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1

During the initial session, the ct mentions that she's been hospitalized several times for "severe depression". The client becomes tense and guarded when the therapist attempts to explore the hospitalizations saying that "its all in the past". She also states adamantly that she won't give permission to get those records. The therapist should FIRST:

A. assess her current level of depression

B. Reassure her that the focus will be on the present

C. Acknowledge her right to decide about releasing records.

D. Explore her resistance to sharing her records

C. Acknowledge her right to decide about releasing records

2

Obtaining informed consent from clients ...

(legal? ethical? both? neither?)

Obtaining informed consent from clients is
BOTH LEGAL & ETHICAL

3

A 72-year-old elderly widower is brought for an evaluation to a clinic by his daughters, both of whom live an hour away from where he still resides in the family home. The daughters are concerned that there is “no one to look after Dad.” When they came to visit him, they found the house in complete disarray: full trashcans, sink overflowing with dirty dishes, clogged toilet, and no clean clothes. The neurological and mental status exam reveals no dementia. The man is ambulatory although a cane is recommended. The daughters want to place him in an assisted living facility, but the father is adamantly opposed and wants to stay in his home. The therapist’s course of action is to:

A. request a follow-up appointment with the father and make an adult protective services report regarding abandonment.


B. discuss with the daughters the possibility of applying for legal guardianship of their father.


C. respect the client’s right to self-determination and arrange for an in-home evaluation.


D. explore the daughters’ willingness to have him live with one of them.

C. respect the client’s right to self-determination and arrange for an in-home evaluation.

4

When developing a private practice a therapist should consider all of the following to ensure continuity of care, except:


A. Informing clients of procedures in case of emergencies.


B. Developing a professional will.


C. Developing alternative resources in case of therapist absences.


D. Providing clients with three additional referrals at onset of therapy.

D. Providing clients with three additional referrals at onset of therapy.

5

A therapist, who was formerly employed as a financial planner, now treats couples with relationship issues. Occasionally, the therapist will assist a couple he is treating with financial planning when that is one of the sources of their conflict. The therapist’s behavior is:


A. Acceptable because he has the training.


B. Acceptable because it aligns with treatment goals.


C. Unacceptable because it is outside his scope of practice.


D. Unacceptable because it is outside his scope of competence.

C. Unacceptable because it is outside his scope of practice.

6

A therapist has been treating a woman for depression in private practice for four months. During an emotional session the client discloses that she was sexually molested when she was eight by her neighbor. The therapist has minimal training in treating childhood sexual abuse. The therapist should:


A. Inform the client of the limitations of the therapist’s training.


B. Seek consultation immediately.


C. Refer the client to a therapist trained in child sexual abuse.


D. Provide client with psychoeducation about the link between sexual abuse and depression.

B. Seek consultation immediately.

7

A therapist has been treating a client with Generalized Anxiety Disorder for five months. The client’s symptoms have disappeared and the client is functioning well. The therapist enjoys the sessions with the client so she has been reluctant to bring up termination. Also, the client pays full fee and the therapist is worried about losing the income. The therapist’s behavior is:



A. Acceptable because the client is benefiting from the treatment.


B. Illegal.


C. Illegal and unethical.


D. Unethical.

D. Unethical.

8

A therapist receives a court order to testify in a hearing for a client accused of child abuse. The therapist should FIRST:



A. assert privilege.


B. contact the client to determine their wishes.


C. consult with a lawyer regarding the matter.


D. review the client’s records to determine what needs to be shared.

C. consult with a lawyer regarding the matter.

9

A 13-year-old girl is referred by her teacher for therapy for depression. The therapist determines she is mature enough to consent for her treatment. LEGALLY the therapist should first:



A. Obtain written consent for treatment from the client.


B. Determine whether her parents should give consent.


C. Obtain a release to speak to the teacher.


D. Assess for any crisis issues.

B. Determine whether her parents should give consent.

10

A family consisting of a mother, stepfather, 13-year-old son and 11-year-old daughter seeks family therapy after the recent marriage of the mother and stepfather. From whom should the therapist obtain informed consent?


A. All of them


B. The mother because she has custody of her kids.


C. The mother and stepfather because the children are too young to consent.


D. The mother, stepfather and 13 year-old because the 11 year old isn’t old enough to consent.

A. All of them

11

A new client comes to the initial therapy session in crisis. The therapist does not inform the client of the fee prior to the initial session. When the client receives the bill, she refuses to pay. In this situation, the therapist should:



A. take client to small claims court.


B. accept client’s refusal to pay.


C. inform the client that future treatment will be withheld if she refuses to pay.


D. explain to the client that she is responsible for the payment in full.

B. accept client’s refusal to pay.

12

A client suffering from Bipolar I Disorder commits suicide after leaving the psychiatric hospital. The client had been seeing a therapist for five months. The client's legal representative contacts the therapist and requests access to the client’s records. How should the therapist respond?


A. Delay meeting the representative and consult a lawyer.


B. Meet with the representative and provide a copy of the record.


C. Allow representative access to the records after signing a release.


D. Deny the request to meet and to access the records.

C. Allow representative access to the records after signing a release.

13

A private practice therapist has decided to not use insurance companies for payment to protect their clients’ confidentiality .Also in the interest of protecting client confidentiality, the therapist keeps the client records secured in a locked file cabinet and include only the dates of treatment and whether the client was “better” or “worse.” Is the therapist in compliance with professional guidelines?



A. Yes, because the records are secure in a lock file cabinet.


B. Yes, because the therapist documents all treatment encounters.


C. Yes, because the therapist is not a HIPAA covered entity.


D. No, because the there is insufficient documentation.

D. No, because the there is insufficient documentation.

14

A school counselor refers a 14-year-old boy to therapy following an altercation with another student. The client reports a good relationship with his parents. The therapist should first:



A. obtain signed consent from the client.


B. discuss the need to have parental consent to begin therapy.


C. determine how the client feels about his parents consenting to treatment.


D. request a release of information to speak with school counselor.

C. determine how the client feels about his parents consenting to treatment.

15

A therapist in a small rural community has decided to consult with a colleague about a client who does not seem to be progressing in therapy. As part of the consultation the therapist should:


A. Obtain a release from the client since the colleague might know him/her.


B. Make the best effort at omitting any identifying information about the client.


C. Disguise the client’s identity by changing demographic information.


D. Convey minimum amount of information needed to get help.

A. Obtain a release from the client since the colleague might know him/her.

16

A single father seeks the assistance of a therapist in a family service agency. In the initial session, the client asks the therapist who will have access to what he talks about in session. The therapist’s MOST appropriate response to him is:



A. Request that he sign a release of information.


B. Reassure him that confidentiality will be maintained.


C. Explain the agency policies and limits of confidentiality.


D. Elicit information about why this issue has been identified.

C. Explain the agency policies and limits of confidentiality.

17

A client seeks treatment for relationship issues and wants to use her insurance. After the initial assessment, the therapist determines that the client does not meet the criteria for a medical diagnosis to bill the insurance. When the therapist informs the client, the client states that she won’t be able to attend therapy if she can’t use her insurance and states that she really needs help. The therapist should:


A. Provide the client with a list of low fee providers.


B. Submit the insurance claim with adjustment disorder diagnosis.


C. Submit an insurance claim with the closest possible diagnosis.


D. Slide her fee to accommodate the client’s income.

A. Provide the client with a list of low fee providers.

18

A new client in treatment reports feelings of wanting to hurt the client's parent who was the perpetrator of domestic violence during the client’s upbringing. After the disclosure, the therapist should NEXT:



A. warn the parent of the client’s intent to harm.


B. determine whether the client has a plan.


C. discuss ways the client can confront the parent non-violently.


D. assess client’s history of violent behavior.

B. determine whether the client has a plan.

19

During the initial therapy session with a new client, a therapist becomes aware that the client recently ended a romantic relationship with another client. It is apparent that neither of the clients is aware that the other is seeing the therapist for therapy. The therapist is unsure if providing therapy to both clients is ethical. After the therapist reviews the ethical standards, what else should the therapist do to resolve the issue?



A. refer the new client to another therapist.


B. discuss the situation with the clients involved.


C. consult with knowledgeable colleagues.


D. continue to meet with the clients.

C. consult with knowledgeable colleagues.

20

What action should a therapist take when a client reports intentions to steal from a store?


A. Maintain the client’s confidentiality.


B. Notify the store manager of the client’s intent.


C. Request that the client’s family monitor the client.


D. Report the client to a local law enforcement agency.

A. Maintain the client’s confidentiality.

21

A therapist meets with a client who has recently lost her husband. After the session, the sister telephones the therapist expressing concern about her sister’s increased drinking. How should the therapist respond?



A. Attempt to reduce the sister’s concern about the client.


B. Explain that information cannot be disclosed without a client’s consent.


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.

B. Explain that information cannot be disclosed without a client’s consent.

22

A patient in therapy reports that she visited her 83 year-old mother in a nursing home and that her mother had bruises on her wrists and bed sores. The patient said her mother seemed fearful and would not say how she got the bruises. The therapist should:



A. File a mandated report with Adult Protective Services immediately.


B. Encourage the patient to schedule a meeting with the nursing home director.


C. File a mandated report with the police immediately.


D. Determine how long the issues have been going on with the nursing home.

C. File a mandated report with the police immediately.

23

A therapist is treating a self-referred 14-year-old adolescent for depression. The client’s parents are divorced and although he spends weekends with his mother, his father has sole legal custody. The client’s mother attempts to contact the therapist to find out how therapy is progressing. How should the therapist respond?



A. Meet with mother to discuss the client’s progress as she has a right to access information about her child’s treatment.


B. Refuse to speak with the client’s mother unless the father has signed a release, as he has sole legal custody.


C. Refuse to speak with the mother until you have notified the father and client of the call.


D. Refuse to speak with the client’s mother unless the son has signed a release.

D. Refuse to speak with the client’s mother unless the son has signed a release.

24

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?



A. Recommend he tells her in the session and offer to process the information.


B. Assure him that confidentiality will be maintained and encourage him to tell his partner.


C. Validate the client’s fears, but remind him of the “no secrets” policy.


D. Remind client of the limits of confidentiality and mandate to protect the girlfriend.

B. Assure him that confidentiality will be maintained and encourage him to tell his partner.

25

A therapist receives a subpoena for a client who is in the midst of a custody battle with her ex-husband. When he informs the client of the subpoena, the client says “I have nothing to hide, give them my records”. The therapist is concerned that the release of the records would be harmful to the client and her case. The therapist should next:



A. release the records to the court.


B. discuss concerns with client.


C. document concerns in notes.


D. assert privilege on behalf of the client.

B. discuss concerns with client.

26

Following an injury, a client becomes involved in a lawsuit and the therapist’s testimony has been requested by the client’s lawyer. The client waives privilege and tells the therapist that he would like him to testify in court. The therapist does not believe the testimony is in the client’s best interests but he insists. How should the therapist proceed?



A. Refuse to testify as it is not in the best interest of the client.


B. Obtain a release to consult with the client’s lawyer to explain concerns.


C. Edit testimony and only provide information that would benefit the client.


D. Proceed with testifying.

B. Obtain a release to consult with the client’s lawyer to explain concerns.

27

A therapist is treating a client who is involved in a contentious custody battle with his ex-wife. The therapist receives a subpoena for client’s records from the wife’s lawyer. The therapist should FIRST:



A. contact the client and discuss the pending release.


B. provide a copy of the records immediately.


C. consult with a lawyer regarding the matter.


D. assert privilege on behalf of the client.

D. assert privilege on behalf of the client.

28

A 15-year-old client reports that he has been having sex with his new girlfriend. The therapist is unsure of the girlfriend’s age, but knows she is younger than the client. The therapist believes the client is too young to be having sex. How should the therapist handle the client’s disclosure?


A. Remind the client of the limits of confidentiality as it relates to sex between minors.


B. Seek consultation to handle countertransference.


C. Determine the age of the girlfriend.


D. File a child abuse report.

A. Remind the client of the limits of confidentiality as it relates to sex between minors.

29

A therapist learns that a patient’s mother-in-law recently disciplined her child with spanking that left red marks. The patient is very upset and doesn’t know how to approach her mother-in-law about the incident. The therapist’s initial interventions should include:



A. explore the client’s reluctance to approach mother-in-law.


B. invite the mother-in-law to session to discuss the incident with the client.


C. assess how client has handled issues with mother-in-law in the past.


D. inform the patient that you must make a report of suspected child abuse.

D. inform the patient that you must make a report of suspected child abuse.

30

A therapist is leading a group for high school kids with truancy issues. During the group, one of the members shares that his friend emailed him naked pictures of a female classmate. The therapist should:



A. Contact the parents and inform them of incident.


B. File a child abuse report immediately.


C. Assess whether this has happened before.


D. Provide psychoeducation about the impact of internet exploitation.

B. File a child abuse report immediately.