking by herself multiple times. The daughter sits quietly as the mother adds that her older brother died in a car accident a year ago and the daughter “hasn’t been the same since." The daughter adds, “Tell that to dad, he’s the one that needs help.” Which of the following referral sources should the therapist consider in this case? Score: 1 of 1 A. Teen grief group; Psychiatrist; substance abuse center for assessment B. Medical Doctor; Tutoring; Alcoholics Anonymous Correct C. Teen grief group; Family therapy; substance abuse center for assessment Rationale: Answer C is the best because it addresses the issues presented in the stem: grief, family dynamics and the alcohol use by the client. There is no indication that she needs tutoring so B and D are out. There isn’t a clear indication for a psychiatrist at this point, thus A is out as well. (Treatment Planning) D. Teen grief group; Tutoring; Alcoholics Anonymous

Answer 111

A therapist meets with 19-year-old woman who is in her first year of college. She expresses feelings of depression and loneliness. She explains that she had a very close group of friends in high school, played on the soccer team, and received straight A's. Since starting at school, she has met several people but has not developed many good friendships and her grades are low. She says, “If things don’t get better, I’m not sure what I’ll do.” Which of the following actions should the therapist take to assess this client? Score: 1 of 1 A. Explore client’s goals and identify possible obstacles; identify healthy coping mechanisms; determine support networks available to client. Correct B. Ask client if she has thoughts of self-injury; identify healthy coping mechanisms; determine how long symptoms have been present. Rationale: The most important factor to consider in this case is the potential for self-harm. The only answer that assesses for this is (B). The therapist may choose to use the interventions identified in answers (A), (C), and (D) but the priority is to focus on immediate safety. (Clinical Evaluation) C. Explore client’s goals and identify possible obstacles; refer to medical doctor to assess for biological factors; determine how long symptoms have been present. D. Identify healthy coping mechanisms; determine support networks available to client; identify client’s internal strengths.

Answer 112

A therapist is treating Arturo, a 29-year-old construction worker. Arturo has a history of anger issues manifested by fights and physical altercations throughout his twenties. During the latest session, Arturo reports that a new boss laid him off from a job he’s had for four years. The client denies thoughts of hurting the boss, but is enraged when he talks about him. The following day, Arturo’s wife leaves a message informing the therapist that her husband didn’t sleep at all the last night, was up drinking, and plans to “surprise the boss” after work. How should the therapist clinically manage the situation? Score: 1 of 1 A. Contact the wife to verify the threat and document both the content of the message and the conversation with her in the client’s medical record. B. Document the content of the message and contact the client’s former employer to report the danger. C. Contact the client to assess for risk since the information regarding the threat cannot be taken seriously if it comes from a third party. Correct D. Notify local law enforcement and the client’s former employer of the threat only revealing the information that is relevant to the situation at hand. Rationale: There is enough information to justify breaking confidentiality, and time might be of essence, thus (A) is not the best answer. Family members with information about danger to others can trigger a duty to protect situation, thus (C) is out. The best answer is (D) because there is enough information to justify breaking confidentiality. You MUST notify police so that makes (D) a better answer than (B). In addition, the law requires that we still honor the client’s confidentiality and only reveal the information that communicates the severity of the risk.(Crisis Management)

Answer 113

A couple is seeing a therapist for marital problems. The couple has a history of infidelity and resulting lack of trust. During a session, the wife compliments her husband. The husband responds to the wife’s compliment by stating, “It’s nothing” and avoids eye contact. Which of the following interventions would a Systems therapist use to address the observed interaction between the husband and wife? Score: 1 of 1 A. Explore the wife’s reason for the compliment and how the lack of trust inhibits the husband’s ability to accept it. B. Assist the husband in accepting the compliment and explore how it affects him emotionally. C. Focus on the husband’s inability to accept praise and explore the role trust plays in this dynamic. Correct D. Share the observation of their interaction and investigate the impact of wife's compliment on each of them. Rationale: The therapist can help the couple develop a greater awareness of their interactions by sharing his/her observation and facilitating an exploration of this dynamic (D). In addition, the interventions included in answers (A), (B), and (C) are not as strong because they only address one member of the treatment unit rather than the entire treatment unit--the couple. Furthermore, A is also wrong because it assumes the husband is lacking trust. (Treatment)

Answer 114

Adam is a 52-year-old man who was court mandated to attend 24 individual therapy sessions for domestic violence. He states that he verbally and physically abused his ex-wife for several years. He shares that as a child he was frequently beaten by his father and says he still has occasional nightmares about the abuse. He adds that he is court-ordered to deal with the DV issues and doesn’t want to talk about his past abuse. What interventions would a Symbolic-Experiential therapist utilize in the middle phase of treatment with Adam? Score: 1 of 1 A. Identify the triggers to Adam’s violent episodes; Clarify the underlying beliefs about himself and others. B. Teach assertiveness skills; Identify how anger was expressed in his family of origin. C. Require Adam to do twenty push-ups if he has the urge to be violent; Use empty chair to dialogue with ex-spouse and/or father. Correct D. Encourage Adam to express feelings related to abuse; Use empty chair to dialogue with ex-spouse and/or father. Rationale: Answer (A) is more fitting for a CBT theory, so the answer is wrong. Answer (B) is an intervention that is descriptive of a Bowenian theory. Answer (C) describes a Strategic theory intervention. The only answer that describes a Symbolic-Experiential therapy is (D). (Treatment)

Answer 115

A 35-year-old lawyer is referred to therapy by his physician for symptoms of anxiety and panic. His physician wants the client to initiate therapy before prescribing medication. The client, however, believes that only medication will control his symptoms and that therapy is a “waste of time.” Which of the following interventions would a Cognitive Behavioral therapist use to address the client’s participation in therapy? Score: 0 of 1 A. Interpret the client’s distorted cognitions and identify their connection to his current symptoms of anxiety and panic. B. Explore the client’s disappointment with his physician and validate his automatic thoughts as a logical consequence. Should have chosen C. Examine the client’s assumptions regarding treatment and collaborate with him to promote a shift in personal conclusions. Rationale: The best answer is (C) as it attends to his views of therapy. CBT therapists don’t interpret, so answer (A) is out. There isn’t an indication of the client being “disappointed” with the doctor so that knocks out (B). You could do (D) after doing (C). (Treatment) Incorrect D. Provide psychoeducation on the benefits of Cognitive Behavioral therapy and explore his previous experience with therapy.

Answer 116

A therapist is working in a small rural town and is the only provider within the area. A neighbor from a nearby farm requests that her son receive counseling services. The therapist has seen the boy on several occasions in the local store but has minimal interaction with him or his mother. How should the therapist respond to the request? Score: 1 of 1 Correct A. Agree to provide therapy to her son as the existing dual relationship is minimal and does not have a negative impact on the therapist’s objectivity. Rationale: It would be unethical for the therapist to treat the child if, as a neighbor the boy interacted with the therapist on a regular basis outside of the therapy room, since it could be detrimental to his treatment. However, the stem reports minimal interaction and the therapist is the only choice in the area. Thus (A) is the best answer. In rural areas, neighbors could live miles apart (B) and since the vignette notes minimal interactions, this is not an issue. You could do (C), but as it is a rural area, the next town might be very far away. It can be assumed the clinician is licensed; therefore, consulting with a supervisor is unnecessary (D). (Ethics) B. Explain it’s unethical to treat the son because he is your neighbor and entering a therapeutic relationship when any dual relationship exists is considered unethical. C. Follow a community standard of care and provide the neighbor with referrals to therapists in the next closest community. D. Given the request presents a clear conflict, the therapist should consult with supervisor to determine if providing treatment is ethical.

Answer 117

A therapist working in an elementary school is approached by a teacher in the hallway. The teacher asks the therapist for professional advice about Quintin, a six-year-old student who recently joined the school. Quintin had been diagnosed with ADHD at his previous placement. “He just does not get along with anyone,” states the teacher, “and his classmates do not seem to like him very much. Do you think this is because of ADHD or just his personality?” What steps should the therapist consider given this information? Score: 1 of 1 A. Let the teacher know that it is likely a combination of Quintin’s diagnosis and personality that are at play; Discuss possible options with Quintin’s parents; Enroll the child in an after-school social club. B. Let the teacher know that it is likely a combination of Quintin’s diagnosis and personality that are at play; Contact Quintin’s parents; Refer the child for a medication evaluation. Correct C. Inform the teacher about ADHD and implication of such diagnosis; Discuss possible options with Quintin’s parents; Refer the child to a social skills group. Rationale: It is beneficial for children diagnosed with ADHD to participate in social skills groups (C), especially when it is noted that the child is having difficulties getting along with other students. An after-school social club (A) might not be appropriate until the child participates in a group that will help him build skills. The referral for a medication evaluation (B) and the need for an aide (D) might be something the therapist deems appropriate in the future, but the first step would be a referral to a social skills group. (D) is also out since the teacher does not mention child’s struggle with academics. (Treatment Planning) D. Inform the teacher about ADHD and implication of such diagnosis; Inquire about the child’s academic performance; Recommend the parents request an aide to assist with the child in class.

Answer 118

A 38-year-old woman, a mother of two daughters ages 8 and 10, calls an Experiential family therapist and shares that she recently remarried and her new husband also has two children, boys ages 6 and 8. Her daughters live with them permanently and the husband’s boys are there every other week. The woman complains that none of the kids get along and that their house is “total chaos” when they are all together. The therapist instructs the woman to bring the entire family to therapy. When they arrive the mother is the only one who greets the therapist and no one else makes eye contact. Which of the following actions are representative of how an Experiential therapist would address the family’s presentation? Score: 1 of 1 A. Review what the mother shared with you during the phone call and direct questions to all family members since an experiential therapist believes the entire family must be involved. Correct B. Wait for someone in the family to speak since an experiential therapist believes initiative must be taken by the family. Rationale: A Symbolic-Experiential therapist is not going to start the session but is going to wait until the family initiates the conversation. That is called Battle for Initiative and answer (B) is the only one that is fitting with this modality. The rest of the answers have the therapist initiating the conversation and that would go against this theory. This is an example where the incorrect answers will include a concept that matches to the theory, but counters how the therapist would function in the room. (Treatment) C. Acknowledge the silence since an experiential therapist believes it is important to be authentic and share how they are experiencing the dynamics playing out in the room. D. Provide psychoeducation on blended families and normalize their problems since this would be the first step a therapist should take regardless of their theoretical orientation.

Answer 119

A therapist sees a couple, Sandra and Josephine, shortly after the birth of their first child. The two explain that they went through several years of finding a donor and in vitro fertilization before Sandra became pregnant. Now that they finally have a child, they are feeling very stressed by the demands of parenthood and guilty that they are not thoroughly enjoying what they worked so hard to achieve. They find themselves arguing over who should complete various tasks related to child rearing and general household chores. In addition, they share that both of their families live out of state so they cannot rely on them to help with childcare. What information is most important for the therapist to consider when developing a treatment plan? Score: 1 of 1 Marked A. The couple’s understanding of how changes in a family’s life cycle can exacerbate stress levels; their ability to communicate feelings of guilt and the emotional strain caused by the birth of their baby; their ability to properly care for the newborn. B. The type of relationship the couple had prior to the birth of their child; their ability to communicate feelings of guilt and the emotional strain caused by the birth of their baby; the couple’s social support and access to resources. Correct C. The couple’s understanding of how changes in a family’s life cycle can exacerbate stress levels; their ability to communicate feelings of guilt and the emotional strain caused by the birth of their baby; their social support and access to resources. Rationale: The therapist would need to collaborate with the couple and understand how the couple views the issues causing stress, how communication plays a role in their relationship and ability to cope with the stress and guilt; and since the couple notes their families are far away, identifying supports or lack thereof would be helpful (C) when developing a treatment plan addressing their specific needs and concerns. Answer (A) is incorrect because there is nothing to indicate an issue with their ability to care for the newborn. Answer (B) is not as strong as (C) because the relationship they had prior to the birth of their child is not as important as their current ability to communicate. It is important to pay attention to what the stem is discussing. The stem doesn’t indicate a lack of willingness to participate in therapy (D). The stem specifically notes stress caused by the birth of the first child, arguing, and geographical distance from family, so that is where the therapist should start when trying to develop a treatment plan. (Treatment Planning) D. The couple’s willingness to engage in treatment; the type of relationship the couple had prior to the birth of their child; their ability to communicate feelings of guilt and the emotional strain caused by the birth of their baby.

Answer 120

A 19-year-old college student initiates therapy and reports that the previous night she went to an off-campus party. She states that she only had one drink then blacked out and woke up naked in a bedroom. Which of the following actions should the therapist initially take in this crisis situation? Score: 1 of 1 A. Re-establish the client’s feelings of control by encouraging her to file a police report to protect other women from the perpetrator. Correct B. Evaluate the client’s support systems and coping skills and refer her to an emergency room for an examination. Rationale: The best answer is B. In a crisis you assess coping and support and provide needed referrals -- in this case the ER because it will have a rape kit for testing. Answer A pushes client to take a particular action. C could be done at a later date. D breaks the client’s confidentiality and assumes she’s been through something like this before. (Crisis Management) C. Develop the client’s trauma narrative of the event to desensitize emotional impact. D. Explore how the client has dealt with similar trauma and notify the university of the assault.

Answer 121

A man is referred to therapy to address work issues he has been dealing with over the past few months. During the initial assessment, the client talks about his difficult childhood, physical abuse by his parents and two divorces. He is afraid that his current girlfriend is cheating on him and attributes his recent job problems to his chaotic relationship with her. He acknowledges drinking alcohol most nights of the week to help him relax but does not feel it is a problem. Which of the following issues are most important for the therapist to consider when developing a treatment plan? Score: 0 of 1 A. Client’s referral source; client’s potential risk of job loss; psychological response to childhood physical abuse. B. Range of current and past coping skills; psychological response to childhood physical abuse; client’s potential risk of job loss. Should have chosen C. Client’s referral source; The quantity and frequency of client’s substance use; range of current and past coping skills Rationale: This is an example of a question where several answers are okay, but one is stronger as a whole when compared to the others. Two issues that would most strongly influence our answer choice would be the referral source--if the client was self-referred or referred by the girlfriend, our treatment plan would be different than if the client was referred by his EAP. Since answers (B) and (D) do not include this option, they can be eliminated. The other important issue in this case is substance use--if a client indicates potential abuse, we would need to understand this first and foremost when developing our treatment plan, as this would need to be addressed before other issues can be addressed. This allows us to eliminate answer (A). The best answer remaining is answer (C). (Treatment Planning) Incorrect D. Range of current and past coping skills; quantity and frequency of client’s substance use; problems with his relationship.

Answer 122

Tamara, a 38-year-old Baptist minister, and her 28-year-old husband, Michael, who are both African American, self-refer for couples therapy. Tamara recently gave birth to a son with Downs Syndrome. Tamara states, "Michael doesn’t understand my stress. I have a congregation that relies on me, but I am so worried about everything that I can't sleep and can’t think clearly.” She complains that Michael drinks nightly and doesn’t get out of bed all day. “I can't trust him with our baby." Michael responds, "I begged you not to go through with the pregnancy when we found out the baby was defective. Don't blame me for your child care problems while you keep working 16 hours every day." Throughout the initial appointment, Tamara compulsively checks her cell phone for messages, while Michael sits rigidly with his arms crossed and stares at the floor. How would a Cognitive-Behavioral therapist incorporate the couple's religious beliefs into the treatment plan based on the case presented in the vignette? Score: 0 of 1 A. Enable the couple to identify the positive value of the marital dyad as embraced by their religious beliefs; encourage Tamara and Michael to explore alternative spiritual interpretations for their marital discord. Should have chosen B. Assist the couple in using their religious beliefs to reframe the perception of the child as "defective”; facilitate dialogue between Tamara and Michael about the impact of Tamara's ministry on their marital discord. Rationale: Answer (A) is wrong since it doesn’t specifically include CBT interventions and neither part of the answer is indicated in the stem. The value of the marital dyad is not being questioned in the stem, and there is no need to explore alternative interpretations of the marital dyad, as much as there is a need to determine the couple’s understanding of the marital discord. Answer (B) has all the necessary parts to it. It describes CBT interventions that are relevant to the case, and religious beliefs are incorporated. Answer (C) is out since the first part only deals with Michael and ignores the couple, and the second part brings up a divorce, which was not mentioned in the stem. The first part of answer (D) has already been discussed, and the second part is not appropriate since a CBT therapist is not going to challenge the couple’s insight but will teach the couple how to challenge their own thoughts. (Treatment) C. Explore the thoughts that trigger Michael’s desire to drink; promote dialogue on how potential divorce would be received within the religious community. Incorrect D. Recommend that Tamara and Michael explore alternative spiritual interpretations for their marital discord; challenge the couple's insight into their spiritual differences regarding their bab

Answer 123

A therapist sees an 18-year-old teenager with a diagnosis of bulimia nervosa and a recent pattern of cutting. The teenager’s pediatrician believes her bulimia in conjunction with recent self-harming behaviors make hospitalization necessary. The parents have taken their daughter to a psychiatrist who determined the client has a comorbid condition of major depressive disorder and recommends intensive outpatient treatment. The client and her parents are confused and frightened. What immediate action should the therapist take to address the client’s needs? Score: 0 of 1 A. Explore the pros and cons of inpatient versus outpatient therapy with the client and her parents and empower them to make a decision. B. Provide psychoeducation to the family about the client’s comorbid diagnosis and complete a Beck Depression Inventory to determine if hospitalization or outpatient treatment is indicated. Should have chosen C. Schedule a case conference with the professionals involved to collaboratively determine what is in the client’s best interest and discuss the outcome with the family. Rationale: The client’s behaviors can be considered high-risk and the most appropriate course of action should be coordinated among all the professionals working with the client (C). This would be the best course of action, since the code of ethics emphasizes the importance of collaborating with all health care providers involved in our clients’ cases. This way the providers can come to a unified solution and present it to the client without confusing the client. Following the case conference, the therapist could take the actions outlined in answers (A), (B) or (C). (Ethics) Incorrect D. Meet with the client and her parents to process their fears and confusion, and help concretize what steps would be most appropriate for the daughter considering her diagnosis and immediate safety concerns.

Answer 124

A family is referred for therapy after the adoption of their 8-year-old nephew. The adopted child’s mother was incarcerated for selling drugs and the father is deceased. The parents report that the child hoards food, is frequently aggressive with their other children ages, 9 and 6, and tends to reject their efforts to include or console him. Which of the following long-term goals should be included in the treatment plan for this family? Score: 1 of 1 A. Identify each family member’s reaction regarding recent adoption; Increase levels of trust between family members; Establish and maintain healthy family connections. Correct B. Increase level of trust between family members; Establish and maintain healthy family connections; Increase family’s ability to identify as cohesive unit. Rationale: The question wants the “long-term goal” for the entire family so B is the best answer that addresses the whole unit and would be what the therapy should work toward. A, C, and D each include shorter-term goals as well as immediate interventions. (Treatment Planning) C. Improve adopted son’s self-confidence and impulse control; Increase family’s ability to identify as cohesive unit; Strengthen family cohesion. D. Improve adopted son’s self-confidence and impulse control; Identify each family member’s reaction regarding recent adoption; Establish and maintain healthy family connections.

Answer 125

A young male therapist in a mental health agency conducts an initial interview with a gay client who seeks treatment for depression and problems in his relationship with his partner. The therapist feels uncomfortable when the client discusses his homosexuality. At the conclusion of the session, the client expresses a desire to continue the therapeutic relationship with the therapist. What steps should the therapist take to address the ethical obligations noted in this case? Score: 1 of 1 A. Since this is a first session, and the therapist has not established rapport with the client, it would be most appropriate to refer the client to another therapist in the agency. B. Continue meeting with the client on a trial basis and process the discomfort with colleagues to identify and address the root cause. Correct C. Consult with colleagues to discuss the root cause of the discomfort and determine if referral or continued services would be in the best interest of the client. Rationale: This question asks what the therapist should do to manage the ethical obligation. In this case, the ethical obligation is to determine if the therapist can work effectively with the client and the client would benefit from treatment. In this question, the cause of the discomfort the therapist is experiencing is unclear--it could be due to lack of experience, it could be a value conflict, or a different issue altogether. Until the therapist understands the cause of the discomfort, they would not be able to determine if they can or cannot work effectively with this client. The best way to approach this situation and figure out the discomfort would be to consult with a colleague (C). Following consultation, the therapist may choose to refer the client to another therapist (A). Continuing to work with the client on a trial basis (B) would create instability and would be detrimental to the client’s treatment and disclosing lack of experience (D) would cause the therapist to focus on self rather than the client and the vignette does not make clear the therapist’s experience working with homosexuals. (Ethics) D. Process with client the therapist’s lack of experience working with homosexuals and provide the client with referral options to receive the most appropriate care.

Answer 126

A 32-year-old woman seeks therapy for depression. In the initial session she discloses that her girlfriend of two years is physically abusive and controls all their money. The patient says she knows that her depression is part of the problem and she wants to make it work with her girlfriend. In addition to discussing a safety plan with the client, which of the following interventions should the therapist consider initially? Score: 1 of 1 Correct A. Find out what the client means by “depression”; Provide referral to DV resources; Identify coping skills. Rationale: The correct answer is (A) because it adequately addresses all points presented in the stem. When working with DV we are to create a safety plan, refer to DV resources, and identify/strengthen coping skills. This client mentions depression, thus it is our obligation to assess for it. Answer (B) is incorrect because it is clinically contraindicated to do therapy with couples where DV is present. Answer (C) is incorrect because the client did not express ambivalence, we do not have enough information for a psychiatric referral, and as therapists we provide DV resources, not encourage clients to take advantage of specific ones. Answer (D) is incorrect because it is unclear at this point whether the client needs medical attention, and answer (A) better accounts for all necessary steps. (Crisis Management / Clinical Evaluation) B. Refer to couples therapy; Explore how client has coped with girlfriend; Identify social supports. C. Explore client’s ambivalence about leaving; Encourage client to join a domestic violence support group; Refer to a psychiatrist. D. Find out what the client means by “depression”; Refer client to an MD; Identify social supports

Answer 127

A 32-year-old woman seeks therapy for depression. In the initial session she discloses that her girlfriend of two years is physically abusive and controls all their money. The patient says she knows that her depression is part of the problem and she wants to make it work with her girlfriend. In addition to discussing a safety plan with the client, which of the following interventions should the therapist consider initially? Score: 1 of 1 Correct A. Find out what the client means by “depression”; Provide referral to DV resources; Identify coping skills. Rationale: The correct answer is (A) because it adequately addresses all points presented in the stem. When working with DV we are to create a safety plan, refer to DV resources, and identify/strengthen coping skills. This client mentions depression, thus it is our obligation to assess for it. Answer (B) is incorrect because it is clinically contraindicated to do therapy with couples where DV is present. Answer (C) is incorrect because the client did not express ambivalence, we do not have enough information for a psychiatric referral, and as therapists we provide DV resources, not encourage clients to take advantage of specific ones. Answer (D) is incorrect because it is unclear at this point whether the client needs medical attention, and answer (A) better accounts for all necessary steps. (Crisis Management / Clinical Evaluation) B. Refer to couples therapy; Explore how client has coped with girlfriend; Identify social supports. C. Explore client’s ambivalence about leaving; Encourage client to join a domestic violence support group; Refer to a psychiatrist. D. Find out what the client means by “depression”; Refer client to an MD; Identify social supports

Answer 128

A therapist is working with a woman from Mexico who speaks limited English and shares, with fear in her voice, that she is undocumented. The client was referred by her friend after the friend noticed bruises and contusions on the client’s body. The client shares that her husband is “extremely abusive,” but has threatened to deport her if she tells anyone. The woman also notes that she comes from a family with a history of DV and says this is just a “normal” part of relationships. What actions should the therapist take to manage the legal and ethical issues presented in this case? Score: 1 of 1 A. Explore the client’s fear of being deported and connect the client to legal resources available for undocumented victims of crime. B. Explore the cultural context of DV and refer the client to a shelter to help end the cycle of abuse. C. Validate client’s expressed feelings of normalcy regarding DV and collaboratively develop a safety plan. Correct D. Validate client’s fears of being deported and develop a comprehensive safety plan including referrals to legal counsel. Rationale: The best answer in this case is answer (D). The client has indicated that she is undocumented and her husband threatened to have her deported if she told anyone he was abusive and there is a tone of fear noted in the vignette. In addition, developing a safety plan and linking her to legal resources so she understands her legal rights would be important. Answer A is not as comprehensive as (D), so it can be ruled out. Answer (B) is a possibility, but again, a safety plan is a better option than a shelter referral. Answer (C) is incorrect because we would not want to validate DV being normal or acceptable. (Law and Ethics)

Answer 129

A therapist is treating Nora, a 32-year-old chiropractor. Nora sought therapy to help her cope with a horrendous incident that happened to her a couple of months ago when she became a victim of a physical and sexual assault outside of her home. The therapist spent a dozen of initial sessions establishing safety and diversifying Nora’s coping strategies. Recently, the therapeutic work has become quite intense. Suddenly, the client begins to say that the event never happened. What is the most likely reason for the client’s change of opinion and the best course of action for the therapist to proceed? Score: 1 of 1 A. Client’s behavior is a sign of repression of the traumatic experience and the therapist ought to normalize the fact that talking about the incident might be rather daunting. Correct B. The client may be avoiding the painful subject and upon venturing such a guess the therapist should return to reestablishing a container of safety. Rationale: Based on the information provided in the stem, avoidance (B) is the most plausible reason for the client’s change of opinion. There is no evidence in the stem to indicate the client is redirecting threatening emotions against herself (C) or is identifying with the aggressor (D). Repression (A) does not happen from one week to the next, it is instead a defense mechanism that is usually found in kids who unconsciously repress early childhood memories. An adult woman who remembered the incident last week or last month is not likely to repress it between sessions. (Treatment) C. The client is redirecting threatening emotions against herself rather than the attacker and the therapist ought to prevent such phenomena by calling it out. D. The client is identifying with the aggressor as evidence by her protecting the negative information against him and the therapist should normalize the process as one that helps the client regain control over the situation.

Answer 130

Rubin, a 46-year-old electrical power engineer is seeking treatment with a therapist in private practice. Rubin is going through a high conflict divorce and custody battle. He decided to seek Cognitive Behavioral therapy to help him deal with the stress of his situation. “My ex and I cannot agree on anything. She continues to paint this terrible picture of me to both the parenting coordinator and our mediator. It feels like this divorce will go on forever,” he tells his therapist. He uses his insurance and the therapist bills for the sessions electronically. Three months into treatment, the client’s records are subpoenaed and the client waives privilege. Which of the following actions must a HIPAA compliant therapist take in this case? Score: 0 of 1 Incorrect A. Keep the client’s medical records separate from the psychotherapy notes and obtain a signed waiver of privilege. B. Ensure that the request for records is bona fide and inform the client of any possible negative outcomes of releasing records. Should have chosen C. Keep the client’s medical records separate from the psychotherapy notes and release only the medical record. Rationale: The correct answer is (C) as this relates specifically to being a HIPAA provider. Answer (A) must be done if you are HIPAA or not. (B) is not a condition of HIPAA and (D) is incorrect as you only turn over the medical record portion of the file. (Law) D. Ensure that the request for records is bona fide and release both the medical record and the psychotherapy notes.

Answer 131

Steven, a 14-year-old, is referred to therapy by his pediatrician. He is brought in by his parents, Jen and Bill, who share that Steven has diabetes but hasn’t been taking his medication regularly since they moved three months ago. Steven says angrily, “Why do you care? You guys are always working.” Jen ignores the comment and adds, “I think he misses his friends, he’s been having a hard time at school fitting in.” What should a family therapist do to initially engage and assess this family? Score: 1 of 1 A. Obtain a release to talk to the pediatrician about the reason for the referral and a separate release to talk to Steven’s school in order to gain a clearer picture of his social difficulties B. Normalize Steven’s non-compliance with his medication as a response to the recent move and inquire about the impact of the move on his social life. Correct C. Invite each family member to share what they think the family issues are and what they hope to get from therapy. Rationale: Answer (A) is incorrect, since it is not answering the question that is oriented towards engaging and assessing the family, as getting releases is not a way to engage the family. Answer (B) does not deal with the entire family but only with Steven, so the question is not answered. Answer (C) addresses the whole family and gets every member involved in the conversation about what they see happening and what they want to accomplish. This is the best answer. Answer (D) has the therapist observing, but the question asked us to engage them; this is a wrong answer as well. (Clinical Evaluation) D. Observe how the family members engage with each other and reenact their issues in the session.

Answer 132

A 54-year-old woman is referred by her doctor after a recent panic attack. The woman shares that she has been having issues with co-workers and is afraid she may get fired. She states that her husband is her main support, but he is a corporate lawyer who travels a lot and they rarely see each other during the week. She has two grown children who are attending university out-of-state. She has few friends and shares that it has always been hard for her to trust people. Besides the client’s self-report about her issues, what additional source of data would an Object Relations therapist use to formulate a complete clinical assessment? Score: 0 of 1 A. A report from the husband. Incorrect B. A report from the doctor. Should have chosen C. How the client and the therapist interact. Rationale: Object-Relations is an offshoot of psychoanalytic theory where the relationship between a therapist and a client acts as one of the most important sources of information. Thus, (C) is the best answer, as it goes along with the main tenet of this theory. The rest of the answers are other good sources of information, but they are not as specific to Object-Relations theory as is answer (C). (Clinical Evaluation) D. A questionnaire filled out by the client and other family members.

Answer 133

A 27-year-old African American man is court-ordered to therapy as a condition of his parole. He served three years in prison for a drug related charge. The therapist is Caucasian. During the initial session the client is reluctant to engage with the therapist. And finally says, “You’re just part of the system of oppression here to tell me what to do.” How should the therapist respond? Score: 1 of 1 A. “I am not sure what you mean by that; can you be more specific.” B. “I am here to help you; it is your choice whether to use therapy or not.” Correct C. “I can see your point of view. I imagine you’ve experienced a lot of oppression and racism in your life.” Rationale: Clinically, the most effective way to build trust and rapport with a client who is mandated to be in therapy and is suspicious of the therapist’s intentions is to meet the client where he is. The only answer that does that is (C). Answer (A) is missing the client and the sentiment he is expressing. Answer (B) also does not address the suspicion the client has just expressed. Answer (D) also ignores the statement the client just made and the feeling behind it. (Treatment) D. “Tell me what you want to work on in therapy.

Answer 134

A Chinese family is referred to therapy by the son’s high school. The son was caught smoking pot during school. The father is a surgeon and shares that he is “very ashamed of his son” and he wants to know how the therapist will help them. What type of approach should the therapist take with this family? Score: 1 of 1 Correct A. A solution-focused approach that provides them with concrete strategies. Rationale: In this question, it is the father’s question that points us towards to correct answer. Since the father is looking for specific strategies of how the therapist can help with this issue, a solution-focused approach (A) would be the best. Answer (B) is too abstract. Answer (C) helps the family take responsibility but does not provide them with specific strategies of how to deal with the situation. Answer (D) could be used after the situation at hand has been dealt with, but as it stands, answer (D) is not addressing the specific needs of the family. (Treatment) B. A psychodynamic approach that addresses their unconscious motivations. C. An existential approach that supports the family to take responsibilities. D. A client-centered approach that focuses on the growth and potential of the client.

Answer 135

A 42-year-old woman seeks therapy after the birth of her second baby. She reports difficulty sleeping, feeling agitated and crying a lot. She tells the therapist that she is afraid she can’t be a “good mom.” The therapist assesses for risk of self-harm and the client reports that she thinks about killing herself on a daily basis. In addition to determining whether the client has a plan and the means, what else should the therapist assess? Score: 1 of 1 Correct A. What has stopped her from killing herself; Any past attempts; Preparatory acts Rationale: The correct answer needs to be oriented towards this woman and her current suicidal state. The first part in answer (B) includes client’s history of mental illness, which is not as relevant during a suicide assessment. Answer (C), similarly, talks about her family history, which is not relevant at the moment. Answer (D) addresses her children, which is not a focus of the question being asked. The best answer here is (A) since it addresses her personal history of passed suicide attempts, preparatory acts (steps taken in advance of committing suicide such as creating a will, finding caretakers for her children), as well as the resources that are currently available to her and that have been keeping her alive so far. (Crisis Management) B. Her history of mental illness and current substance use; Any past attempts; Lethality of the means C. Family history of suicide and social supports; Any self-injurious actions; Availability of the means D. Safety of her children and her willingness to go on medication; Preparatory acts; Family history of suicide and social supports

Answer 136

A therapist is running a support group for teen moms. During one of the group sessions, a 17-year-old client reports that her boyfriend came home high last night, accused her of cheating on him, and started hitting her. “It was like he lost his mind. There was no reasoning with him. He is a completely different person when he is high,” she stated. She shows the group members the bruises on her forearms that she had held up to protect her face. How should the therapist proceed in clinically managing the client’s disclosure? Score: 1 of 1 A. Assess how the client’s child was impacted by the incident; Create a safety plan for the mom and her child; Process the incident with the group. B. Encourage the client to go the hospital; Create a safety plan for the mom and her child; Make a report to protective authorities. C. Determine the client’s current level of safety; refer client’s boyfriend to drug treatment; Encourage the client to go the hospital. Correct D. Assess how the client’s child was impacted by the incident; Inform the client that a child abuse report must be filed; Process the report with the group. Rationale: Since the client is a 17-year-old and she was physically abused, it would be the therapist’s obligation to file a CPS report immediately. The only two answers that has that option are (B) and (D). (B) is a good option, however, if we compare aspects of the two answers we can see that some of the wording is better in (D) than in (B) and we would do (D) before (B). For instance, we would assess client’s child’s safety before sending the client to the hospital. Informing the client that a CPS report must be made and processing it with her and with the group, as opposed to simply making a report, would be a better way to manage this situation clinically since it allows both the client and the group to process that information. Answer (A) does not have an option of making a report, which must be in the answer. And answer (C) does not have that option either, but it also has us referring the client’s boyfriend to drug treatment, and he is neither here in the room, nor is it a priority before a CPS report and her child’s safety assessment. (Crisis Management)

Answer 137

A mother brings her 7-year-old son for treatment following the advice of his school psychologist who recently diagnosed the child with ADHD. In the initial session, the mother shares that her husband thinks the diagnosis is “bogus” and think the child just needs stricter parenting. She adds, that she and her husband have always differed on their parenting approaches. How should the therapist proceed in this case? Score: 0 of 1 A. Provide psychoeducation to mother regarding ADHD and obtain a release to contact school psychologist and teacher. Incorrect B. Explore how their parenting styles differ and provide a referral for medication evaluation. Should have chosen C. Encourage a session with parents to discuss concerns and and obtain a release to contact school psychologist and teacher. Rationale: The best answer is C as it is important to make an effort to include the father and the therapist should be in communication with the school to find out more about this child’s particular issues. (Clinical Evaluation) D. Identify the stimuli that trigger the child’s ADHD behavior and provide a referral for medication evaluation.

Answer 138

A therapist decides to increase her marketing efforts for her private practice where she specializes in treating postpartum depression. She creates a brochure about her psychotherapy practice and solicits testimonials from former clients to include in the brochure. Prior to including any testimonials she has the clients sign an authorization granting permission to publish their testimonials and does not include any identifying information. The therapist’s actions are: Score: 1 of 1 A. Acceptable because she obtained authorization after an in depth discussion of risks and benefits involved. B. Acceptable since she has obtained written authorization and removed any identifying information of the clients thus protecting their right to confidentiality. C. Illegal since she solicited client’s testimonials and this would place an inappropriate burden on the client. Correct D. Illegal and unethical because she solicited testimonials and doing so might create unreasonable expectations of successful treatment for potential new clients. Rationale: It is unethical in this profession to solicit clients' testimonials since client’s confidentiality might be compromised, and it is also illegal since the testimonials might create unreasonable expectations of successful treatment for potential new clients. Therefore, the correct answer is (D). It is illegal to use misleading testimonials, but it is technically not illegal to gather them, so answer (C) is incorrect. Answers (A) and (B) ignore the risk of creating unreasonable expectations of successful treatment for potential new clients. (Law and Ethics)

Answer 139

A therapist is planning to see a client at a residential facility for weekly sessions. The therapist is aware that the client is a conservatee and has been appointed a conservator by the court. The client informs the therapist that the conservator is responsible for paying for treatment. What are the next steps in proceeding with treatment? Score: 1 of 1 A. Discuss the fee for treatment with the conservator before the onset of treatment; Discuss the progress of the treatment on a regular basis with the conservator; Ask the conservator to sign a consent for treatment. Correct B. Obtain a copy of the conservatorship order; Discuss fee for treatment with the conservator before the onset of treatment; Become familiar with the parties involved and their respective rights and responsibilities. Rationale: (B) is the best answer in moving forward in treating this client. You would not discuss the details of treatment unless that was stated in the order which would be unlikely; therefore (A) and (C) are out. You may do all of the things mentioned in (D) but only after treatment is underway, might you call upon the authority of the conservator to involuntarily hospitalize the client. It is not always necessary for the conservator to consent for treatment, but that could be stated in the order. (Law) C. Send all bills for treatment to conservator; Include the conservator in treatment protocols; Invite the conservator to attend sessions. D. Contact conservator for verification of payment provider; Have conservator involuntarily hospitalize client if necessary; Send all bills for treatment to conservator.

Answer 140

A mother brings her 8-year-old son to the clinic for an evaluation. The mother reports he has tantrums at least 4-5 times a week. He is also frequently irritable and difficult to be around. The mother adds that she was deployed for up to six months twice when he was younger but she will be stationed here for a while. During the session the mother and child rarely interact and when they do it is when she scolds him. Which initial diagnoses should the therapist consider? Score: 1 of 1 A. Disinhibited Social Engagement Disorder, Major Depressive Disorder Correct B. Disruptive Mood Regulation Disorder, V. Parent Child Relational Problem Rationale: The symptoms point to Disruptive Mood Regulation Disorder with his frequent tantrums and irritability so answer (B) is the immediate frontrunner. There is also an indication that the Parent Child relationship would be a focus of treatment so that adds to the strength of answer (B). (A) is out because he isn’t demonstrating attachment issues with others. (C) is out because he isn’t arguing with authority and (D) is out because there is not indication of Separation Anxiety. (Clinical Evaluation) C. Oppositional Defiant Disorder, V. Parent Child Relational Problem D. Intermittent Explosive Disorder, Separation Anxiety Disorder

Answer 141

A married couple has been in therapy for two sessions. The husband reports that for the last year his wife has been distant and they are rarely intimate. He expresses concerns that she is having an affair. The wife adamantly denies having an affair, accuses the husband of being paranoid, and explains that she is going through menopause. Over the weekend, the therapist sees the wife kissing and enjoying an intimate dinner with a different man. How should the therapist manage the ethical issues in this case? Score: 1 of 1 A. Contact the wife and inform her that you saw her and remind her of your “no secrets policy.” B. Maintain confidentiality and refer the couple to another therapist. C. Inform the couple in the session and process their reactions. Correct D. Maintain confidentiality and seek consultation for problematic countertransference. Rationale: The best answer is (D). You would want to keep the information to yourself and seek consultation if it became an issue. (A) implies that you are going to tell the husband, which you don’t have support to do under “no secrets” because the wife did not share with you. (B) is something you could do after you consulted as suggested in (D). And (C) is blindsiding the couple; even if you thought this was right, you should consult with others before doing it. (Ethics)

Answer 142

A therapist has been seeing Marta, an 11-year-old girl for six months. During the assessment phase of treatment it is determined that she has ADHD. Her parents have indicated that they are having difficulty managing her behaviors at home. Marta’s teacher has concern about lack of social interactions at school and disruptive behavior in class. During the middle phase of treatment, in addition to a psychiatric evaluation for medication, what interventions and resources should be considered? Score: 1 of 1 A. Refer for psychological testing; Increase frequency of completion of school assignments; Assess for cultural explanations of behavior. B. Refer parents for couples counseling; Assess for medical problems; Assess for level of impairment due to ADHD. C. Refer to medical doctor; Assign parents home exercises; Teach the client more effective study skills. Correct D. Refer client to a social skills group; Implement a reward system to reinforce positive behaviors at home and school; Refer parents to a support group for parents of children with ADHD. Rationale: The correct answer is (D) because it addresses the issues the family is dealing with. In answer (A), referring to psych testing is not necessary because it has already been determined that the child has ADHD; also there is no indication of acculturation in the stem. In answer (B), there is not indication that the parents are in need of couple's therapy and there is no indication of medical problems. The issues in the stem do not particularly deal with study skills, so answer (C) is also out. (Treatment)

Answer 143

A 13-year-old boy who has been in foster care for three months is referred to therapy by the court. The referring social worker reports that he does not follow direction at his foster home, often leaves home for extended periods of time, and has come home smelling like marijuana and cigarettes. He is arguing with teachers and skipping school on a regular basis. What would be the provisional diagnoses for this client? Score: 1 of 1 A. Oppositional Defiant Disorder, Conduct Disorder, Intermittent Explosive Disorder Correct B. Adjustment Disorder, Oppositional Defiant Disorder, Substance Use Disorder Rationale: The correct answer is (B) as it is possible the behavior could be a result of recent home displacement; he is also showing signs of ODD and substance use. Every other answer includes conduct disorder, which is not indicated by the information included in the stem. (D) is out because there is not enough for a diagnosis of RAD. (Clinical Evaluation) C. Major Depressive Disorder, Conduct Disorder, Substance Use Disorder D. Oppositional Defiant Disorder, Reactive Attachment Disorder, Substance Use Disorder

Answer 144

A therapist has been seeing a 42-year-old female client for three years for severe depression and anxiety. She has made significant progress over the course of treatment and seems to be stable and able to manage her symptoms. At the beginning of the termination process, the therapist has reduced the number of sessions to two times per month. During this time, the client is faced with the unexpected death of her eldest son. What is the best course of action in treating this client? Score: 1 of 1 A. Address the grief and loss issues as you proceed with termination. Correct B. Offer to suspend the termination plan and continue to treat the client as needed due to recent crisis. Rationale: It is not advised to terminate with a client that is in crisis; therefore (B) is the best answer. (C) might be a possibility but due to the long and successful therapy with this client, it could be seen as abandonment of the client. Answer (D) could be seen as a strong possibility, however when we compare “suspend the termination process” in (D) and “offer to suspend termination” in (C) the wording in answer (C) is better since it involves the client. It is always best to make such a decision with the client not for the client. (Treatment) C. Continue termination and refer the client to a grief and loss group to help her through the death of her son. D. Suspend the termination process and revisit different coping mechanisms the client acquired in the process of therapy.

Answer 145

A 19-year-old male college student started therapy over a year ago with the chief complaint of social anxiety. Over the course of treatment, he has made measurable progress and developed a small social support system. The therapist believes the goals of therapy have been met and is concerned that continuing in therapy might deter him from continuing to build his social support system. How should the therapist proceed? Score: 1 of 1 A. Share observations with the client about his progress and inform him that treatment will be discontinued. Correct B. Discuss termination with the client and reflect on the progress that has been made. Rationale: (B) is the best answer as it involves the client in the process. Answer (C) assumes continuation of therapy by creating additional goals, which is not indicated. Terminating without processing could be viewed as abandoning your client; therefore (A) and (D) are out. (Treatment) C. Acknowledge progress client has made over course of treatment and collaborate to develop new goals. D. Share observations about his progress and inform him that treatment will be discontinued and also provide referrals for group therapy.

Answer 146

A young boy is brought to therapy by his parents. The 6-year-old boy has had several surgeries to correct a birth defect. The parents report the child is traumatized by his hospital experiences and expresses fear of going to the hospital or the doctor. Which of the following goals would a psychodynamic therapist establish for the middle phase of treatment? Score: 0 of 1 Should have chosen A. Child can recall traumatic event without becoming overwhelmed with negative emotions. Rationale: (A) is the correct answer—that as the therapist works with the client there is a reduction in affect when recalling the traumatic event. (B) is out because typically the therapist would not accompany the child to the doctor. (C) is a goal for the end of treatment and this answer does not address the hospital/doctor issue that the child is working on. (D) is not a realistic goal, since it might be healthy for the child to exhibit some resistance in these circumstances. (Treatment Planning) Incorrect B. Child is able to go to the doctor with the support of the therapist and parents. C. Child is able to display a full range of emotions without experiencing a loss of control. D. Child is able to go to the doctors office without exhibiting any resistance.