Final Exam Sample Questions

Question 1

True or False: Progress notes and process notes are different names for the same type of documentation and legal standard.

Answer 1

False; Legal vs. Clinical – progress notes more specific about goals, process notes more generally what was discussed in session

Question 2

A therapist successfully terminates therapy with a family consisting of a 28-year-old father, a 25-year-old mother, and their two boys, ages 7 and 3. How long will the therapist need to maintain records of therapy, after this last professional contact?

A. 7 years
B. 10 years
C. 14 years
D. 22 years

Answer 2

D. 22 years

Records of treatment involving minors must be maintained for 7 years after the minor turns 18. In this case, the youngest family member in treatment was the 3-year-old. Records should be maintained until the 3-year-old is 25 - which is 22 years from now.

Question 3

A former therapy client requests their full treatment record. The therapist is concerned that the client was never made aware of their diagnosis. The therapist had diagnosed the client with a personality disorder. The therapist should:

A. Release a treatment summary instead of the full file.
B. Refuse to release the records.
C. Consider removing the diagnosis from the file if it is not relevant to the reason for the client’s request.
D. Release the file to the client, and offer to discuss the diagnosis.

Answer 3

D. Release the file to the client, and offer to discuss the diagnosis.

It is true that therapists can refuse to release records if they believe the release would be damaging to the client, but there is nothing in the question to suggest that the therapist sees the risk of such damage. The therapist is just concerned that the client wasn’t aware of the diagnosis. Releasing the file in accordance with the request, and offering to discuss the diagnosis, makes the most sense.

Question 4

The intent of a(n)___ is to define boundaries and clarify the nature of the basic counseling relationship between the counselor and the client.

A. Supervision contract
B. Affirmative assent document
C. HIPAA document
D. Release of information form
E. None of the above

Answer 4

E. None of the Above (Informed Consent)

Question 5

Written consent forms should NOT include:

A. A discussion of how a managed care system will affect the treatment, if applicable
B. A detailed description of what will occur in therapy
C. A statement describing the counselor’s theoretical orientation
D. Clarification pertaining to fees and procedures for filing for insurance reimbursement.
E. All of the above should be included.

Answer 5

B; keyword: detailed. You do not know what is going to go on in therapy – a detailed description cannot occur

Question 6

True or False: Therapists have an ethical duty to warn regarding suicidal clients.

Answer 6

False; B.2.a. Serious and Foreseeable Harm and Legal Requirements - we have a duty to protect, not a duty to warn

Question 7

True or False: Clients can assert privilege to keep their psychotherapy records out of a legal custody battle even if their psychotherapist has reasonable cause to think their depression is so severe that they are at risk of suicide.

Answer 7

False; CA Evidence Code 1024 - privilege does not apply if there is a threat of harm to self (suicidality)

Question 8

True or False: Therapists have a legal duty to warn others (e.g., family members or other health care providers) regarding suicidal clients.

Answer 8

False; CA Civil Code 56.10[C]19 - not a duty to warn; it is a permitted disclosure

Question 9

What precedent was established in Bellah v. Greenson (1978)?

A. A therapist must break confidentiality to prevent a threatened suicide
B. A therapist must break confidentiality to prevent a threatened suicide of a minor
C. A therapist has a responsibility to take reasonable steps to prevent a threatened suicide
D. All of the above
E. None of the above

Answer 9

C. A therapist has a responsibility to take reasonable steps to prevent a threatened suicide.

Did NOT establish that therapists have a specific duty to breach confidentiality; hence, there is a therapeutic duty to PROTECT, but there is NOT a therapeutic duty to do something specific

Question 10

True or False: Griffin (2011) argues that no-suicide contracts are effective in preventing suicide and should be relied upon to meet the standard of care requirement.

Answer 10

False; these contracts are not a legal document, has no relation to actions & may create an illusion of safety for the therapist; safety plans are standard of care – it is a collaborative document

Question 11

A college student living far away from their family is seeing a therapist. The student tells the therapist that she has been having increasing thoughts of suicide. She feels hopeless, has no local social support system, and has a plan for how she would die, though she does not have the means to carry out the plan. The therapist should:

A. Continue regular treatment, as the client is talking openly about her struggles.
B. Consider the client a high risk for suicide and move toward hospitalization.
C. Consider the client a moderate risk for suicide and engage in safety planning.
D. Consider the client a low risk for suicide and develop a no-harm contract.

Answer 11

C. Consider the client a moderate risk for suicide and engage in safety planning.

The client does not pose the kind of imminent danger that would warrant hospitalization. However, her social isolation, hopelessness, and plan are enough that meaningful safety planning should be done. It may also be appropriate to increase the frequency of contact with the client.

Question 12

A client is suing a well-known local businesswoman after their cars collided in an intersection. The client is demanding that the businesswoman cover the client’s cost of therapy. The client says that the accident caused severe trauma. The businesswoman’s lawyer sends a letter to the therapist to demand treatment records. The therapist should:

A. Contact the client and determine how they wish to proceed.
B. Assert privilege on behalf of the client.
C. Immediately turn over the records, as an exception to privilege applies.
D. Ask to be named as a party in the lawsuit.

Answer 12

A. Contact the client and determine how they wish to proceed.

While an exception to privilege does likely apply here, that is a determination for a judge to make, not the therapist. The first thing the therapist should do is contact the client. The client may be happy to release the records. Only if the client does not want the records released, or if the therapist cannot reach the client, should the therapist assert privilege on the client’s behalf. This would then lead to a judge determining whether an exception to privilege applies.

Question 13

A couple has been living together in a romantic relationship for the past 7 years. They have a daughter together. They have never submitted any filings to the state regarding their relationship. How would the state classify their marital status?

A. Common-law married
B. Married
C. Domestic partners
D. Single

Answer 13

D. Single

As noted in the chapter, California has no legal recognition for common-law marriage. Domestic partnerships require filing with the state.

Question 14

A 10-year-old boy is brought to a therapist’s office by his 19-year-old sister, who lives in the family’s home. The sister explains that their parents are both migrant workers who do not speak English and that considering the nature of their work, they would not be able to attend therapy. However, the sister says, the parents support their son receiving therapy. Before engaging the 10-year-old in treatment, the therapist should:

A. Require the parents to attend once in person, to discuss consent for treatment.
B. Require the parents to complete a written consent form, first translating the form to the parents’ language if necessary.
C. Require the sister to complete a Caregiver’s Authorization Affidavit.
D. Require the boy to complete an intelligence test to determine his ability to participate in therapy.

Answer 14

C. Require the sister to complete a Caregiver’s Authorization Affidavit

This affidavit allows other family members in the same home to provide consent for treatment. While involving the parents would likely be helpful, it is not required when a caregiver is providing consent on behalf of the parents.

Question 15

An 80-year-old client tells her therapist that the client was physically abused last year when she was living in a nursing home in Florida. After she reported the abuse to her daughter, the daughter moved her to a nursing home in California, where she now lives. The therapist should:

A. Report the suspected abuse to an adult protective service agency in Florida.
B. Report the suspected abuse to an adult protective service agency in California.
C. Seek the client’s permission to contact the daughter, to determine whether the abuse was previously reported.
D. Maintain confidentiality, and empower the client to report the prior abuse in Florida.

Answer 15

D. Maintain confidentiality, and empower the client to report the prior abuse in Florida.

While the client would be considered an elder now, remember that the definition of an elder requires California residency. The client was not an elder under California’s definition when the abuse occurred. Of course, the client could still report this abuse to Florida authorities themselves, but the therapist here has no reporting mandate.

Question 16

A 12-year-old girl in family therapy with her mother and stepfather reports that she is being bullied in school by a classmate. The classmate is much bigger than the client and has been punching the client to take her money when the two are out of view of the teachers. The client reports this has happened several times, that she is sore and bruised, and that the client keeps trying unsuccessfully to just avoid the classmate. The therapist should:

A. Report suspected abuse to the local child protective agency.
B. Contact the school to see whether the abuse has been previously reported.
C. Empower the parents to report the abuse to the local child protective service agency.
D. Maintain confidentiality, and teach the client ways to overcome bullying.

Answer 16

A. Report suspected abuse to the local child protective service agency.

While the law makes an exception to the definition of abuse for a common schoolyard fight, in this situation the assault is not mutual. It is physical abuse. The therapist has an individual mandate to report, even if the abuse was previously reported at the school.

Question 17

An Associate therapist is arrested for public intoxication while walking home from a party. She is later convicted of the charge and pays a small fine. As it relates to the Associate’s registration with the BBS:

A. Because she was not in her professional role at the time, the conviction is not relevant.
B. She will need to appear before the BBS’s Convictions Committee but is unlikely to face formal disciplinary action.
C. Because the conviction is not related to the duties or functions of a therapist, she need not be concerned.
D. Her registration will likely be disciplined, and she will be assessed for substance abuse.

Answer 17

D. Her registration will likely be disciplined, and she will be assessed for substance abuse.

The BBS takes substance-related violations very seriously. These violations are presumed to relate to the duties and functions of a therapist.

Question 18

Two therapists are studying together for their Clinical Exam. One takes the exam a week before the other. She tells the other, “I passed! It wasn’t that bad. Makes sure you know your CBT interventions and you’ll be fine.” This would likely be considered:

A. Securing a license by fraud.
B. Subverting a licensing exam.
C. A breach of confidentiality.
D. Acceptable, since she did not divulge more specific information.

Answer 18

B. Subverting a licensing exam.

Any action that results in a less-than-level playing field for examinees is subversion of the test. In this case, the Associate’s colleague is being given information about test content that other people about to take the test do not have access to. That presents an unfair advantage.

Question 19

A client is preparing to move to a different part of California. She tells her therapist that she would like to continue working with the therapist via telehealth. Prior to beginning telehealth services, the therapist should:

A. Seek certification from a major telehealth organization.
B. Obtain informed consent from the client specific to telehealth.
C. Identify at least five hospitals within a 20-mile radius of where the client will be.
D. Obtain specific BBS endorsement for telehealth services.

Answer 19

B. Obtain informed consent from the client specific to telehealth.

This is a specific requirement under BBS telehealth regulations. The BBS does not offer telehealth endorsement or require that therapists be certified to conduct telehealth. While the therapist should document reasonable steps taken to identify crisis resources local to the client, there is no specific number or radius requirement.

Question 20

A client texts her therapist just before the scheduled start time of their in-person session. The client tells the therapist that she is stuck in traffic, and would like to begin their session by phone, understanding that she is on the way to the office and the session will be continued in person upon her arrival. The therapist has not had any prior phone sessions with this client. The therapist should:

A. Agree to the client’s request.
B. Inform the client that the session can begin when she arrives at the office.
C. Consider whether the client is appropriate for telehealth services.
D. Inform the client that transitioning to phone sessions requires a new client file.

Answer 20

C. Consider whether the client is appropriate for telehealth services.

While phone sessions do count as telehealth, they do not require a new client file to be created. It would be premature to agree to the client’s request without specific informed consent for telehealth and, before that, considering whether the client is even appropriate for telehealth. At the same time, there’s nothing in the question to suggest that the client is inappropriate for telehealth, or that the request must be refused for this or any other reason.