Clinical Evaluation Flashcards
An 80-year-old client is experiencing impairments in memory and the ability to make decisions. The onset of these problems was abrupt and he is very concerned about them. The therapist should:
A.
refer him for a medical evaluation.
B.
refer him for psychological testing.
C.
include behavioral techniques and environmental manipulation in the treatment plan
D.
suspect that he has dementia
A.
refer him for a medical evaluation.
Some people with Major Depressive Disorder (especially older adults) experience impairments in memory and cognition and the decline is usually abrupt and the person is concerned about them. This man may have Major Depressive Disorder. However, before assigning a diagnosis, the therapist should refer him for a complete physical examination to rule out an underlying medical condition or the effects of a substance.
Answer B is incorrect: A medical examination is more important in order to rule out (or identify) physiological reasons for the man’s impairments.
Answer C is incorrect: These techniques may be useful, especially if the man is in the early stages of dementia. But, before identifying an appropriate treatment, it’s necessary to determine the cause of the man’s symptoms.
Answer D is incorrect: In dementia, cognitive deficits usually have a progressive course and the individual denies or is unaware of the impairments.
Your client is a four-year-old boy, who has recently moved into his grandmother’s home because his mother was sent to jail on a drug charge. The boy has been enjoying a particular toy during the session. After he leaves, you notice that he has taken the toy with him. What is the most likely explanation?
Select one:
A.
He has taken the toy to share at school in show-and-tell.
B.
He is expressing anger at having to come to therapy.
C.
He is expressing a need for some type of continuity and control in his chaotic life.
D.
He has poor impulse control.
C.
He is expressing a need for some type of continuity and control in his chaotic life.
The situation described in this question has likely created a sense of chaos for the boy as well as his grandmother. Young children often use toys, blankets, or stuffed animals as transitional objects, or symbols of comfort and connection. Therefore, this is a likely explanation for the boy’s behavior.
Answer A is incorrect: This is possible but is not the best answer because it doesn’t take into account the situation described in the question.
Answer B is incorrect: The question does not indicate that this boy is angry about coming to therapy.
Answer D is incorrect: This is also a possibility but, like answer A, does not take into account the information provided in the question.
Mike, age 40, is referred to you by the local homeless outreach services. They report that Mike seems fearful, is aloof, and talks to and argues with people who are and are not there and that he has appeared to have had these symptoms on and off for at least the past year. Mike maintains that the government has secretly implanted a microchip in his brain to track his whereabouts. You learn that Mike is a veteran of the Iraq War who retired from the military in 2010. He was trained in the Special Forces and went on missions during the war. He tells you that the CIA is after him because they are afraid he will reveal the classified information he knows. Mike sleeps in parks and his hygiene is poor, but he appears adequately nourished. What should be assessed initially in this case?
Select one:
A.
the possibility that Mike poses a danger to others as a result of his distrust and sense that he is unsafe; the extent to which Mike is able to take care of his own basic needs for food, shelter, and clothing; the possibility that Mike uses alcohol or other drugs excessively, as this would increase his potential for danger and further diminish his functioning; the extent to which Mike would be able to comply with treatment
B.
the possibility that Mike is suicidal as a result of his paranoid delusions and social isolation; the possibility that Mike poses a danger to others as a result of his distrust and sense that he is unsafe; the possibility that Mike currently uses alcohol or other drugs because there is a chance that he may be trying to self-medicate his debilitating symptoms with mind-altering drugs; the validity of Mike’s beliefs about the government
C.
the extent to which Mike is able to take care of his own basic needs for food, shelter, and clothing; whether Mike will harm himself or others since the actions of individuals with psychotic disorders pose a serious, imminent risk to themselves and/or others; whether Mike’s poor personal hygiene is associated with infection or illness; the extent to which Mike’s behavior and judgment are influenced by his mental symptoms
D.
the possibility that Mike may harm others because of his paranoid beliefs; the possibility that Mike currently uses alcohol or other drugs because there is a chance that he may be trying to self-medicate his debilitating symptoms with mind-altering drugs; whether Mike is able to form a supportive therapeutic alliance with you; whether there are any Department of Veteran’s Affairs records or other records on Mike that would provide useful information
A.
the possibility that Mike poses a danger to others as a result of his distrust and sense that he is unsafe; the extent to which Mike is able to take care of his own basic needs for food, shelter, and clothing; the possibility that Mike uses alcohol or other drugs excessively, as this would increase his potential for danger and further diminish his functioning; the extent to which Mike would be able to comply with treatment
While many individuals with psychotic disorders are not violent (more often, they are withdrawn and prefer to be left alone), some are, and Mike presents with several factors that may predispose him to violent behavior, including his distrust of others and sense that he’s not safe. Mike is homeless and his hygiene is poor and there’s a chance that he is gravely disabled due to a mental disorder. Consequently, you must determine whether Mike needs to be hospitalized. It’s not uncommon for people with schizophrenia to try to self-medicate their symptoms with alcohol or other drugs, and substance abuse would further impede Mike’s functioning and complicate his treatment and recovery. Finally, identifying barriers to a client’s ability to participate in treatment (e.g., cognitive impairment or disorganization, inadequate social resources) is especially important when a client has a psychotic disorder. This information would help you determine whether the client needs to be hospitalized and whether hospitalization and other treatments can be voluntary or need to be involuntary. Mike may need to receive inpatient care initially if there is acute psychosis, a co-occurring substance-related disorder, or both, and/or if he needs to be removed from environmental stressors that are maintaining his disorder.
Answer B is incorrect: This answer can be eliminated because it would probably be impossible in your initial assessment to determine whether there is any validity to Mike’s beliefs about the government. Moreover, at the onset of treatment you need to develop a supportive and trusting therapeutic relationship with Mike and would not want to question his beliefs.
Answer C is incorrect: This answer can be eliminated because you’d want to evaluate Mike’s risk for harm to himself or others but, contrary to what is stated in this answer, most individuals with psychotic disorders do not pose an imminent risk to others. In addition, poor personal hygiene may have caused an infection or other illness, but this is less important to assess initially than the factors described in answer A.
Answer D is incorrect: This answer is not as good as answer A because determining if there are other records you should review is of lower priority than assessing Mike’s danger to himself and determining his need for hospitalization.
Your new client is a 26-year-old man who complains of low self-esteem and feelings of shame about behaviors he engaged in while a college student. The client appears nervous during the session, but you observe that he is able to carry on a conversation with you and that his affect is appropriate. What does “appropriate affect” refer to?
Select one:
A.
The client’s ability to express a full range of emotions.
B.
The client’s ability to manage strong feelings that would otherwise interfere with his adaptive functioning.
C.
The client’s emotional tone matches the idea, thought, or topic he is describing.
D.
The client is willing to talk about his feelings.
C.
The client’s emotional tone matches the idea, thought, or topic he is describing.
This is a concise description of appropriate affect. Compared to mood, affect is more reactive and variable. In other words, affect is an emotional state of relatively short duration. Affect is considered to be “appropriate” when an individual is in touch with his emotions and can express them as he feels them in response to specific emotional or situational stimuli (e.g., when he cries while talking about something very sad).
During the mental status exam of a new client, you ask the client what factors led him to decide to quit his job two weeks ago. Apparently, you are interested in evaluating the client’s:
Select one:
A.
concentration.
B.
judgment.
C.
abstract reasoning.
D.
registration.
B.
judgment.
Judgment is the ability to evaluate alternatives and, on a mental status exam, is assessed by asking the client to discuss past choices or decisions or to say what he would do in a hypothetical situation (e.g., if he found an unsigned paycheck lying on the sidewalk).
Answer A is incorrect: Concentration (attentiveness and distractibility) is evaluated by requiring the client to focus on a specific task – e.g., by having the client name the months or days of the week backward.
Answer C is incorrect: Abstract reasoning is a higher-order cognitive function that is typically assessed by having the client identify similarities between pairs of objects or explaining the meaning of well-known proverbs.
Answer D is incorrect: Registration refers to immediate memory and is assessed by asking the client to immediately repeat a short list of words, numbers, or other information.
Your client reports that he has been feeling depressed and having difficulty sleeping through the night. He adds that he has lost interest in his job and hobbies. You administer the Beck Depression Inventory-II to assess the depth of the client’s depression and find that his score is fairly high. With regard to telling the client about the results of this test, you should do which of the following?
Select one:
A.
Avoid telling the client the results at this time because you cannot draw meaningful conclusions from the results of a single test.
B.
Avoid telling the client the results because he may misunderstand them and become upset.
C.
Re-administer the test after providing therapy and give the client the results of the second test.
D.
Tell the client the results of the test but use language that is meaningful to him.
D.
Tell the client the results of the test but use language that is meaningful to him.
This answer describes an ethical and clinically beneficial way of sharing test results with a client. A therapist should explain test results using language the client will understand and that will not unduly upset him. For instance, it would be unethical to give a client only the raw test data or to use technical jargon because such information would probably mean little to a client and could lead him to misunderstand his test results.
Answer A is incorrect: The Beck Depression Inventory-II is designed to provide the specific information you were seeking - the level of the client’s depression.
Answer B is incorrect: The client has the right to know the results of his test.
Answer C is incorrect: Although you will, in all likelihood, readminister the test after a period of treatment, the client has the right to know the results of his first test.
At the beginning of therapy, a client’s motivation to change can be best assessed by doing which of the following?
Select one:
A.
Exploring what led her to seek treatment.
B.
Asking her how she normally copes with problems.
C.
Attempting to establish a therapeutic contract.
D.
Observing her body language.
A.
Exploring what led her to seek treatment.
While all of these actions could tell you something about a client’s motivation to change, the most direct way is to determine the client’s reason for coming to therapy. For example, an adult who comes in voluntarily because she is in the midst of a crisis will be much more motivated than a teenager who comes involuntarily because her parents think she’s a “juvenile delinquent.”
Selena seeks advice from a therapist at the university counseling center. She tells the therapist that she’s concerned about her weight and that it is very important for her to stay in shape, but that she “just doesn’t feel hungry a lot of the time.” Selena reports that she’s doing “okay” in her classes and that she has a lot of test-taking anxiety and some difficulty reading and concentrating. Testing indicates that her intelligence is above average. The MOST important thing for the therapist to do in this case would be:
Select one:
A.
treat her eating disorder.
B.
treat any underlying depression.
C.
help her with referrals to tutors.
D.
refer her for a medical evaluation.
D.
refer her for a medical evaluation.
This question is challenging because it presents many issues. However, it is asking for the “most” important thing to do. The most important thing would be to refer the woman for a medical evaluation to identify any medical conditions that might be associated with her lack of hunger and reading and concentration problems.
Answer A is incorrect: This answer is not correct because there is not sufficient information to conclude this woman has an eating disorder.
Answer B is incorrect: There is no real indication that this client is depressed.
Answer C is incorrect: Although referrals to tutors may be helpful, this will not deal with the majority of her presented problems.
Mary, a 64-year-old widow, brings her 19-year-old grandson, Alex, to you for an evaluation. She reports that Alex, who lives with her, began having “strange problems” about eight months ago: He has trouble focusing and doing ordinary, day-to-day things, and she often has to monitor him. He is also often agitated and has a hard time sleeping. Mary says she knows that he used methamphetamines once but that he’s now “clean.” She thinks Alex is depressed about his parents who are recovering drug addicts and live out of state and can’t take care of him. Alex tells you that voices in his head talk to him sometimes and he likes their company. He doesn’t work or go to school, and he says he’s not sure what he wants to do for a career. Which of the following requires immediate assessment in order to evaluate risk?
Select one:
A.
Alex’s suicide potential; Mary’s coping skills; Alex’s need for inpatient care; whether Alex poses a danger to others
B.
Alex’s ability to perform activities of daily living; Mary’s mental status; Mary’s social support system; Alex’s suicide potential
C.
Alex’s mental status; Alex’s drug history; whether Alex poses a danger to others; Mary’s coping skills
D.
Mary’s well-being; Alex’s suicide potential; Alex’s mental status; Mary’s social support system
D.
Mary’s well-being; Alex’s suicide potential; Alex’s mental status; Mary’s social support system
The vignette suggests that Mary is the only person caring for Alex and, as a result, may be feeling overwhelmed and physically and emotionally exhausted. Therefore, evaluating her well-being is a top priority. This would include determining if she has anyone she can turn to for support and evaluating her immediate support needs. In addition, suicide risk is always an important consideration for individuals with psychotic and/or depressive symptoms, and you’d want to obtain additional information on Alex’s mental status to determine if he needs to be hospitalized at this time.
Answer A is incorrect: Assessing Alex’s suicide potential, Mary’s coping skills, and Alex’s need for hospitalization are all important. However, the vignette does not suggest that Alex poses a danger to others (e.g., it does not say he is currently aggressive or hostile or describe a history of violence). Although the use of methamphetamines is associated with an increased risk for violent behavior, you don’t know that Alex is currently using drugs.
Answer B is incorrect: This answer can be eliminated because evaluating Alex’s ability to perform activities of daily living is not a top priority since he is not living alone. In addition, there’s no reason to assume that Mary’s mental status needs to be evaluated.
Answer C is incorrect: This is not the best answer because, as noted above, there’s no reason to believe that Alex is a danger to others. Also, the limited information given about Alex’s drug use suggests that he’s not currently using drugs, so this is not a factor that you’d assess first to evaluate risk.
During her first session, a female client complains of headaches, fatigue, and excessive anxiety. The woman says that she has a history of anxiety and depression but that her feelings of anxiety are much more frequent and intense now. She can think of nothing that precipitated this change in her health and emotional state. The therapist’s first priority in this case would be to:
Select one:
A.
recognize that the headaches, fatigue, and anxiety are depressive symptoms and continue working with her.
B.
include in the treatment plan the use of behavioral techniques to alleviate the woman’s anxiety,
C.
refer the woman to a colleague for psychological assessment if the therapist is not experienced in administering and interpreting assessment techniques him- or herself.
D.
refer the woman to a physician because her symptoms might be due to a medical condition.
D.
refer the woman to a physician because her symptoms might be due to a medical condition.
Because the client’s symptoms might be due to a medical condition, before developing a treatment plan or determining whether psychological testing is needed, the therapist would want to refer the client to a physician for a medical evaluation.
Answer A is incorrect: The therapist would not want to conclude this without first ruling out the possibility that the woman’s symptoms are due to a medical condition.
Answer B is incorrect: This might be useful later, but a medical exam is the best first step.
Answer C is incorrect: This might be useful later and you might have been tempted by this answer since it refers to ethical behavior, but a referral for a medical exam is the first priority.
Your client reports that he has been feeling depressed and having difficulty sleeping through the night. He adds that he has lost interest in his job and hobbies. You administer the Beck Depression Inventory-II to assess the depth of the client’s depression and find that his score is fairly high. With regard to telling the client about the results of this test, you should do which of the following?
Select one:
A.
Avoid telling the client the results at this time because you cannot draw meaningful conclusions from the results of a single test.
B.
Avoid telling the client the results because he may misunderstand them and become upset.
C.
Re-administer the test after providing therapy and give the client the results of the second test.
D.
Tell the client the results of the test but use language that is meaningful to him.
D.
Tell the client the results of the test but use language that is meaningful to him.
This answer describes an ethical and clinically beneficial way of sharing test results with a client. A therapist should explain test results using language the client will understand and that will not unduly upset him. For instance, it would be unethical to give a client only the raw test data or to use technical jargon because such information would probably mean little to a client and could lead him to misunderstand his test results.
Answer A is incorrect: The Beck Depression Inventory-II is designed to provide the specific information you were seeking - the level of the client’s depression.
Answer B is incorrect: The client has the right to know the results of his test.
Answer C is incorrect: Although you will, in all likelihood, readminister the test after a period of treatment, the client has the right to know the results of his first test.
You are referred a client who has no health insurance and very little money. The client says that she has been in therapy before and it was not a good experience but that she’s willing to give it another try in order to save her marriage. The client is listless and detached, she speaks very slowly when responding to your questions, and she says that, lately, she feels tired “all the time.” You and the client negotiate a low fee that the client can afford to pay. What would you do next?
Select one:
A.
Help the client identify the source of her depressed mood by having her make a list of what she is depressed about and then process it with you.
B.
Arrange for the client to undergo a physical examination.
C.
Discuss the client’s prior experiences with therapy to better understand her motivation for coming in and review all documentation of prior treatment efforts.
D.
Identify the client’s primary needs by clarifying her statement about “saving her marriage” and determining whether she needs to be referred to public financial assistance programs at this time.
B.
Arrange for the client to undergo a physical examination.
This question presents several significant issues – i.e., the woman’s symptoms, lack of money, concerns about her marriage, and prior negative experiences in therapy. The most pressing issue, however, is the woman’s observable symptoms, which need to be evaluated by a medical professional right away. The incorrect answers emphasize the other issues and overlook the potential medical crisis. (Note that, even if you and the client were unable to negotiate a fee she could afford to pay, by accepting the referral, you have started treatment with her and would still have an ethical obligation to arrange for her to obtain medical attention.)
During the first session with you, a client complains of fatigue and excessive “nervousness.” The client says that she has a history of periodic depression but has never felt so nervous or anxious before. She was treated for depression two years ago and says that her mood has improved since then. Now, she’s just a “nervous wreck” and feels like she can never calm down. What would you do initially in assessing this problem?
Select one:
A.
Obtain a detailed history of the onset, development, frequency, and nature of the client’s anxiety symptoms.
B.
Ask the client about other symptoms she is experiencing to determine whether her depression has returned.
C.
Ask the client about recent events, stressors, and transitions in her life and explore her responses to them.
D.
Obtain a general medical history which includes any medications the client is taking, and refer the client for a physical examination.
D.
Obtain a general medical history which includes any medications the client is taking, and refer the client for a physical examination.
This question is difficult because a therapist would do a variety of different things when assessing a client who reports symptoms of anxiety and/or a history of depression, including the things described in answers A, B, and C. However, this is the best answer because ruling out the possibility that a medical condition or substance or medication use accounts for a client’s symptoms is always a top priority.
During your first face-to-face meeting, a client reports feeling extremely guilty about taking supplies from his office to use at home. How would you proceed?
Select one:
A.
Identify whether the client’s poor judgment is pervasive or related to only this area of functioning by assessing impulse control in other areas.
B.
Recognize that pervasive feelings of guilt may indicate a depressed mood and ask the client about other symptoms he has been experiencing.
C.
Allow the client to continue expressing himself and respond to him without judgment.
D.
Explain that people usually feel guilty about stealing in order to encourage the client’s continued self-expression, normalize his feelings, and reduce his distress.
C.
Allow the client to continue expressing himself and respond to him without judgment.
During the first meeting with a client, you should focus on whatever the client considers important to talk about and avoid jumping to conclusions about his problems or concerns. Unless you need specific data, you should ask mostly open-ended questions and focus on giving the client an opportunity to explore and clarify his thoughts and feelings about his behavior in a safe way. You should also focus on conveying acceptance, as this can facilitate the development of trust.
Answer A is incorrect: While it’s possible that the client has a generalized problem with poor judgment or impulse control, it’s too early for you to draw either of these conclusions. You need to test your assumptions and perceptions by continuing your interview with the client and obtaining information from other sources.
Answer B is incorrect: It is too early to assume that the client’s feelings of guilt indicate depression.
Answer D is incorrect: Though normalizing a client’s feelings or behaviors can often be useful, this client is probably aware that people who steal usually feel guilty about it. This answer also has a bit of a judgmental tone, which you would want to avoid.
Lola experiences feelings of guilt about her sexual behavior during her adolescence and young adulthood. She joined the hippie movement and espoused “free love” and lived with a man “in sin,” as she now calls it. She was raised a Catholic and has since returned to her faith, which remains a very important part of her life. She admits that, when her children were in high school, she pressured her son to be a priest and her daughter to be a nun because she was concerned they were acting in immoral ways. This best illustrates which of the following?
Select one:
A.
enmeshment
B.
unfinished business
C.
projection
D.
reintegration
C.
projection
Projection is a defense mechanism that involves attributing an introjected part of the self to another. Projection is generally thought of as comprising a repressed or unknown part of the self. However, it can also consist of a repudiated and consciously known part of the self.
Answer A is incorrect: Enmeshment is a form of faulty family functioning consisting of overinvolvement of family members in one another’s lives.
Answer B is incorrect: Unfinished business is a term usually associated with Gestalt therapy. The process between the mother and son in this question would not be described as unfinished business.
Answer D is incorrect: The harmonizing of separate parts is called integration. The breaking down into the integrated component parts is called disintegration. When disintegration is followed by a reorganization of the individual parts into a harmonious whole, the process is called reintegration. For instance, a bipolar patient is disintegrated during the illness and reintegrated following it. This is not what is described in the question.
