LE 3 Flashcards
A psychologist’s former client, who has received several notifications regarding their outstanding bill, sends a written request and authorization form to the psychologist for their treatment records. The client indicates that he would like to share these records with his current therapist. The psychologist should:
Select one:
A.
release the records after the cilent pays their bill
B.
release the records
C.
release the records only if it is an emergency
D.
release the records to the current therapist only
The correct answer is B.
Per APA Ethics Code 6.03, “psychologists may not withhold records under their control that are requested and needed for a client’s/patient’s emergency treatment solely because payment has not been received.” However, according to HIPAA, psychologists may not under any circumstances withhold records for nonpayment. Thus, it is technically ethical but actually illegal to withhold the records for nonpayment in non-emergency situations. Therefore, the psychologist should release the records to the client.
Answers A & C: The psychologist cannot withhold treatment records for nonpayment regardless of whether or not it is an emergency or non-emergency.
Answer D: Given that the request is coming from the former client, the psychologist should release the records directly to the client rather than the treating therapist.
A psychologist is treating a minor who was legally authorized to seek treatment by himself. The client’s mother emails the psychologist with a written request for the client’s treatment records. How should the psychologist respond to this request?
Select one:
A.
The psychologist should offer to write a treatment summary rather than release the records.
B.
The psychologist should discuss this request with the client and then release the records.
C.
The psychologist should not release the records, and offer to schedule a phone call with the client’s mother to discuss the treatment plan
D.
The psychologist should not release the records.
The correct answer is D.
If a minor is legally authorized to get treatment by himself or herself, their parent or guardian may be denied access to the treatment records. Also, per California law, when a minor participates in therapy with their parent’s consent, the minor’s parent or guardian may be denied access to the treatment record if the provider determines that this would have a detrimental impact on the therapeutic relationship or the minor’s physical or emotional wellbeing.
Answer A: Although psychologists often offer to write a treatment summary in lieu of the treatment records, this psychologist should not release anything (treatment summary or records) to the minor’s parent, as the client was legally authorized to obtain treatment on their own.
Answer B: The psychologist may decide to discuss this request with the client; however, they should not release the records without the client’s consent.
Answer C: Similarly, in this situation, the psychologist should not review any confidential information during a phone call with the client’s mother.
As a thank you for sending new therapy clients, a psychologist regularly sends a therapist a gift card. This behavior is considered: _______________.
Select one:
A.
unethical
B.
ethical
C.
unethical if the gift card was over $50
D.
ethical if the therapist gave the client other referrals as well
The correct answer is A.
Per APA Ethics Code 6.07, payments or fee-splitting between psychologists and other professionals must be based on services provided (clinical, administrative, etc.). Psychologists cannot pay another professional for a referral, as this may lead to a conflict of interest. In addition, per CA Laws and Regulations, Article 6, “any rebate, refund, commission, preference, patronage dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring patient, clients, or customers to any person is unlawful.” Thus, sending gifts for referrals, particularly when they are of significant monetary value and/or are sent on a regular basis, is unethical and illegal.
Answer B: This behavior is generally frowned upon and considered unethical.
Answer C: Sending small gifts (under $50) to referral sources during the holidays may be seen as acceptable behavior. However, in this question the psychologist is regularly sending a gift card as a thank you for a referral, which is considered unethical.
Answer D: Regardless of whether or not the therapist also gave the client other referrals, the therapist may have been influenced by the history of gift giving to refer to this psychologist, which is considered unethical.
A psychologist would like to transfer their records to an electronic record keeping system. Upon storing the records electronically, the original copies should be ________________.
Select one:
A.
kept for a minimum of 3 years
B.
kept for a minimum of 5 years
C.
kept for a minimum of 7 years
D.
destroyed
The correct answer is D.
After the records are stored electronically, the original hard copies may be destroyed and there is no requirement to store the original hard copies for a minimum amount of time. Psychologists should ensure that electronic records are kept safe and intact.
Answers A & B are incorrect.
Answer C: California law requires that treatment records are maintained for all patients for a minimum of seven years after the treatment has been completed. For minors, treatment records should be kept until the patient turns 25 years old.
A client, who is the president of a large company, tells their psychologist that they are looking to hire a new director of sales. The psychologist passes on this information to another one of their clients after they mention that they recently lost their job and are looking for employment. Did the psychologist break confidentiality?
Select one:
A.
Yes, this would constitute as a breach of confidentiality.
B.
No, this would not constitute as a breach of confidentiality if the psychologist did not reveal the name of the client.
C.
No, this would not be considered a breach of confidentiality if the information is also posted publicly.
D.
Yes, this would be considered a breach of confidentiality if the source of this information was reasonably identifiable.
The correct answer is A.
Confidentiality refers to a patient’s right to have communications kept within the bounds of the professional patient-therapist relationship. This information cannot be revealed to anyone outside of the professional relationship, unless this is permitted by law or mandated by law. A breach of confidentiality occurs when a psychologist discloses a patient’s confidential information to a third party without a signed authorization. In this question, the psychologist is sharing confidential information that was obtained during their treatment with another client. Thus, this would constitute a breach of confidentiality.
Answers B & D: Even if the psychologist did not reveal the name of their client, they cannot disclose information that was obtained within the bounds of treatment.
Answer C: If the psychologist obtained this information from a public website rather than from their patient, this would not constitute as a breach of confidentiality. However, in this situation, the psychologist obtained the information from their patient, which is a break in confidentiality.
A client tells their psychologist that their previous therapist often discussed his troubled marriage and asked for advice on their personal life. The client also reported that this therapist would stand a bit too close to her and put his hand on her lower back when they were walking out of the therapy office, which made her uncomfortable. The psychologist feels that this therapist made an ethical violation. They should:
Select one:
A.
Report these concerns to the licensing board.
B.
Discuss these concerns with the previous psychologist and attempt to resolve the issue.
C.
Validate the clients experience and discuss coping strategies.
D.
Discuss the rules and guidelines that govern a psychologist’s behavior and the patient’s right to file a complaint.
The correct answer is D.
First and foremost, the psychologist must protect their clients confidentiality. As a result, they should discuss these concerns with the patient and their right to report.
Answer A: The psychologist cannot make a report to the Board unless they have a signed authorization from their patient.
Answer B: Similarly, the psychologist cannot reach out to the previous psychologist, as this would break their patients confidentiality.
Answer C: While the psychologist should validate their patients experience and provide coping skills, they should also review the guidelines and regulations for psychologists and the patient’s right to report this behavior to the ethics committee or state licensing board.
During a session, a client tells their therapist that they are extremely upset with their neighbor who lives across the street. They are planning to smash their neighbors mailbox tomorrow night with a hammer while they are sleeping. The therapist should:
Select one:
A.
Report this to local law enforcement and attempt to warn the neighbor.
B.
Report this to local law enforcement.
C.
Validate their clients experience and discuss coping techniques
D.
Attempt to warn the neighbor.
The correct answer is C.
This question raises the issue of Tarasoff, which refers to a therapists legal duty to warn, protect, and predict when a client (or their family members) communicate to the therapist that there is a serious threat of physical violence against a reasonably identifiable victim(s). If so, the therapist should make reasonable efforts to communicate the threat to the victim or victims and the law enforcement agency. In this situation, the patient is making a threat towards someone’s property, which does not constitute a Tarasoff situation. Thus, the therapist should not break confidentiality by reporting this to local law enforcement or attempting to warn the victims family.
Answers A, B, and D: Instead, the therapist should discuss ways to cope with these negative feelings. Moreover, they may explore the potential adverse consequences associated with smashing in their neighbor’s mailbox. Of note, if the patient made a threat to a person’s property that would also result in someone being harmed, this would be considered a Tarasoff situation and the therapist should report this to local law enforcement and attempt to warn the victims family.
A 17-year-old client tells their psychologist that he got into a physical fight with a classmate at his school and shows him the bruises on his arms. He says that he frequently fights and messes around with this classmate during recess. The psychologist should _____________.
Select one:
A.
report this incident to child protective services
B.
call the clients parents and make a safety plan
C.
further assess the situation to determine if both parties are willingly engaging in this fight
D.
continue to treat the client and keep this information confidential
The correct answer is C.
Per California Laws and Regulations section 11165.6, the term “child abuse or neglect includes physical injury or death inflicted by other than accidental means upon a child by another person, child abuse or neglect does not include a mutual affray between minors.” Thus, it is important to understand whether or not both parties have the intent to fight with one another. For example, two children willingly wrestling with each other during recess is not considered child abuse and reportable, despite one child having bruises. Thus, the psychologist should further assess the situation. Is the child scared or afraid of this other boy? Or, are they both on the wrestling team and practice during recess? More information is needed here.
Answer A: Given the information provided, the psychologist should further assess the situation before filing a report. The psychologist could call child protective services to consult in this situation though.
Answer B: Similarly, it would be important to check in with the parents if the child is unsafe; however, the psychologist should further assess the situation before breaching confidentiality and talking with the parents.
Answer D: Again, depending on the circumstances surrounding this incident, this may be the appropriate choice; however, more information is needed. The client may be sharing this information to get help and thus it would be appropriate for the psychologist to make a safety plan for the client.
A psychologist who is licensed in New York would like to start treating a client who lives in California. In accordance with the California Board of Psychology, the psychologist can provide psychological services in California for up to ___ days in the calendar year.
Select one:
A.
45
B.
30
C.
180
D.
15
The correct answer is B.
Per the California Board of Psychology, a psychologist who is licensed in another state can provide psychological services in California for up to 30 days in the calendar year.
Answers A & D are incorrect.
Answer C: If the psychologist has applied to the board for a California license, they can provide services in California for up to 180 calendar days from when they submitted their application or started living in California, whichever comes first.
A client is in therapy to address symptoms of depression and anxiety related to their recent breast cancer diagnosis. The treating psychologist lost their mother to breast cancer last month and frequently tears up when the client discusses her diagnosis. During the last few sessions, the psychologist has started to deflect the clients conversation away from their breast cancer diagnosis, as it is too painful to discuss. How should the psychologist proceed?
Select one:
A.
Seek consultation to determine if the psychologist can remain objective in treatment.
B.
Continue to treat the client, as these personal difficulties will improve overtime.
C.
Seek their own personal therapy for the loss of their mother.
D.
Refer the patient out to another provider.
The correct answer is D.
Per the APA Ethics Code, 2.06 Personal Problems and Conflicts, “when psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they should take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.” Moreover, a therapist should refer a patient out when their personal beliefs or issues are interfering with the effectiveness of therapy. In this question, the psychologist’s recent loss of a parent due to breast cancer is impeding their ability to discuss the client’s primary concern in session. Avoiding this topic is likely making the therapy less effective and may even be harmful to the patient. Thus, the psychologist should refer the patient out to another provider.
Answer A: Consultation would help the psychologist determine if they are able to stay objective and effective when treating a client. However, in this instance, it is clear that the psychologist’s history is negatively impacting the treatment as they are unable to devote the therapy time to discuss the client’s main concerns. Thus, referring the patient out is the best option listed.
Answer B: Preventing the client from discussing their main concerns may be harmful to their well-being and overall treatment. The psychologist should therefore take action rather than wait it out.
Answer C: While seeking their own therapy may be helpful, it does not address the primary issue of what a psychologist should do when their personal beliefs are interfering with the treatment.
A psychologist who has been licensed for two years writes an online advertisement that says she has been practicing in the field for ten years, which includes her time in graduate school. Upon sharing this advertisement with a colleague to ensure that they are following the APA Ethics Code, they suggest that the psychologist _____________.
Select one:
A.
remove this statement as it is misleading to the public
B.
include her licensing number in the advertisement
C.
include her licensing number and the date of licensure in the advertisement
D.
keep the ad as written
The correct answer is A.
Per the APA Ethics Code, Advertising and Other Public Statements, 5.01, “psychologists do not make false, deceptive, or fraudulent statements concerning (1) their training, experience, or competence.” Although the psychologist was “practicing in the field for ten years” while she was in graduate school, this statement may be misleading to the public. Specifically, the public may assume that she has been licensed for 10 years. Therefore, the psychologist should remove this statement.
Answer B: Psychologists must include their license number in any advertising, public directory, or solicitation of business. However, this suggestion does not address the underlying issue of making a misleading statement to the public and thus removing that statement.
Answer C: Although providing the date of licensure may help elucidate the number of years the psychologist has been licensed, it is possible that the public may not know how to interpret this date and thus defer to the misleading statement made by the psychologist.
Answer D: As mentioned previously, the psychologist should remove this statement to ensure that she is not making any deceptive statements to the public regarding her training, experience, or competence.
An adult patient tells their psychologist that their father physically abused them as a child. The psychologist should:
Select one:
A.
report this incident if it was a frequent occurrence.
B.
report this incident if it was associated with using an object on bare skin.
C.
encourage the client to report this abuse on their own.
D.
maintain confidentiality and discuss this further in therapy.
The correct answer is D.
If an adult patient reports a history of child abuse, the psychologist should determine if there are any children currently at risk. For example, if the perpetrator has access to children and may be abusing children. If so, the psychologist should file an abuse report. If not, the psychologist should maintain confidentiality. In contrast, if a minor reports a history of child abuse, the psychologist is required to make a report. For this question, given the information provided, the psychologist is not required to report this history of abuse.
Answers A & B: If a minor was reporting the abuse, then the psychologist should report the abuse regardless of whether or not it was a single event or frequent occurrence. In addition, if a minor is reporting an incident or physical injury involving an object on bare skin, a report should be made.
Answer C: Again, child abuse is reported when it is reported by a minor or if there is a risk of this abuse is occurring now. Although the adult patient may decide to report this incident, the psychologist is not obligated to report the abuse. Moreover, it may not be clinically indicated for the psychologist to encourage the client to report their history of child abuse.
A child client informs their psychologist that their mother slapped them in the face after they made a racist comment at the dinner table. The client reports that this is the first time something like this has happened. Is this considered child abuse?
Select one:
A.
Yes, this is considered child abuse.
B.
Yes, this is considered child abuse if the incident left a bruise or mark on their face.
C.
No, if the child is at least 16 years old.
D.
No, a parent is permitted to discipline their child.
The correct answer is B.
Per the California Laws and Regulations, Section 11165.6 Child Abuse or Neglect, “child abuse or neglect includes physical injury or death inflicted by other than accidental means upon a child by another person.” In California, parents are permitted to discipline children with corporal punishment, including spanking; however, this discipline should not include “willful cruelty, unjustifiable or unreasonable punishment, or unlawful corporal punishment or injury. Generally speaking, a child abuse report should be made if the physical insurance is associated with a bruise or mark on the child. Or, if the discipline involves using an object on bare skin (belt buckle on bare skin) or hitting with a closed fist. In this situation, this would be considered child abuse if the incident left a mark or bruise on the child’s face.
Answer A: Given the information provided, it is difficult to determine whether or not this would be considered child abuse or a physical injury. Thus, more information, such as whether or not the incident left a mark or bruise is needed.
Answer C: Per California Laws and Regulations, Section 11165, “child means a person under the age of 18 years.” Thus, a child abuse report could be made for a 16 or 17-year-old.
Answer D: Again, reasonable parental discipline is allowed and slapping a child for using a racial slur may not constitute as child abuse, unless there was a physical injury. Thus, as Answer B indicates a physical injury, this is the best option.
A psychologist who is licensed in California would like to start temporarily treating a patient via telehealth. The psychologist:
Select one:
A.
should obtain verbal or written consent from the patient for use of telehealth prior to delivering these services.
B.
can only obtain written consent from the patient for use of telehealth prior to delivering these services.
C.
does not need to obtain any additional consent forms for telehealth.
D.
should ensure that their telehealth is fully HIPAA-compliant if they are providing services during the coronavirus pandemic.
The correct answer is A.
Per California law, psychologists should obtain verbal or written consent before delivering telehealth or telemedicine services to a patient.
Answers B & C: Psychologists should obtain written OR verbal consent, and make sure that the consent is documented. This is the case regardless of whether or not the services are temporary.
Answer D: In April 2020, a good faith provision of telehealth services during the COVID-19 public health emergency was issued. Per a California executive order, “if you are a covered health care provider subject to HIPAA, your delivery of psychological services via telehealth is not required to be HIPAA compliant, but must be consistent with the notification, and you must give due consideration to the measures encouraged by the notification to safeguard patient privacy.” The order further states that psychologists can use many popular applications, such as Apple Facetime, Facebook Messenger video chat, Google Hangouts, Zoom, and Skype, though they should notify their patients that these third-party applications may introduce privacy risks.
The Board of Psychology (BOP) recognizes a spectrum of actions that are available when dealing with consumer complaints against licensed psychologists. Which of the following is considered a non-disciplinary and public procedure taken by the BOP to address minor violations?
Select one:
A.
Citation and Fine
B.
Order of Abatement
C.
Educational Letter
D.
Probation
The correct answer is A.
Citations and fines are considered a “non-disciplinary” action taken by the BOP to address minor violations, such as false advertising or misrepresentation. They are public record and thus are not kept confidential.
Answer B: Orders of abatement are actually included in all citation and fine cases and specifically requires the cessation of certain activities or behaviors. An order of abatement may follow an educational letter or letter of warning (see below) if the individuals fail to heed the warning.
Answer C: An educational letter or a letter of warning is also considered a non-disciplinary procedure taken by the BOP to address a minor infraction. This letter is kept confidential and is used to educate a licensee of the requirements of the law to avoid future violations or possible disciplinary action.
Answer D: A licensee is placed on probation after they received a formal statement of charges. Probation is considered a disciplinary action taken by the BOP and is public information. More information regarding BOP administrative actions can be found here: https://www.psychology.ca.gov/consumers/spectrum.shtml
Is a psychologist who works in a private practice considered a HIPAA covered entity?
Select one:
A.
Yes, if they are licensed in the state of California.
Incorrect
B.
Yes, all mental health practitioners are required to follow HIPAA.
C.
No, if they do not accept insurance and do not bill electronically.
D.
No, if they do accept third party reimbursement.
The correct answer is C.
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that was signed into effect in 1996. The HIPAA rules are complex and apply to covered entities and business associates. HIPAA covered entities include health plans and certain health care providers. Specifically, health care providers, such as doctors and psychologists, are considered HIPAA covered entities if they transmit any health information in electronic form in connection with a transaction.
Answers A & B: While extremely rare, not every licensed psychologist or mental health practitioner is subject to HIPAA. For example, a psychologist who does not accept insurance or bill electronically is not considered a HIPAA covered entity.
Answer D: Even if a psychologist does not accept third-party reimbursement, they may bill their clients electronically, which would make them a HIPAA covered entity.
As part of an Employee Assistance Program (EAP), a psychologist is providing therapy services to an employee at the expense of the employer. The employer asks the psychologist if their employee, Mark, attended therapy sessions within the past month. Can the psychologist release this information?
Select one:
A.
Yes, the psychologist can release the employees diagnosis(es) and session attendance for billing purposes.
B.
Yes, if Mark is participating in mandatory counseling due to disciplinary problems.
C.
Yes, the psychologist can release information on the employees diagnoses, session attendance, and functional limitations that may impact their ability to perform at work.
D.
No, the psychologist cannot release any information regarding the employee without a signed authorization form.
The correct answer is B.
Confidentiality is the hallmark of an EAP to ensure its success. However, if the employee agrees to participate in counseling as part of disciplinary action or is referred to therapy by their employer, the psychologist can disclose the number of sessions attended to their employer.
Answers A, C, & D: Generally speaking, the psychologist cannot disclose any information related to the employees identity, diagnosis, or treatment plan without a signed authorization form. Exceptions to confidentiality arise when there is an employee who is participating in mandatory counseling sessions as part of disciplinary action, if there is a suspicion of child or elder abuse, and during safety emergencies.
A child client recently started therapy to address symptoms of depression. During a therapy session, the client discloses that their symptoms started after they were raped a few weeks ago. Can the psychologist share this information with the client’s parents without the client’s consent?
Select one:
A.
Yes, if the client requires medical care.
B.
Yes, a health care provider is permitted to inform a minors parent or guardian without the minors consent if the minor alleges that they were raped.
C.
Yes, if the client is younger than 12 years of age.
D.
No, this information can only be released with the client’s consent.
The correct answer is C.
If a child is younger than 12 years old and reports that they have been raped, the psychologist must attempt to contact the child’s parents or guardian. The psychologist should record the date and time of the attempt and whether the attempt was successful or not.
Answer A: A minor of any age that reports that they have been raped can consent to medical care related to diagnosis, treatment, and collection of evidence.
Answer B: If the client is 12 years or older, the psychologist should keep this information confidential and they are not permitted to release this information without the minor’s consent. Thus, health care providers can only release this information if the child is younger than 12 years old.
Answer D: Again, if the client is 12 years or older, the psychologist can only release this information with the minor’s consent.
A psychologist’s treatment records are subpoenaed after their client’s death. The psychologist should:
Select one:
A.
refuse to release the records, as psychotherapist-patient privilege survives the death of a patient.
B.
offer to provide a treatment summary.
C.
release the treatment records if they are needed for a legal proceeding.
D.
release the records if the personal representative of the deceased is authorizing the release.
The correct answer is D.
Per California Laws and Regulations Code 56.11, “an authorization for the release of medical information by a provider of health care, health care service plan, pharmaceutical company, or contractor shall be valid if it is signed and dated by one of the following (4) the beneficiary or personal representative of a deceased patient.” Thus, the holder of privilege is the personal representative of the deceased, which is generally the executor or administrator of the estate. This person can waive or assert privilege on behalf of the deceased patient. Generally speaking, if the treatment records of a deceased client are requested, the psychologist should assert privilege and resist disclosure of the records until the holder of privilege gives them direction. For answer D, the personal representative of the deceased is requesting the records and thus the psychologist should follow their wishes and release the records.
Answer A: While the psychologist should take care in protecting their clients confidentiality following their death, the treatment records can be released if requested by the personal representative of the deceased.
Answer B: The psychologist could offer to provide a treatment summary; however, this does not get at the underlying issue of who holds the privilege following a clients death and thus is not the best answer available.
Answer C: However, treatment records are commonly subpoenaed for legal proceedings and psychologists should follow the proper channels (check-in with the holder of privilege) before releasing any records. Of note, if the treatment records are being requested via a court order, the psychologist should release the records and follow the court order.
A client is participating in court-ordered therapy. A few sessions into this treatment, the court requests information regarding the clients progress. Can the psychologist release this information to the court?
Select one:
A.
Yes, the court has a right to the information and there is no confidentiality.
B.
Yes, though the psychologist should only release the minimum amount of information necessary to answer the questions from the court.
C.
Yes, though only information on the client’s diagnosis and session attendance can be released.
D.
No, the psychologist cannot release any information to the court without a signed release from the client.
The correct answer is D.
In court-ordered therapy, the client hires the psychologist. Therefore, the client has a right to confidentiality and information can only be provided to the court if they have a signed authorization form from the client. Ideally, the psychologist should clarify the nature of the court-ordered treatment and the information that the court may need or request at the onset of treatment. Nevertheless, the psychologist can only release information to the court if the client signs a release form.
Answers A, B & C: Again, for court-ordered therapy, the client hires the psychologist. Therefore, the client is the client and has a right to confidentiality. Of note, for court-ordered evaluations, the client is the court and thus there is no confidentiality.
A psychologist is starting therapy with a new patient. While they obtained verbal informed consent, they forgot to have the patient sign an informed consent form. How should the psychologist proceed?
Select one:
A.
The psychologist can proceed with treatment and should document that they obtained verbal consent.
B.
The psychologist can proceed with treatment if they document that they will obtain written consent at the next available opportunity.
C.
The psychologist should email the patient the consent form and ask them to sign and return the form within 24 hours.
D.
The psychologist should not proceed with treatment until they obtain both verbal and written informed consent.
The correct answer is A.
Per the APA Ethics Code, section 3.10 Informed Consent, when psychologists provide therapy, they should “obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons[and psychologists should] appropriately document written or oral consent, permission, and assent.” In other words, while it is considered standard practice to secure verbal and written informed consent, the APA ethics code only requires that informed consent is provided and documented. Thus, the psychologist can proceed with treatment with verbal informed consent and should document this in their notes.
Answers B, C, & D: Although the psychologist may want to obtain written consent, it is not necessary to proceed with treatment.
A patient reports that they were involved in a drunk driving accident five years ago that resulted in the death of a middle-aged woman. They further disclose to their psychologist that they fled the scene of the crime and that the case is likely still open. The psychologist should:
Select one:
A.
report the crime to the authorities, as this is the protocol for open criminal cases.
B.
keep this confidential.
C.
report the crime to the authorities, as it occurred within the past seven years.
D.
report the crime to the authorities, as this will ultimately help the patient move forward.
The correct answer is B.
Generally speaking, all communication between a psychologist and their patient is kept confidential. Thus, if a patient discloses that they have committed a crime, including homicide, this is kept confidential. Of note, there are exceptions to confidentiality, such as if a patient makes a serious threat of future violence to a person or if a patient reports that they are abusing a child, elder, or dependent adult.
Answer A: Regardless of whether or not the case is open or closed, this information is kept confidential.
Answer C: Similarly, there is no time limit for when a case should or shouldn’t be reported to the authorities and this information should be kept confidential.
Answer D: The psychologist should not break confidentially by reporting this crime to the authorities, despite whether or not they think it would help their patients overall treatment.
On three separate occasions, a patient makes sexual advances towards their psychologist. During a recent session, the patient puts his hand on the psychologist’s thigh and laughs after she stands up and moves away. He then tells the psychologist that he always gets what he wants. The psychologist should ____________________.
Select one:
A.
discuss the pamphlet Professional Therapy Never Includes Sex during their next session
B.
discuss how the patients behavior manifests in other relationships during their next session
C.
start the process of pretermination counseling during their next session
D.
terminate the therapy prior to their next session
The correct answer is D.
Per the APA Ethics Code, Section 10.10 Terminating Therapy, “psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.” As the psychologist is feeling “highly uncomfortable” and likely threatened, they are fully within their rights to terminate the therapy. Of note, the psychologist could break confidentiality and seek a protective order against a client/patient if they suspect that they will threaten or harm them.
Answer A: When a psychologist becomes aware through a patient that they had a sexual relationship with a psychologist during the course of treatment, they should review this pamphlet with their patient. Although the psychologist could review this pamphlet with their patient, this answer does not address the underlying issue of the psychologist’s safety.
Answer B: It would be helpful to address this behavior with the client. However, the behaviors described in the vignette make it difficult to continue with the treatment.
Answer C: Per the APA Ethics Code, “except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists should provide pretermination counseling and suggest alternative services providers as appropriate.” Thus, while psychologists are encouraged to provide pretermination counseling, this is not required by the ethics code and depends on the specific circumstances. As it is likely that this behavior will continue in a future session and possibly even escalate, the psychologist should terminate the therapy and provide appropriate referrals.
During a group therapy session, a client takes out her phone, takes a picture with the group members, and says that she is going to post the photo to her social media account. The psychologist leading the group should:
Select one:
A.
ignore this behavior and praise the client when she is participating in the group discussion.
B.
refer to the group rules which states that the group members will maintain confidentiality and discuss that posting the photo on social media violates this rule
C.
tell the clients that they have legal and ethical responsibility to maintain the confidentiality of the group members and should therefore delete the photo
D.
ask the client to obtain permission from the group members before posting the photo on social media
The correct answer is B.
At the onset of group therapy, psychologists should discuss the unique roles and responsibilities of both the psychologist and the group members. Specifically, the psychologist should discuss their obligation to maintain confidentiality and the limits of confidentiality. Also, the psychologist should clarify that while the clients or group members are not legally or professionally obligated to maintain confidentiality, they can request that all group members maintain confidentiality. Thus, the psychologist should refer to the group rules, which states that the group members will maintain confidentiality, and discuss how posting the photo would violate this rule.
Answer A: Although positive reinforcement can be helpful to decrease disruptive behaviors, this answer does not get at the underlying issue of confidentiality.
Answer C: While the group members should be encouraged to maintain confidentiality, they are not bound by a professional code and do not have a legal obligation to maintain confidentiality.
Answer D: While this is a reasonable request, the other group members may feel pressured into giving their permission to post the photo. Thus, the psychologist should indicate that this behavior would violate the group rules. Ideally, the psychologist should also create group rules regarding social media use so that they can refer to these policies when issues arise.
A psychologist is utilizing cognitive behavioral therapy (CBT) to treat a client with a DSM-5 diagnosis of Generalized Anxiety Disorder. During their fifth therapy session, the client reveals that she is experiencing motor tics when she is feeling anxious and would like to reduce these behaviors. Although the psychologist is familiar with the Comprehensive Behavioral Intervention for Tics (CBIT), they do not have clinical experience treating clients with motor tics. Thus, the psychologist should:
Select one:
A.
seek consultation in this area.
B.
refer the client out
C.
seek supervision in this area.
D.
continue to treat the clients anxiety, as this will likely improve her motor tics.
The correct answer is A.
Psychologists need to practice within the scope of their competence. One of the gold standard treatments for motor tics is Comprehensive Behavioral Intervention for Tics (CBIT), which includes a combination of awareness training and competing response training. Although the psychologist is familiar with this treatment, they do not have clinical experience using this technique and thus are not ready to practice this technique independently. As a result, they should seek consultation or additional training.
Answer B: The psychologist has experience treating the primary concern (GAD) and it may be harmful to abruptly end treatment. Thus, the psychologist should continue with treatment with additional consultation.
Answer C: Supervision typically occurs when a psychologist is in training. The psychologist is familiar with treating the disorder; however, if they were in the early stages of their career prior to licensure, they should seek supervision to develop clinical experience using the technique described in this case.
Answer D: The psychologist should make an effort to address the client’s overall clinical presentation, which includes motor tics.
A client tells their therapist that they have also been participating in therapy with another therapist for the same issues. How should the psychologist proceed?
Select one:
A.
The psychologist should carefully consider any potential issues and seek outside consultation when working with the client to ensure the welfare of the client.
B.
The psychologist should encourage the client to only see one therapist, as seeing two therapists for the same issue can lead to confusion.
C.
The psychologist should obtain a release form to coordinate treatment with the other provider.
D.
The psychologist should further clarify the need for two therapists, carefully consider any potential issues, discuss these issues with the client, and proceed with caution and sensitivity.
The correct answer is D.
Per the APA Ethics Code, Section 10.04, Providing Therapy to Those Served by Others, “in deciding whether to offer or provide services to those already receiving mental health services elsewhere, psychologists should carefully consider the treatment issues and the potential clients/patients welfare. Psychologists should discuss these issues with the client/patient or another legally authorized person on behalf of the client/patient in order to minimize the risk of confusion and conflict, consult with the other service providers when appropriate, and proceed with caution and sensitivity to the therapeutic issues.”
Answer A: Although the psychologist should carefully consider any potential issues, the ethics code does not mandate outside consultation.
Answer B: There is a high potential for confusion, which may hinder the clients treatment; however, the ethics code does not necessarily ban a client from seeing two therapists and this answer is too prescriptive.
Answer C: The psychologist should obtain a release form to consult with the other therapist; however, this response does not address the need to discuss any potential issues with the client and proceed with caution and sensitivity.
Per the APA Ethics Code, which of the following best describes when a psychologist can terminate therapy?
Select one:
A.
When it is reasonably clear that the client no longer needs the service, is not likely to benefit, or is being harmed by continued service.
B.
When it is reasonably clear that the client or someone close to the client is threatening or endangering the psychologist.
C.
When it is reasonably clear that the client no longer needs the service, is not likely to benefit, or is being harmed by continued service or the client or someone close to the client is threatening or endangering the psychologist.
D.
The psychologist can terminate therapy at any time, as long as they provide pre-termination counseling.
The correct answer is C.
Per the APA Ethics Code Section 10.10 Terminating Therapy, “(a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. (b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship. (c) Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pre-termination counseling and suggest alternative service providers as appropriate.
Answers A & B: Although these responses contain acceptable reasons for terminating therapy, Answer C combines both of these responses and thus is the most comprehensive and “best” answer.
Answer D: Psychologists can terminate therapy based on reasonable professional judgment. This does not mean that they can terminate treatment “at any time.” For example, if a client is in imminent need of treatment or in crisis, it may not be professional or ethical to end treatment. Also, while psychologists are encouraged to provide pre-termination counseling, they are not violating this standard if this is “precluded by the client/patient or third-party payors.”
A 14-year-old girl calls a psychologist for a consultation regarding ongoing symptoms of anxiety. They indicate that they would like to proceed with outpatient services without parental consent. Can the psychologist proceed with treatment?
Select one:
A.
No, the psychologist cannot proceed with treatment without consent from a parent or legal guardian.
B.
Yes, if in their professional opinion, it would be inappropriate to involve the parent or guardian.
C.
Yes, if in their professional opinion, the child is mature enough to participate and it would be inappropriate to involve the parent or guardian.
D.
Yes, the psychologist can proceed without parental consent only if the client is the alleged victim of child abuse.
The correct answer is C.
The California Family Code and Health and Safety Code outline circumstances in which minors (12 years or older) can legally consent to treatment. Per the California Family Code (Sections 6920-6930), a minor who is 12 years of age or older may consent to mental health treatment or counseling on an outpatient basis if “(1) The minor, in the opinion of the attending professional person, is mature enough to participate intelligently in the outpatient services” and “(2) The minor (A) would present a danger of serious physical or mental harm to self or to others without the mental health treatment or (B) is the alleged victim of incest or child abuse. However, the California Health and Safety Code (124260), expands these circumstances and indicates that “the mental health treatment or counseling of a minor authorized by this section shall include involvement of the minors parent or guardian, unless the professional person who is treating or counseling the minor, after consulting with the minor, determines that the involvement would be inappropriate. The professional person who is treating or counseling the minor shall state in the client record whether and when the person attempted to contact the minors parent or guardian, and whether the attempt to contact was successful or unsuccessful, or the reason why, in the professional persons opinion, it would be inappropriate to contact the minors parent or guardian. Taken together, a minor who is 12 years or older does not have to be at risk to self or others or a victim of child abuse or incest to receive mental health treatment without parental consent.
Answer A: As stated above, children who are 12 years or older can proceed without parental consent if they are mature enough to participate and it would be inappropriate to involve the parent.
Answer B: The client also has to be mature enough to participate intelligently.
Answer D: Although this is a reason for permitting a minor to participate in mental health treatment without parental consent, it is not the “only” reason.
Who is the holder of privilege?
Select one:
A.
The patient when they do not have a legal guardian or conservator.
B.
The patient’s psychologist.
C.
The patient’s personal representative, unless they are deceased.
D.
The patient and their psychologist both hold privilege.
The correct answer is A.
Privilege refers to the right to keep confidential communications from being disclosed in a legal proceeding. The patient, when they do not have a legal guardian or conservator, holds privilege.
Answers B & D: The psychologist may assert privilege on their clients behalf; however, only the patient holds privilege.
Answer C: The patient’s personal representative only holds privilege when the patient is deceased.
A patient is seeking treatment for anxiety. During the initial phone call, the patient reports that they do not want the psychologist to communicate with their previous or current psychiatrist. The psychologist should:
Select one:
A.
follow the clients wishes and proceed with treatment without communicating with other treatment providers.
B.
refer the patient out, as they are placing limitations of their duty to provide competent care.
C.
proceed with treatment and revisit this topic in a few months when the patient is more comfortable.
D.
proceed with treatment if the patient provides a good explanation for limitation placed on the psychologist.
The correct answer is B.
Psychologists should be wary of treating a patient who is putting excessive limitations upon their duty to provide competent and comprehensive care. Thus, it is in the psychologist’s best interest to state their practice policies related to communicating with other health care providers about the patient’s mental health. If the patient is uncomfortable with this policy, the psychologist should provide appropriate referrals.
Answer A: Failure to coordinate the care and consult with other current providers may open the psychologist up to claims of negligence. Thus, it is in the psychologist’s best interest to refer this client out if they are unable to follow the standard of care for their practice.
Answer C: The psychologist should be upfront about their practice policies and should not begin treatment with a patient that is placing limitations on their duty of care as this opens them up to possible risks and claims.
Answer D: The psychologist should be upfront about their practice policies and should not begin treatment with a patient that is placing limitations on their duty of care as this opens them up to possible risks and claims.
Within a group private practice, licensed psychologist A supervises three psychological associates, and licensed psychologist B supervises one psychological associate. If the practice would like to add one more psychological associate to their group practice, they should be supervised by:
Select one:
A.
licensed psychologist A
B.
licensed psychologist B
C.
neither licensed psychologist
D.
both the licensed psychologist A and B
The correct answer is B.
Per the California Board of Psychology, there are limitations on the number of psychological associates a provider can supervise at one time. Specifically, a licensed psychologist can only supervise up to three psychological associates at a time. Thus, licensed psychologist B is able to supervise the new psychological associate.
Answers A, C, and D: Licensed psychologist B is able to supervise the new psychological associate and should be the one to supervise the new psychological associate.
A psychologist who was previously licensed in the state of California let their license expire for four years while they took some time off. If the psychologist would like to reinstate their California license, they should:
Select one:
A.
petition for reinstatement of their license.
B.
move their license to inactive status and then renew their license.
C.
apply for a new license.
D.
file an application for renewal and pay any outstanding fees.
The correct answer is C.
Per the California Laws and Regulations, Section 2986. Effect of failure to renew within prescribed time, “a person who fails to renew his or her license within the three years after its expiration may not renew it, and it may not be restored, reissued, or reinstated thereafter, but that person may apply for and obtain a new license if he or she meets the requirements of this chapter provided that he or she: (a) Has not committed any acts or crimes constituting grounds for denial of licensure. (b) Establishes to the satisfaction of the board that with due regard for the public interest, he or she is qualified to practice psychology. (c) Pays all of the fees that would be required if application for licensure was being made for the first time.” In other words, a license can be renewed with three years of expiration. However, after three years, the psychologist must apply for a new license.
Answer A: A psychologist may petition for reinstatement of their license if their license has been revoked, suspended, or surrendered. However, in this case, the psychologist’s license has been expired for over three years and thus they have to apply for a new license.
Answer B: A psychologist can move their active license to inactive status if they are not planning on practicing for a period of time. However, an expired license cannot be placed on inactive status.
Answer D: Again, as the psychologist’s license has been expired for four years, they must apply for a new license.
A parent calls a psychologist asking for their child’s raw test scores from a recent assessment to keep in their records. They indicate that they are concerned about his mood and that he has been making a lot of negative statements recently. The psychologist should:
Select one:
A.
further assess the child’s mood and provide appropriate referrals
B.
release the raw and scaled scores if the assessment was completed within the past three years
C.
not release the scores, as this should be kept confidential to protect test security
D.
offer to schedule a meeting to discuss the results, as they are unable to release the raw scores as this would compromise the test security
The correct answer is A.
In this situation, the first priority is to ensure that the child is safe and that the parent is aware of various crisis resources. Also, it may be helpful to review the recommendations from the assessment, which likely includes psychotherapy.
Answer B: Per the APA Ethics Code, “test data includes raw and scaled scores should be released to whomever is designated on the release of information form. Psychologists may refuse to release data if they believe there is potential for “substantial harm, or the misuse or misinterpretation of test data.” Generally speaking, the client’s parents have a right to the raw and scaled test scores. They should also provide information regarding how to interpret various test scores (scaled scores, t-scores, percentiles, etc.). However, this response is spoiled by the second part, and the results can be released even if the testing was completed more than three years ago.
Answer C: Releasing the raw scores does not compromise the test security and it is good practice to include these in your report as they allow for your work to be reviewed and double checked by an outside provider.
Answer D: Although it may be helpful to schedule a meeting to review the results, the psychologist can also release the raw scores, and this would not compromise test security.
After witnessing a car accident, a psychologist pulls over and gives her business card to the victims. The psychologist states that they specialize in post-traumatic stress disorder and encourages the victims to contact her for treatment. The psychologist actions were:
Select one:
A.
unethical and illegal
B.
ethical and legal
C.
unethical and legal
D.
ethical and illegal
The correct answer is C.
Per the APA Ethics Code 5.06 In-Person Solicitation, “psychologists do not engage, directly or through agents, in uninvited in-person solicitation of business more actual or potential therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence. However, this prohibition does not preclude 1) attempting to implement appropriate collateral contacts for the purpose of benefitting an already engaged therapy client/patient or (2) providing disaster or community outreach services.” In this situation, the potential clients are under undue influence because of their particular circumstances (just got into a car accident). Thus, while this behavior is legal, it is considered unethical.
Answers A & D: These responses are incorrect.
Answer B: If the psychologist was working with a community disaster response team to assess individuals and provide appropriate referrals, it would be considered ethical and legal to provide their business contact information.
A psychologist is interviewing applicants for a position in their private group practice. They recently find out that their top candidate has been the subject of an ethics complaint. The psychologist decides to offer the position to someone else. The psychologist has acted:
Select one:
A.
unethically because they cannot discriminate in the hiring process.
B.
ethically if their decision was based on the outcome of the proceedings.
C.
ethically if the proceedings for the ethics complaint was related to failure to report child abuse.
D.
unethically because they are not permitted to take action based on the outcomes of such proceedings.
The correct answer is B.
Per the APA Ethics Code, Section 1.08 Unfair Discrimination Against Complainants and Respondents, “psychologists do not deny persons employment, advancement, admissions to academic or other programs, tenure, or promotion, based solely upon their having made or their being the subject of an ethics complaint. This does not preclude taking action based upon the outcome of such proceedings or considering other appropriate information.” Thus, if the psychologist’s decision was based on the outcome of the meeting, their actions would be ethical.
Answer A: This answer is too vague. The psychologist would be within their rights to not offer a position to a psychologist who lost their license due to an ethical violation. However, they would be acting unethically if they based their decision solely on the fact that the psychologist had a complaint filed against them and not based on the outcome of the ethics proceedings.
Answer C: There are not any stipulations regarding the subject of the ethics complaint. Overall, the employer cannot discriminate based on the fact that a psychologist has been the subject of an ethics complaint.
Answer D: Taking action based on the outcome of the proceeding is ethical rather than unethical.
A colleague tells another psychologist that they are sleeping with their client. He feels very badly and tells the psychologist that he is planning on ending this relationship as soon as possible. The psychologist should:
Select one:
A.
continue to talk with their colleague and come to an informal resolution
B.
report their colleague to an ethics committee or state licensing board
C.
report their colleague to an ethics committee or state licensing board if they are unable to come to an informal resolution
D.
attempt to come to an informal resolution because reporting the psychologist to the board would be a violation of the clients confidentiality
The correct answer is B.
As this is a serious offense, the psychologist should report their behavior directly to the licensing board. Per the APA Ethics Code, Section 1.04 Informal Resolution of Ethical Violations, “when psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved.” However, as in this case, per Section, 1.05 Reporting Ethical Violations, “if an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under, or is not resolved properly in that fashion, psychologists take further action appropriate to the situation. Such action might include referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities.” Thus, the psychologist should report the psychologist directly to the board or an ethics committee.
Answers A & C: As this is a serious offense, it is not appropriate for an information resolution and the psychologist should report this behavior directly to the board without an information resolution. This is because there is not an informal resolution that is appropriate given the severity of the offense.
Answer D: The psychologist can report their colleague to an ethics committee or to the board without providing the name of the client/patient to ensure that confidentiality is protected.
A client tells their psychologist that they are in a serious romantic relationship with their previous therapist. She quickly further explains that they ended therapy before they officially started dating a month later. She indicates that they never had any sexual contact while she was his patient, that he was overall very professional. What should the psychologist do with this information?
Select one:
A.
The psychologist should incorporate this background information into their case conceptualization and treatment plan.
B.
The psychologist should report this sexual misconduct to the board.
C.
The psychologist should give the client/patient the pamphlet, Professional Therapy Never Includes Sex.
D.
The psychologist should only report the previous psychologist to the board if they find out that there was sexual contact during the course of treatment.
The correct answer is A.
It is illegal and unethical to have sexual contact within two years following termination of therapy. Thus, if a therapist is found guilty of sexual contact with a former patient within two years of termination, their license could be revoked. When a psychologist learns of sexual misconduct between a psychologist and their patient, they can ONLY report this offense to the BOP if they have a signed written authorization from the patient. Answer A is the only option that maintains confidentiality and is thus the best option.
Answer B: Again, the psychologist reporting this behavior to the board without a signed release form would be considered a breach of confidentiality.
Answer C: If a psychologist becomes aware of sexual contact between a patient and their therapist during the course of treatment, they should provide the patient with the pamphlet, Professional Therapy Never Includes Sex. In this case, the patient stated that they did not have sexual contact during treatment, and therefore, it would not make sense to provide the pamphlet.
Answer D: Having sexual contact with a patient during treatment or with a former patient within two years of therapy termination is both considered unethical and illegal.
A psychologist receives a signed authorization form from their adult therapy patient, which indicates that they would like to have their records inspected by another psychologist. The psychologist is concerned about the sensitive information in their treatment records and should therefore:
Select one:
A.
deny the request if they believe that access to these records is reasonably likely to endanger the life or physical safety of the individual or another person.
B.
permit the inspection of the records within five working days after the request is received.
C.
permit the inspection of the records within ten business days after the request is received.
D.
offer to write a treatment summary instead.
The correct answer is B.
Psychologists should generally permit inspection of their records within five working days after a written request is received.
Answer A: Per HIPAA, a patient’s access to their records can be denied when the health care professional has determined that access is reasonably likely to endanger the life or physical safety of the individual or another person. However, this does not apply to other qualified health care professionals and they are almost always permitted to view a patient’s records, with proper consents in place.
Answer C: While treatment summaries should be prepared within ten working days, the psychologist should permit an inspection of their treatment records within five working days after a written request is received.
Answer D: Again, qualified health care professionals are generally almost always able to view the records within five business days and thus this request should be granted.
A patient reports that her husband, with whom she shares three children with, has become increasingly physical with her after losing his job a few months ago. The psychologist can make a report without her permission if:
Select one:
A.
her child has witnessed the domestic violence and has unjustifiable emotional suffering.
B.
the husband is at least 65 years old.
C.
this incident marks a pattern of physical and emotional abuse.
D.
she has a physical mark or bruises from the incident.
The correct answer is A.
The California Penal Code (Section 11160) states that health practitioners who provide medical services to a person suffering from any wound resulting from assault or abuse, are mandated to report this information. In contrast, mental health providers or psychologists are not mandated to report the assault. They are not even permitted to report assault unless the patient gives explicit written consent. An exception to this rule is if a child witnesses domestic violence. This is frequently considered willful cruelty or unjustifiable punishment. Thus, a child report should be made if the psychologist feels that this has caused unjustifiable emotional suffering.
Answer B: If the patient were 65 years old, this would be considered elder abuse. However, in this case, we do not know the victim or patient’s age and thus, the psychologist is not a mandated reporter.
Answers C & D: Again, mental health providers cannot break confidentiality and report assault unless they have the patients permission, regardless of whether or not this was a pattern of abuse or if there are bruises. If the psychologist makes a report without the patient’s consent, this would be a severe violation of confidentiality.
A psychologist posts on a popular social media site that he is seeking referrals for a couples counselor for his therapy client. He indicates that his client is in his early 40s, has three children under the age of five, and that he and his wife work full time in the medical field. The psychologist has acted:
Select one:
A.
ethically, as he has a duty to find appropriate referrals for his clients
B.
unethically
C.
ethically, if he did not include the client’s name or location
D.
ethically, if he obtained written authorization to request referrals from his colleagues
The correct answer is B.
Psychologists should be aware of their duty of confidentiality and reveal the minimum amount of information necessary to obtain appropriate referrals. Is knowing that the client and his partner work in the medical field, have three children under the age of five, and is in his early 40s really necessary to find the right referral for him? This seems like an unnecessary level of detail to post on a public social media platform. Thus, these actions are considered unethical.
Answer A: If a psychologist is not competent in a particular area, they should refer the client out and find appropriate referrals. Given that the client is seeking a psychologist for an issue that is not part of his current treatment, the psychologist is not obligated to find other appropriate referrals for him.
Answer C: Although the psychologist did not provide their patient’s name or location, they offered an abundance of details that could lead to others knowing or making an educated guess about the client’s identity.
Answer D: If he was permitted to post on a social media site, this might be considered ethical and permissible. However, in this case, the psychologist does not specify that he is seeking referrals by posting details of his marriage on a social media site.
