Final Mock I Flashcards
A 23-year-old combat veteran seeks therapy on the advice of his medical doctor. The man is wheelchair bound due to an injury sustained during direct combat in Iraq. He presents with a flat affect and avoids eye contact when responding to the therapist’s questions. He scores high on the MAST alcohol assessment. Which of the following best explains the client’s behaviors?
A. The client is continuing to experience the fight or flight response to trauma experienced during combat
B. The client sustained neurological damage during direct combat.
C. The client is incapable of reintegrating himself back into civilian society
D. The client is experiencing common stress reactions due to trauma
A 23-year-old combat veteran seeks therapy on the advice of his medical doctor. The man is wheelchair bound due to an injury sustained during direct combat in Iraq. He presents with a flat affect and avoids eye contact when responding to the therapist’s questions. He scores high on the MAST alcohol assessment. Which of the following best explains the client’s behaviors?
Score: 0 of 1
Incorrect
A. The client is continuing to experience the fight or flight response to trauma experienced during combat
B. The client sustained neurological damage during direct combat.
C. The client is incapable of reintegrating himself back into civilian society
Should have chosen
D. The client is experiencing common stress reactions due to trauma
Rationale: The correct answer to this question is D. Answer A is incorrect because it is inaccurately describing the symptoms presented. A fight or flight response would include signs of hyperarousal, which are not described in this vignette. Answer B is incorrect because the symptoms presented may or may not be linked to neurological damage; we do not have enough information to reach this conclusion nor are we medically trained to make this determination. Answer C is incorrect because nothing in the stem indicates he has not reintegrated into civilian society and, even if that was indicated, this statement disregards individual resiliency. Answer D is the only answer that is broad enough to explain the client’s symptom without jumping to conclusions. (Clinical Evaluation)
A therapist working in a community college meets with a client who shares he is a DACA Dreamer. The client reports increased anxiety about his future in the United States. He shares that his anxiety is interfering with family functioning, academics, and he is scared for what the future holds. How should the therapist clinically manage the situation in this case?
Score: 1 of 1
A. Ensure client has access to legal support or provide referral
Normalize client’s fears regarding future uncertainty
Utilize CBT to decrease symptoms of anxiety
B. Ensure client has access to legal support or provide referral
Normalize client’s fears regarding future uncertainty
Collaboratively develop goals for treatment
C. Validate client’s fears regarding possible deportation
Collaboratively develop goals for treatment
Identify immigrant advocacy groups for client to engage with
D. Validate client’s fears regarding possible deportation
Collaboratively develop goals for treatment
Provide psychoeducation regarding DACA legislation to help decrease client’s anxiety
A therapist working in a community college meets with a client who shares he is a DACA Dreamer. The client reports increased anxiety about his future in the United States. He shares that his anxiety is interfering with family functioning, academics, and he is scared for what the future holds. How should the therapist clinically manage the situation in this case?
Score: 1 of 1
A. Ensure client has access to legal support or provide referral
Normalize client’s fears regarding future uncertainty
Utilize CBT to decrease symptoms of anxiety
Correct
B. Ensure client has access to legal support or provide referral
Normalize client’s fears regarding future uncertainty
Collaboratively develop goals for treatment
Rationale: The correct answer is B. Each of the answers provided is a possibility; there is nothing blatantly wrong in any answer choice. The weakest answer is included in D, providing psychoeducation regarding DACA legislation. The vignette does not mention the client’s lack of knowledge regarding DACA, nor is it clear the therapist has the ability to provide psychoeducation in this area. Plus, since this is a legal issue, we would refer to a lawyer who is well-versed in the law and would be able to understand the particulars of the client’s case. Therefore answer D can be eliminated. Answer C does not include a referral for legal support, which would be a priority and can also be eliminated. Answer A and B include legal support and normalization of fears. However, answer B engages the client in developing goals for treatment, which is a stronger option than answer A, which includes utilizing CBT. The client and therapist may determine CBT is appropriate, but only after goals are collaboratively developed. (Treatment)
C. Validate client’s fears regarding possible deportation
Collaboratively develop goals for treatment
Identify immigrant advocacy groups for client to engage with
D. Validate client’s fears regarding possible deportation
Collaboratively develop goals for treatment
Provide psychoeducation regarding DACA legislation to help decrease client’s anxiety
A hospital-based therapist meets with an older woman whose husband is currently hospitalized due to early signs of dementia and breathing difficulties. The attending physician has recommended that he be moved into a long-term care facility once his breathing has stabilized; however, the woman adamantly states that she wants to take care of her husband at home and fears the level of care he would receive from strangers. How should the therapist proceed when considering their legal and ethical responsibilities?
Score: 1 of 1
A. Honor the client’s self-determination
Assist the client in identifying home health care options
Provide client with psychoeducation regarding dementia and caretaker responsibilities
B. Honor the client’s self-determination
Assist the client in identifying home health care options
Assist client in advocating for her husband’s needs with the attending physician
C. Encourage client to visit long-term care facilities
Provide psychoeducation regarding dementia and caretaker responsibilities
Determine if the client is able to provide adequate care based on husband’s diagnosis
D. Encourage client to visit long-term care facilities
Provide psychoeducation regarding dementia and caretaker responsibilities
Encourage client to discuss options with her children
A hospital-based therapist meets with an older woman whose husband is currently hospitalized due to early signs of dementia and breathing difficulties. The attending physician has recommended that he be moved into a long-term care facility once his breathing has stabilized; however, the woman adamantly states that she wants to take care of her husband at home and fears the level of care he would receive from strangers. How should the therapist proceed when considering their legal and ethical responsibilities?
Score: 1 of 1
Correct
A. Honor the client’s self-determination
Assist the client in identifying home health care options
Provide client with psychoeducation regarding dementia and caretaker responsibilities
Rationale: The best answer is A. The vignette explicitly states the woman wants to take care of her husband at home, so it would be going against her wishes by encouraging her to visit long-term care facilities. Therefore, answers C and D can both be eliminated. These answers are wrong for other reasons, too. It is not the role of the therapist to determine if the client is able to provide adequate care, as stated in answer C. Answer D is wrong because it encourages the client to discuss options with her children, who are not even mentioned in the vignette (plus, even if there were children, this pushes up against the client’s self-determination). Answer B includes the option of assisting the client in advocating for her husband’s needs with the attending physician, which is incorrect since there is nothing to indicate the husband’s needs are going unmet. This leaves us with the correct answer, A, which honors client’s self-determination, assists in identifying resources to achieve goal, and offers psychoeducation to assist the client in making an informed decision. (Ethics)
B. Honor the client’s self-determination
Assist the client in identifying home health care options
Assist client in advocating for her husband’s needs with the attending physician
C. Encourage client to visit long-term care facilities
Provide psychoeducation regarding dementia and caretaker responsibilities
Determine if the client is able to provide adequate care based on husband’s diagnosis
D. Encourage client to visit long-term care facilities
Provide psychoeducation regarding dementia and caretaker responsibilities
Encourage client to discuss options with her children
A therapist working in a hospital setting meets with a 19-year-old male with a diagnosis of schizophrenia. The client was brought in by his parents who were concerned with their son’s erratic behavior. During the intake session, the therapist realizes the client is actively hallucinating. Which of the following actions should the therapist take to manage this case?
A. Assess whether the client needs to be hospitalized
Refer client and family to NAMI for psychoeducation
Refer client to group therapy
B. Assess whether the client needs to be hospitalized
Refer client and family to NAMI for psychoeducation
Refer for family therapy
C. Refer client and family to NAMI for psychoeducation
Refer for family therapy
Initiate hospitalization
D. Refer client and family to NAMI for psychoeducation
Refer for family therapy
Refer client to group therapy
A therapist working in a hospital setting meets with a 19-year-old male with a diagnosis of schizophrenia. The client was brought in by his parents who were concerned with their son’s erratic behavior. During the intake session, the therapist realizes the client is actively hallucinating. Which of the following actions should the therapist take to manage this case?
Score: 1 of 1
A. Assess whether the client needs to be hospitalized
Refer client and family to NAMI for psychoeducation
Refer client to group therapy
Correct
B. Assess whether the client needs to be hospitalized
Refer client and family to NAMI for psychoeducation
Refer for family therapy
Rationale: The correct answer is B. The vignette states that the client is actively hallucinating, so the priority would be assessing whether or not hospitalization is required. This allows us to eliminate answers C and D which do not include this option. The referral to NAMI is appropriate, since the parents have a child who is struggling with a severe mental illness. NAMI would be a great resource, providing psychoeducation about mental illness and assisting the parents in identifying community support. Answer B is stronger than A because family therapy would be a stronger answer choice than referring for group therapy. The vignette clearly indicates the parents are actively involved in their child’s life and concerned by his behavior. Family therapy would provide an opportunity for them to process the client’s diagnosis and what it means for the client, his parents and their family system. (Crisis Management)
C. Refer client and family to NAMI for psychoeducation
Refer for family therapy
Initiate hospitalization
D. Refer client and family to NAMI for psychoeducation
Refer for family therapy
Refer client to group therapy
A 64-year-old African American woman initiates therapy with complaints of difficulty with sleep and adjusting to a recent diagnosis of Parkinson’s Disease. The client lives with her daughter and son-in-law, but reports feeling lonely since her husband passed away less than a year ago. She is fearful of how her disease will progress and scared that her daughter and son-in-law will start to resent her for being needy and helpless. Which of the following actions should the therapist take to assess this client?
Score: 1 of 1
A. Request release of information to speak with neurologist regarding diagnosis
Assess for compliance with medications
Identify client’s strengths and coping skills
B. Request release of information to speak with neurologist regarding diagnosis
Assess for compliance with medications
Gather family history including relationship with daughter and son-in-law
C. Complete a mental status exam to understand progression of Parkinson’s Disease
Assess for elder abuse due to stated concerns and increased risk with presence of neurological disease
Identify client’s strengths and coping skills
D. Complete a mental status exam to understand progression of Parkinson’s Disease
Assess for elder abuse due to stated concerns and increased risk with presence of neurological disease
Assess for compliance with medications
A 64-year-old African American woman initiates therapy with complaints of difficulty with sleep and adjusting to a recent diagnosis of Parkinson’s Disease. The client lives with her daughter and son-in-law, but reports feeling lonely since her husband passed away less than a year ago. She is fearful of how her disease will progress and scared that her daughter and son-in-law will start to resent her for being needy and helpless. Which of the following actions should the therapist take to assess this client?
Score: 1 of 1
Correct
A. Request release of information to speak with neurologist regarding diagnosis
Assess for compliance with medications
Identify client’s strengths and coping skills
Rationale: The correct answer is A. When comparing the first parts of answers A and B with C and D, speaking with the neurologist to understand the progression of Parkinson’s is stronger than completion of mental status exam. The neurologist would be able to provide a more complete picture for the therapist. Answers C and D also include assessment of elder abuse, which is incorrect since the client is not an elder or dependent. Answer A is stronger because we would prioritize assessing client’s personal strengths and coping skills before moving on to gathering family history. (Clinical Evaluation)
B. Request release of information to speak with neurologist regarding diagnosis
Assess for compliance with medications
Gather family history including relationship with daughter and son-in-law
C. Complete a mental status exam to understand progression of Parkinson’s Disease
Assess for elder abuse due to stated concerns and increased risk with presence of neurological disease
Identify client’s strengths and coping skills
D. Complete a mental status exam to understand progression of Parkinson’s Disease
Assess for elder abuse due to stated concerns and increased risk with presence of neurological disease
Assess for compliance with medications
A therapist has been in private practice for 10 years, working under his own license. The therapist is interested in developing his skills in Emotionally Focused Therapy (EFT) and has already attended several workshops. Which of the following actions should the therapist take to stay aligned with ethical guidelines?
Score: 1 of 1
A. Seek case consultation on a regular basis with an Emotionally Focused “expert” practitioner
Continually participate in EFT trainings and stay up-to-date on relevant literature Integrate EFT techniques with clients who will clearly benefit from modality
B. Seek case consultation on a regular basis with an Emotionally Focused “expert” practitioner
Continually participate in EFT trainings and stay up-to-date on relevant literature
Limit use of EFT in practice until adequate training and education is completed
C. Provide accurate information to clients regarding level of training and experience Integrate EFT techniques into clinical practice only when indicated for presenting problem
Develop clear understanding of contraindications to avoid causing harm
D. Provide accurate information to clients regarding level of training and experience Integrate EFT techniques into clinical practice only when indicated for presenting problem
Engage in ongoing consultation to ensure proper use of EFT techniques
A therapist has been in private practice for 10 years, working under his own license. The therapist is interested in developing his skills in Emotionally Focused Therapy (EFT) and has already attended several workshops. Which of the following actions should the therapist take to stay aligned with ethical guidelines?
Score: 1 of 1
A. Seek case consultation on a regular basis with an Emotionally Focused “expert” practitioner
Continually participate in EFT trainings and stay up-to-date on relevant literature Integrate EFT techniques with clients who will clearly benefit from modality
B. Seek case consultation on a regular basis with an Emotionally Focused “expert” practitioner
Continually participate in EFT trainings and stay up-to-date on relevant literature
Limit use of EFT in practice until adequate training and education is completed
C. Provide accurate information to clients regarding level of training and experience Integrate EFT techniques into clinical practice only when indicated for presenting problem
Develop clear understanding of contraindications to avoid causing harm
Correct
D. Provide accurate information to clients regarding level of training and experience Integrate EFT techniques into clinical practice only when indicated for presenting problem
Engage in ongoing consultation to ensure proper use of EFT techniques
Rationale: The strongest answer is D. It is critical for the therapist to inform the clients of their training and knowledge prior to initiating treatment. This disclosure allows the clients to make an informed decision about whether or not they want to enter into a therapeutic relationship with the provider. This answer is not included in answers A or B, which allows you to eliminate them. When comparing options C and D, engaging in ongoing consultation (in answer D) is a stronger option than understanding the contraindications (in answer C). Understanding the contraindications is redundant since the answer choice already addresses appropriateness of when to integrate EFT. (Ethics)
A therapist has a private practice that specializes in working with adolescents and trauma. The therapist has been working with Sasha, an 11-year-old girl, for two years. Sasha’s parents initiated individual therapy for her after she was molested by a family friend. The perpetrator was taken to trial, was found guilty of molestation and was sentenced to jail time. Sasha’s parents recently learned that the perpetrator is scheduled to be released and shared this news with the therapist. They ask the therapist not to share this information with Sasha because they are scared it will disrupt all of the progress she has made in therapy. Which of the following actions should the therapist take in this case?
Score: 0 of 1
A. Remind the parents that the daughter is your client and maintaining this secret would cause an unhealthy triangulation dynamic.
B. Discuss the pros and cons of sharing this information with the client and explore safety planning with parents following perpetrators release.
C. Normalize the parents’ concerns and assure them the information will not be shared with the client.
Incorrect
D. Explore parents’ concerns of sharing the information and discuss methods of disclosure to client as well as potential for regression.
A therapist has a private practice that specializes in working with adolescents and trauma. The therapist has been working with Sasha, an 11-year-old girl, for two years. Sasha’s parents initiated individual therapy for her after she was molested by a family friend. The perpetrator was taken to trial, was found guilty of molestation and was sentenced to jail time. Sasha’s parents recently learned that the perpetrator is scheduled to be released and shared this news with the therapist. They ask the therapist not to share this information with Sasha because they are scared it will disrupt all of the progress she has made in therapy. Which of the following actions should the therapist take in this case?
Score: 0 of 1
A. Remind the parents that the daughter is your client and maintaining this secret would cause an unhealthy triangulation dynamic.
Should have chosen
B. Discuss the pros and cons of sharing this information with the client and explore safety planning with parents following perpetrators release.
Rationale: The correct answer is B. Answer A and C can be eliminated because they are too rigid–it’s not clear if sharing the information with the client is or is not appropriate. Answer A removes any possibility of withholding the information, while answer C removes any possibility of sharing. Answer D assumes disclosure, while disregarding the parents’ stated concerns and desires. Answer B allows the therapist to process the pros and cons of disclosing the information, which would then inform how they proceed. In addition, answer B is very strong because it includes safety planning now that the perpetrator will be released from jail. (Treatment)
C. Normalize the parents’ concerns and assure them the information will not be shared with the client.
Incorrect
D. Explore parents’ concerns of sharing the information and discuss methods of disclosure to client as well as potential for regression.
A Marine Officer initiates therapy after returning from a yearlong tour of duty. He has a wife and 3-year-old child and resides in a predominantly civilian community. He is struggling with his return to civilian life and reports feelings of anger and resentment toward his family and friends. He shares that most of the time he feels like an outsider. The client tells the therapist his combat brothers recommended he seek therapy, but he has serious doubts that a civilian therapist would understand what he’s been through or be able to help him. Which of the following actions should the therapist take in this case?
Score: 1 of 1
A. Inform the client of therapist’s experience working with military personnel and provide referral for in vivo desensitization to address combat-related trauma
B. Conduct a comprehensive assessment and refer to the Veterans Association to receive a psychiatric evaluation
C. Conduct a comprehensive assessment and identify client’s goals of treatment
D. Inform the Marine of therapist’s experience working with military personnel and discuss expectations of treatment
=
A Marine Officer initiates therapy after returning from a yearlong tour of duty. He has a wife and 3-year-old child and resides in a predominantly civilian community. He is struggling with his return to civilian life and reports feelings of anger and resentment toward his family and friends. He shares that most of the time he feels like an outsider. The client tells the therapist his combat brothers recommended he seek therapy, but he has serious doubts that a civilian therapist would understand what he’s been through or be able to help him. Which of the following actions should the therapist take in this case?
Score: 1 of 1
A. Inform the client of therapist’s experience working with military personnel and provide referral for in vivo desensitization to address combat-related trauma
B. Conduct a comprehensive assessment and refer to the Veterans Association to receive a psychiatric evaluation
C. Conduct a comprehensive assessment and identify client’s goals of treatment
Correct
D. Inform the Marine of therapist’s experience working with military personnel and discuss expectations of treatment
Rationale: The correct answer is D. The first step in meeting with this client is to provide informed consent. The client is making it clear that he is struggling with civilian life and doesn’t trust that a “civilian therapist” would understand him or be able to help. Based on these comments in the vignette, it would be important for the therapist to disclose how much experience they have with military personnel. It could be the client would like to work with someone who also served or is very familiar with military culture and the therapist’s response would influence how the client wants to proceed. In addition, it would be important to identify what the client’s expectations are for therapy and if the therapist is able to assist in meeting those expectations. Answer A can be eliminated because it assumes the client has combat-related trauma, which is not mentioned in the vignette. Answer B can also be eliminated since the vignette makes no mention of the need for a psychiatric evaluation–all we know is the client is struggling to re-acclimate to civilian life and feels anger. Answer C is an appropriate action for the therapist to take, but only following informed consent. (Ethics)
A 50-year-old man is referred to therapy by his doctor. The client is a high school biology teacher who has been working in the field for over 20 years and has 10 years remaining before he can retire. The man tells the therapist his wife encouraged him to seek therapy because he comes home depressed most days, but does not feel he can leave his job or find a new career at his age. He reports difficulty sleeping through the night, often waking up and ruminating on his dread for the next workday. He believes he is depressed and that the symptoms worsen each day. The client’s insurance has approved ten sessions of individual therapy. Which of the following interventions would be appropriate in this case?
Score: 1 of 1
A. Refer client to a career counselor
Encourage client to pursue avocational activities to find fulfillment outside of work
Teach client mindfulness activities
B. Refer client to a career counselor
Encourage client to pursue avocational activities to find fulfillment outside of work
Challenge client’s assumptions about career opportunities and age
C. Teach client mindfulness activities
Encourage client to journal his thoughts and feelings
Refer client to a career counselor
D. Challenge client’s assumptions about career opportunities and age
Encourage client to journal his thoughts and feelings
Encourage client to focus on aspects of his career that he enjoys
A 50-year-old man is referred to therapy by his doctor. The client is a high school biology teacher who has been working in the field for over 20 years and has 10 years remaining before he can retire. The man tells the therapist his wife encouraged him to seek therapy because he comes home depressed most days, but does not feel he can leave his job or find a new career at his age. He reports difficulty sleeping through the night, often waking up and ruminating on his dread for the next workday. He believes he is depressed and that the symptoms worsen each day. The client’s insurance has approved ten sessions of individual therapy. Which of the following interventions would be appropriate in this case?
Score: 1 of 1
A. Refer client to a career counselor
Encourage client to pursue avocational activities to find fulfillment outside of work
Teach client mindfulness activities
B. Refer client to a career counselor
Encourage client to pursue avocational activities to find fulfillment outside of work
Challenge client’s assumptions about career opportunities and age
Correct
C. Teach client mindfulness activities
Encourage client to journal his thoughts and feelings
Refer client to a career counselor
Rationale: The correct answer is C. Answers A and B each include encouraging client to pursue avocational activities, which is incorrect since the vignette does not mention this as an issue. The client’s presenting complaint is his job, but we have no information regarding the presence of absence of avocational activities outside of work. In addition, answer B and answer D include challenging the client’s assumptions about career opportunities and age. It would not be appropriate for the therapist to challenge the client’s assumptions as this could be a practical consideration on the client’s part and a career counselor would be better suited to address the client’s beliefs on this issue. Therefore, D can also be eliminated. Answer C is strong all around. Teaching client mindfulness activities would help to address the ruminating that interferes with sleep. Journaling thoughts and feelings could help client understand potential cognitive distortions and gain greater insight into how his thoughts are affecting his feelings. Finally, a career counselor would be able to assist the client in identifying alternatives, if possible, or confirm client’s belief that it would be difficult to change jobs at this point in time. (Treatment)
D. Challenge client’s assumptions about career opportunities and age
Encourage client to journal his thoughts and feelings
Encourage client to focus on aspects of his career that he enjoys
A therapist is treating a 24-year-old woman who has a history of child physical and sexual abuse. The woman ran away from her family when she was 17-years-old and has been living on the streets and in single room occupancy hotels (SROs) for several years. She was recently diagnosed at a community mental health agency with Bipolar Disorder and though she was given medication to treat a psychotic episode, decided to cease the use of any prescription drugs. Which of the following scenarios would provide justification for the therapist to initiate hospitalization?
A. The client refused any medications and is showing signs of rapid and significant decompensation.
B. The client refuses to take the prescribed medication, but is continuing to utilize recreational drugs.
C. The client refuses to comply with the medication recommendation to address her diagnosis and potential psychosis.
D. The client continues to avoid use of medications and is showing signs of aggression toward the therapist.
A therapist is treating a 24-year-old woman who has a history of child physical and sexual abuse. The woman ran away from her family when she was 17-years-old and has been living on the streets and in single room occupancy hotels (SROs) for several years. She was recently diagnosed at a community mental health agency with Bipolar Disorder and though she was given medication to treat a psychotic episode, decided to cease the use of any prescription drugs. Which of the following scenarios would provide justification for the therapist to initiate hospitalization?
Score: 1 of 1
Correct
A. The client refused any medications and is showing signs of rapid and significant decompensation.
Rationale: The best answer for this question is A. Clinicians initiate involuntary hospitalization (5150s) if their client has a mental disorder that is causing them to be a danger to themselves or others and they are unwilling to engage in the appropriate type of care–in this case lack of medication compliance. Answer A states the client is showing signs of significant decompensation, meaning her mental health is deteriorating, and it notes it is occurring rapidly, which increases the level of risk. Since she is refusing to comply with the prescribed medication, and her mental health is significantly deteriorating, hospitalization would be indicated. Answer B is incorrect because it does not indicate the client’s mental health status, so it’s not clear hospitalization is required. The same holds true for answer C. The client’s diagnosis and lack of medication compliance is not, in and of itself, enough to warrant a 5150, we would need to see symptoms of concern present to move in this direction. Answer D could be tempting, but the term “aggressive” is too vague and could refer to the client being verbally aggressive, which would not be enough to initiate an involuntary hold. (Crisis Management)
B. The client refuses to take the prescribed medication, but is continuing to utilize recreational drugs.
C. The client refuses to comply with the medication recommendation to address her diagnosis and potential psychosis.
D. The client continues to avoid use of medications and is showing signs of aggression toward the therapist.
A father pursues therapy for himself and his 7-year-old son who is struggling with feelings of abandonment and separation anxiety since his mother abruptly left them five months earlier. The father reports that since the unexpected departure of his wife, his son has developed a slight physical tic that worsens when his anxiety is triggered. The son insists on sleeping in the same room as his father and cries whenever he and the father are apart. Which of the following interventions would a Gestalt therapist use in family therapy in the middle stage of treatment?
Score: 0 of 1
A. Ask the son and father to role play, with father taking on role of the mother thus allowing son to express his anger and sorrow toward her.
B. Encourage expression of feelings that arise in the room with therapist and provide space to verbally and physically express emotions.
C. Encourage the son to imagine his mother is in the room and to tell her how it feels to be abandoned and encourage father to imagine his wife is in the room and express how her actions affected their son.
D. Meet with father and son separately to allow each a safe space to fully feel and express their emotions.
A father pursues therapy for himself and his 7-year-old son who is struggling with feelings of abandonment and separation anxiety since his mother abruptly left them five months earlier. The father reports that since the unexpected departure of his wife, his son has developed a slight physical tic that worsens when his anxiety is triggered. The son insists on sleeping in the same room as his father and cries whenever he and the father are apart. Which of the following interventions would a Gestalt therapist use in family therapy in the middle stage of treatment?
Score: 0 of 1
A. Ask the son and father to role play, with father taking on role of the mother thus allowing son to express his anger and sorrow toward her.
Should have chosen
B. Encourage expression of feelings that arise in the room with therapist and provide space to verbally and physically express emotions.
Rationale: The correct answer is B. In this vignette, the treatment unit is the father and son, so it’s important to focus on interventions that engage both of them. The intervention in answer A is focused on supporting the son, but not the father. Answer C is similarly focuses to heavily on the son and his relationship with the mother. While answer C is very strongly linked to Gestalt therapy, it is not a good intervention based on the information shared in the vignette. It is always important to keep in mind that the client comes over the theory. Answer D is also incorrect because it is unnecessary to separate the treatment unit; there is nothing to indicate this is necessary. Answer B is the strongest answer since it engages the father and son equally and is appropriate for Gestalt since it is focused on the here and now. (Treatment)
Incorrect
C. Encourage the son to imagine his mother is in the room and to tell her how it feels to be abandoned and encourage father to imagine his wife is in the room and express how her actions affected their son.
D. Meet with father and son separately to allow each a safe space to fully feel and express their emotions.
A therapist receives a phone call from Michael, a 45-year-old male who shares he was recently terminated from his job and is planning to sue his former employer. On the advice of his lawyer, he requests to meet with the therapist to address the emotional consequences of his “wrongful termination.” He asks the therapist about past experience dealing with clients involved in lawsuits. The therapist has experience working in the legal system, testifying as both an expert, as well as percipient witness in multiple cases. Which of the following actions should the therapist take prior to working with this client?2
A. Clarify the client’s expectations of therapy and ensure the client has a clear understanding of the therapist’s experience with legal proceedings.
B. Clarify the client’s expectations of therapy and ensure appropriate boundaries are established.
C. Ensure appropriate boundaries are established and inform the client you will not participate in legal proceedings unless a court order is issued.
D. Determine if the client is experiencing emotional distress or interested in therapy for legal proceedings only.
A therapist receives a phone call from Michael, a 45-year-old male who shares he was recently terminated from his job and is planning to sue his former employer. On the advice of his lawyer, he requests to meet with the therapist to address the emotional consequences of his “wrongful termination.” He asks the therapist about past experience dealing with clients involved in lawsuits. The therapist has experience working in the legal system, testifying as both an expert, as well as percipient witness in multiple cases. Which of the following actions should the therapist take prior to working with this client?2
Score: 0 of 1
Incorrect
A. Clarify the client’s expectations of therapy and ensure the client has a clear understanding of the therapist’s experience with legal proceedings.
Should have chosen
B. Clarify the client’s expectations of therapy and ensure appropriate boundaries are established.
Rationale: The best answer to this question is B. This question is testing your knowledge of the potential ethical issues associated with a therapist taking on dual roles with a client. The most important things to address in a situation like this one are 1. ensuring your client’s expectations of therapy are accurate and 2. that boundaries are clearly established–what is your exact role with the client. Answer A addresses the client’s expectations, but does not address boundaries. Answer C ensures boundaries, but the second part of the sentence is incorrect. The therapist could be subpoenaed by a lawyer and this, too, would require them to participate in a legal proceeding. Their role, however, would not be as an expert witness, but as the client’s therapist. Answer D is too narrow in focus and would be more appropriately addressed through a broader exploration of client’s expectations. (Ethics)
C. Ensure appropriate boundaries are established and inform the client you will not participate in legal proceedings unless a court order is issued.
D. Determine if the client is experiencing emotional distress or interested in therapy for legal proceedings only.
A therapist meets with a new family that was referred by the rabbi at their temple. The younger child, a boy, was recently diagnosed with leukemia and the family is struggling to cope since learning of his diagnosis. His sister appears withdrawn and the parents report she is isolating herself from friends and her grades are dropping. The son is crying during the session and says he is sorry for disappointing his parents and sister. Which of the following actions would a Systems therapist take to complete a comprehensive assessment?
Score: 0 of 1
A. Consult with the son’s oncologist to understand the prognosis and its effect on the family
Assess the emotional range of each family member
Ask the parents and sister to respond to the son’s expressed guilt
B. Consult with the son’s oncologist to understand the prognosis and its effect on the family
Assess the emotional range of each family member
Explore what psychotherapy represents to each family member and what they hope to achieve
C. Observe verbal and nonverbal communication patterns to determine each family member’s communication stance
Ask the family to describe their relationship dynamics prior to and following the son’s diagnosis
Explore how the son feels about his diagnosis and ask the parents and sister to share how it affects them
D. Observe verbal and nonverbal communication patterns to determine each family member’s communication stance
Ask the family to describe their relationship dynamics prior to and following the son’s diagnosis
Normalize the family’s response to the son’s diagnosis and provide space for grieving
A therapist meets with a new family that was referred by the rabbi at their temple. The younger child, a boy, was recently diagnosed with leukemia and the family is struggling to cope since learning of his diagnosis. His sister appears withdrawn and the parents report she is isolating herself from friends and her grades are dropping. The son is crying during the session and says he is sorry for disappointing his parents and sister. Which of the following actions would a Systems therapist take to complete a comprehensive assessment?
Score: 0 of 1
A. Consult with the son’s oncologist to understand the prognosis and its effect on the family
Assess the emotional range of each family member
Ask the parents and sister to respond to the son’s expressed guilt
B. Consult with the son’s oncologist to understand the prognosis and its effect on the family
Assess the emotional range of each family member
Explore what psychotherapy represents to each family member and what they hope to achieve
Should have chosen
C. Observe verbal and nonverbal communication patterns to determine each family member’s communication stance
Ask the family to describe their relationship dynamics prior to and following the son’s diagnosis
Explore how the son feels about his diagnosis and ask the parents and sister to share how it affects them
Rationale: The correct answer is C. The question requires you find answers that are appropriate for Systems therapy and assist with information gathering to guide treatment. Since the vignette is pointing to family therapy, the priority will be on answers that focus on the entire treatment unit, thus ruling out answers A and B. If the son was our client, rather than the family, then is would make more sense to speak with the oncologist. Answer D can be ruled out because the third part of the answer is an intervention and would not assist the therapist in gathering information. (Clinical Evaluation)
Incorrect
D. Observe verbal and nonverbal communication patterns to determine each family member’s communication stance
Ask the family to describe their relationship dynamics prior to and following the son’s diagnosis
Normalize the family’s response to the son’s diagnosis and provide space for grieving
Acsa, a 51-year-old woman immigrated to the United States with her family from El Salvador in 1968. Her parents brought her as a baby and she now has three children who are all citizens. Acsa began therapy to address severe anxiety about her immigration status and fears of deportation. She received legal counsel and was able to obtain citizenship. Now that her citizenship is secure, Acsa reports her anxiety levels have diminished and she believes her goals for treatment have been achieved. What actions should the therapist take prior to terminating treatment?
Score: 0 of 1
A. Review the goals of treatment with Acsa and confirm all presenting issues have been adequately addressed.
B. Review the goals of treatment and determine if Acsa requires support with other mental health issues.
C. Ensure Acsa receives appropriate referrals for community resources assisting immigrants from El Salvador.
D. Review anxiety management strategies Acsa employed over the course of therapy and discuss possible re-engagement with therapy in future.
Acsa, a 51-year-old woman immigrated to the United States with her family from El Salvador in 1968. Her parents brought her as a baby and she now has three children who are all citizens. Acsa began therapy to address severe anxiety about her immigration status and fears of deportation. She received legal counsel and was able to obtain citizenship. Now that her citizenship is secure, Acsa reports her anxiety levels have diminished and she believes her goals for treatment have been achieved. What actions should the therapist take prior to terminating treatment?
Score: 0 of 1
Incorrect
A. Review the goals of treatment with Acsa and confirm all presenting issues have been adequately addressed.
B. Review the goals of treatment and determine if Acsa requires support with other mental health issues.
C. Ensure Acsa receives appropriate referrals for community resources assisting immigrants from El Salvador.
Should have chosen
D. Review anxiety management strategies Acsa employed over the course of therapy and discuss possible re-engagement with therapy in future.
Rationale: The best answer is D. Prior to terminating with clients, it’s important to review what was gained and learned over the course of treatment. Answer D provides an opportunity to review and consolidate therapeutic gains that the client can continue to use outside of treatment. Answer D also provides for the possibility of the client returning to therapy, if needed. Answer A is incorrect because the client feels her goals have been achieved; the therapist does not need to confirm whether or not this is true before agreeing to terminate. Answer B is incorrect because the client had clear goals for treatment and feels they have been achieved, it is not the role of the therapist to search for other possible mental health issues. Answer C can be ruled out because the community resources for immigrants would be more appropriate for someone who recently immigrated, not someone who has spent her entire life in this country. (Treatment)
A therapist meets with a long-term client who is being treated for an anxiety disorder. The client works in the security industry and arrives to his session after finishing his shift. The client presents as angry, speaking in a loud and agitated voice. The therapist notices the client has a gun in his holster and feels uncomfortable sitting with someone who is armed. How should the therapist manage the situation?
Score: 1 of 1
A. Immediately end session and reschedule while ensuring client understands he cannot bring any weapons to future sessions.
B. Discuss the effect of the weapon in the room, end session and request client refrain from bringing it to future sessions.
C. Remain in the room with client and process how the presence of his weapon affects the therapist and the therapeutic process.
D. Remain in the room with client and remind him of office policies to ensure future compliance of “No weapons” policy
A therapist meets with a long-term client who is being treated for an anxiety disorder. The client works in the security industry and arrives to his session after finishing his shift. The client presents as angry, speaking in a loud and agitated voice. The therapist notices the client has a gun in his holster and feels uncomfortable sitting with someone who is armed. How should the therapist manage the situation?
Score: 1 of 1
A. Immediately end session and reschedule while ensuring client understands he cannot bring any weapons to future sessions.
Correct
B. Discuss the effect of the weapon in the room, end session and request client refrain from bringing it to future sessions.
Rationale: The correct answer is B. There are several clues in the vignette that help guide you to the correct answer. First, this is a long-term client so rapport is already present, making it easier for the therapist to quickly discuss the issue and impose a boundary. Second, the client appears angry, making this a more serious and pressing concern. Third, the vignette explicitly notes the therapist is uncomfortable. These three factors make answer B the strongest option available. Answer A is too abrupt, the therapist would need to explain why they are ending the session. Answers C and D are incorrect because the therapist should not continue with the session if they feel uncomfortable with their client in possession of a weapon. (Crisis Management)
C. Remain in the room with client and process how the presence of his weapon affects the therapist and the therapeutic process.
D. Remain in the room with client and remind him of office policies to ensure future compliance of “No weapons” pol
A therapist working in juvenile hall meets with a 15-year-old male client. The client was sentenced to serve time following his involvement in a hate crime perpetrated against a 13-year-old transgender classmate. His file shows that he has a history of engaging in illegal activities and spent time in juvenile hall on two separate occasions. The client presents as hostile toward the therapist and demonstrates a lack of remorse for his most recent offense. Which of the following actions should the therapist take to develop a treatment plan?
Score: 1 of 1
A. Refer client for medical exam to rule out organic contributors to his behaviors
Consult with parents and criminal justice officials regarding client’s psychosocial history Explore stimuli that trigger client’s anger
B. Refer client for medical exam to rule out organic contributors to his behaviors
Consult with parents and criminal justice officials regarding client’s psychosocial history Explore client’s history as victim of child abuse
C. Explore client’s understanding of the reason he was sentenced to time in juvenile hall Gather history of client’s aggressive and illegal behaviors
Consult with parents and criminal justice officials regarding client’s psychosocial history
D. Explore client’s understanding of the reason he was sentenced to time in juvenile hall Gather history of client’s aggressive and illegal behaviors
Assess client for appropriateness of psychotropic medication
A therapist working in juvenile hall meets with a 15-year-old male client. The client was sentenced to serve time following his involvement in a hate crime perpetrated against a 13-year-old transgender classmate. His file shows that he has a history of engaging in illegal activities and spent time in juvenile hall on two separate occasions. The client presents as hostile toward the therapist and demonstrates a lack of remorse for his most recent offense. Which of the following actions should the therapist take to develop a treatment plan?
Score: 1 of 1
A. Refer client for medical exam to rule out organic contributors to his behaviors
Consult with parents and criminal justice officials regarding client’s psychosocial history Explore stimuli that trigger client’s anger
B. Refer client for medical exam to rule out organic contributors to his behaviors
Consult with parents and criminal justice officials regarding client’s psychosocial history Explore client’s history as victim of child abuse
Correct
C. Explore client’s understanding of the reason he was sentenced to time in juvenile hall Gather history of client’s aggressive and illegal behaviors
Consult with parents and criminal justice officials regarding client’s psychosocial history
Rationale: The correct answer is C. Answer A can be ruled out because it’s unclear the client’s behavior is a consequence of anger. Generally speaking, we can always rule out answers that assume a particular emotion that is not clearly stated in the vignette. Answer B is incorrect because it assumes the client was a victim of child abuse, which is not mentioned in the vignette. Answer D is also incorrect because the therapist cannot assess for appropriateness of psychotropic medication; this is outside our scope of practice. The strongest answer that allows the therapist to gather general information linked to the client’s presenting problems is C. (Treatment Planning)
D. Explore client’s understanding of the reason he was sentenced to time in juvenile hall Gather history of client’s aggressive and illegal behaviors
Assess client for appropriateness of psychotropic medication
Xander, a 44-year-old male, seeks treatment after his wife of 10 years files for divorce. Xander informs the therapist that his wife is divorcing him in large part because of his “demons.” The client shares that he had a difficult childhood and never learned how to cope with his problems, but instead turned to alcohol to try and numb himself. He explains that he has tried to stop drinking, but is never successful and typically drinks at least 4-5 drinks a night. When the client presents for his fourth session, he seems confused and agitated and his hands are visibly shaking. He tells the therapist that he stopped drinking completely a few days ago because he wants to prove to his wife he can get better. What actions should the therapist take in this case?
Score: 1 of 1
A. Refer the client to an inpatient treatment program
Encourage client to schedule an appointment with his primary care physician
Assess client’s trauma history
B. Refer the client to an inpatient treatment program
Assess client’s trauma history
Discuss possibility of couples counseling if client indicates wife is open to reconciliation
C. Refer client to a detox facility
Discuss possibility of couples counseling if client indicates wife is open to reconciliation
Encourage client to schedule an appointment with his primary care physician.
D. Refer client to a detox facility
Provide psychoeducation regarding risks of rapid alcohol withdrawal
Encourage client to receive immediate medical attention.
Xander, a 44-year-old male, seeks treatment after his wife of 10 years files for divorce. Xander informs the therapist that his wife is divorcing him in large part because of his “demons.” The client shares that he had a difficult childhood and never learned how to cope with his problems, but instead turned to alcohol to try and numb himself. He explains that he has tried to stop drinking, but is never successful and typically drinks at least 4-5 drinks a night. When the client presents for his fourth session, he seems confused and agitated and his hands are visibly shaking. He tells the therapist that he stopped drinking completely a few days ago because he wants to prove to his wife he can get better. What actions should the therapist take in this case?
Score: 1 of 1
A. Refer the client to an inpatient treatment program
Encourage client to schedule an appointment with his primary care physician
Assess client’s trauma history
B. Refer the client to an inpatient treatment program
Assess client’s trauma history
Discuss possibility of couples counseling if client indicates wife is open to reconciliation
C. Refer client to a detox facility
Discuss possibility of couples counseling if client indicates wife is open to reconciliation
Encourage client to schedule an appointment with his primary care physician.
Correct
D. Refer client to a detox facility
Provide psychoeducation regarding risks of rapid alcohol withdrawal
Encourage client to receive immediate medical attention.
Rationale: The best answer to this question is answer D. The client is exhibiting signs of acute alcohol withdrawal and requires immediate medical care due to the associated health risks. Answers A and B can easily be ruled out because they do not adequately address the client’s medical needs and the appropriate referral of a detox program. Answer C includes the referral to a detox facility, but is not as strong as answer D because it only encourages the client to schedule a medical appointment, but does not make clear the immediate need of medical attention. In addition, the client’s primary presenting issues are his inability to cope with possible trauma and his alcoholism. It is not clear couples counseling would be appropriate based on his more immediate needs. Answer D includes the detox referral and need for immediate medical attention. It would also make sense to explain the risks associated with rapid detox without medical support. (Crisis Management)
A therapist is providing individual therapy to a married man. The therapist has been billing for sessions through the client’s family insurance plan. The wife contacts the therapist to state she and her husband are getting divorced, and since the insurance is through her work, demands that the therapist discontinues billing her insurance for his sessions. How should the therapist manage the legal issues presented in this case?
Score: 0 of 1
A. Inform the wife that you will need the husband to make any changes to the insurance arrangement and continue established billing practices.
B. Inform the husband of the wife’s demand and identify alternative payment arrangements.
C. Contact the insurance company directly to determine if the husband continues to be covered by the family plan.
D. Inform the husband of the wife’s demand and refer him for legal counsel regarding his rights during divorce proceedings.
A therapist is providing individual therapy to a married man. The therapist has been billing for sessions through the client’s family insurance plan. The wife contacts the therapist to state she and her husband are getting divorced, and since the insurance is through her work, demands that the therapist discontinues billing her insurance for his sessions. How should the therapist manage the legal issues presented in this case?
Score: 0 of 1
A. Inform the wife that you will need the husband to make any changes to the insurance arrangement and continue established billing practices.
Incorrect
B. Inform the husband of the wife’s demand and identify alternative payment arrangements.
Should have chosen
C. Contact the insurance company directly to determine if the husband continues to be covered by the family plan.
Rationale: The correct answer is C. Answer A could be an appealing option, but we do not have a release to speak with the wife and it’s also unclear if the wife has any say in requesting changes to billing. Answer B can be eliminated because it is premature for the therapist and husband to identify alternative payments. Answer D is also premature and can be eliminated. The best starting point would be to contact the insurance company and determine if the husband’s insurance coverage continues as is or if it has changed. (Law)
D. Inform the husband of the wife’s demand and refer him for legal counsel regarding his rights during divorce proceedings.
A married same-sex couple seeks family therapy with their daughter, age 13 and son, age 11. The fathers are concerned because their daughter and son have been fighting a lot and all of the techniques that worked in the past to resolve conflict are failing them. The daughter states that her brother is always picking on her and making fun of her looks. The son says that his sister thinks that everything he does is wrong and tries to get him in trouble so she can receive all of the positive attention. Which of the following actions should the therapist take to build rapport with the entire family?
Score: 1 of 1
A. Ask the family members to stand up and have the children collaboratively create a sculpture of the family as they see it.
B. Normalize sibling conflict and explore what strategies used in the past would successfully resolve conflict between the brother and sister.
C. Teach the family how to utilize “I” statements when communicating to decrease any tendency toward defensiveness.
D. Demonstrate an understanding of the family’s presenting concerns through the use of reflective listening.
A married same-sex couple seeks family therapy with their daughter, age 13 and son, age 11. The fathers are concerned because their daughter and son have been fighting a lot and all of the techniques that worked in the past to resolve conflict are failing them. The daughter states that her brother is always picking on her and making fun of her looks. The son says that his sister thinks that everything he does is wrong and tries to get him in trouble so she can receive all of the positive attention. Which of the following actions should the therapist take to build rapport with the entire family?
Score: 1 of 1
A. Ask the family members to stand up and have the children collaboratively create a sculpture of the family as they see it.
B. Normalize sibling conflict and explore what strategies used in the past would successfully resolve conflict between the brother and sister.
C. Teach the family how to utilize “I” statements when communicating to decrease any tendency toward defensiveness.
Correct
D. Demonstrate an understanding of the family’s presenting concerns through the use of reflective listening.
Rationale: The correct answer is D. The question is specifically asking which actions the therapist should take to build rapport with the clients. The only answer that focuses on rapport building is answer D. Reflective listening is a useful tool that allows therapists to demonstrate empathy and let the family know the therapist hears what they are saying. Answers A, B and C are all appropriate actions to take with this family, but they do not assist in rapport building. (Treatment)
A therapist specializes in providing telemedicine to clients with physical limitations that inhibit their mobility and make it difficult to receive in-person therapy. The therapist receives a phone call from new potential client who informs the therapist that he spends 6 months of the year in California and 6 months out of state. How should the therapist respond to address the legal issues presented in this case?
Score: 0 of 1
A. Inform the client that it would be inappropriate to begin services due to an inability to provide continuity of care when client is out of state.
B. Explain laws regarding telemedicine outside of the therapist’s jurisdiction and assist client in locating therapists able to practice in both states.
C . Provide informed consent for telemedicine, and discuss the therapist’s inability to provide services when client is residing outside of California.
D. Provide informed consent for telemedicine and explore how therapy could benefit client considering therapist’s jurisdictional limitations.
A therapist specializes in providing telemedicine to clients with physical limitations that inhibit their mobility and make it difficult to receive in-person therapy. The therapist receives a phone call from new potential client who informs the therapist that he spends 6 months of the year in California and 6 months out of state. How should the therapist respond to address the legal issues presented in this case?
Score: 0 of 1
A. Inform the client that it would be inappropriate to begin services due to an inability to provide continuity of care when client is out of state.
Should have chosen
B. Explain laws regarding telemedicine outside of the therapist’s jurisdiction and assist client in locating therapists able to practice in both states.
Rationale: The correct answer to this question is B. The best option would be to explain the laws that govern telemedicine and assist the client in locating a professional who could provide continuity of care, meaning ongoing therapeutic services regardless of client’s location. Answer A can be eliminated because it is incomplete; we would need to do more than just tell the client it would be inappropriate to provide care. Answers C and D are incorrect because it would not be in the best interest of the client to begin working with a therapist who is only able to provide services for part of the year. (Law)
Incorrect
C. Provide informed consent for telemedicine, and discuss the therapist’s inability to provide services when client is residing outside of California.
D. Provide informed consent for telemedicine and explore how therapy could benefit client considering therapist’s jurisdictional limitations.
Question 142
Kyana is a 16-year-old African-American female who plays tennis for her high school. Her parents initiate therapy for her because she is experiencing severe performance anxiety. Kyana shares that she will no longer permit her family to watch her play, experiences severe heart palpitations during tennis matches, and has abruptly ended several games when she became too overwhelmed by her anxiety. How would a Cognitive Behavioral Therapist intervene in the middle stage of therapy?
Score: 0 of 1
A. Encourage the client to challenge the automatic thoughts that lead to her feelings of anxiety and continue practicing calming strategies.
C. Initiate exposure therapy by asking Kyana to vividly describe a tennis match in which she loses and is being judged by spectators.
D. Assign homework that requires Kyana to write out the story of her anxiety and act it out with the therapist.
Question 142
Kyana is a 16-year-old African-American female who plays tennis for her high school. Her parents initiate therapy for her because she is experiencing severe performance anxiety. Kyana shares that she will no longer permit her family to watch her play, experiences severe heart palpitations during tennis matches, and has abruptly ended several games when she became too overwhelmed by her anxiety. How would a Cognitive Behavioral Therapist intervene in the middle stage of therapy?
Score: 0 of 1
Should have chosen
A. Encourage the client to challenge the automatic thoughts that lead to her feelings of anxiety and continue practicing calming strategies.
Rationale: The correct answer is A. In the middle phase of treatment, the therapist would encourage the client to challenge her automatic thoughts while also utilizing calming strategies to deal with symptoms of anxiety. Answer B is more early stage treatment; by middle stage the client will already have learned the relaxation techniques. Answer C is possible, but the exposure therapy would not start with negative experiences, but rather gradually work to more difficult exposures. Initiating exposure therapy would start with something like, imagining oneself on the tennis court, rather than losing and being negatively judged. Answer D is not a CBT technique and can be eliminated. (Treatment)
Incorrect
B. Teach Kyana relaxation techniques that can be utilized during exposure to anxiety triggers.
C. Initiate exposure therapy by asking Kyana to vividly describe a tennis match in which she loses and is being judged by spectators.
D. Assign homework that requires Kyana to write out the story of her anxiety and act it out with the therapist.
A 65-year-old male client began meeting with a therapist following the death of his wife two years prior. The bulk of his time in treatment was spent processing his grief and figuring out a way to continue leading a meaningful life without his wife in it. During this process he embraced the use of spiritual practices. As part of the termination process, the client wants to make amends for mistakes he believes he made. The client arrives for a session presenting the therapist with a mug, apologizing for breaking one when he first began treatment. How should the therapist ethically manage the client’s gift?
Score: 0 of 1
A. Decline to accept the gift to avoid potential exploitation of client.
B. Accept the gift only if it is clinically appropriate.
C. Accept the gift and process its meaning with the client.
D. Decline to accept the gift and process the possible feelings of rejection with the client.
A 65-year-old male client began meeting with a therapist following the death of his wife two years prior. The bulk of his time in treatment was spent processing his grief and figuring out a way to continue leading a meaningful life without his wife in it. During this process he embraced the use of spiritual practices. As part of the termination process, the client wants to make amends for mistakes he believes he made. The client arrives for a session presenting the therapist with a mug, apologizing for breaking one when he first began treatment. How should the therapist ethically manage the client’s gift?
Score: 0 of 1
A. Decline to accept the gift to avoid potential exploitation of client.
Should have chosen
B. Accept the gift only if it is clinically appropriate.
Rationale: The correct answer is B. The gift of a mug is likely to be low cost, so it is unnecessary to decline the gift or consider potential exploitation of the client. This means answers A and D can be eliminated. Answer C would be a good option, but answer B is stronger because it takes into account the meaning of the gift and consideration of clinical implications. (Ethics)
Incorrect
C. Accept the gift and process its meaning with the client.
D. Decline to accept the gift and process the possible feelings of rejection with the client.
A 33-year-old pregnant woman confides in her therapist that she was recently severely beaten by her husband. She informs the therapist that her husband is only abusive when he is under the influence of alcohol and that he does not drink regularly. She insists that she does not want to leave her husband, as she has nowhere for her and her two-year-old daughter to go. What should the therapist do in this case?
Score: 0 of 1
A. Refer the client to an MD for a medical evaluation
B. Assist the client in developing a safety plan and refer her to a domestic violence group
C. Respect the client’s right to self-determination and her decision not to leave the situation
D. Inform the client of domestic violence shelters that could house her and her daughter
A 33-year-old pregnant woman confides in her therapist that she was recently severely beaten by her husband. She informs the therapist that her husband is only abusive when he is under the influence of alcohol and that he does not drink regularly. She insists that she does not want to leave her husband, as she has nowhere for her and her two-year-old daughter to go. What should the therapist do in this case?
Score: 0 of 1
Should have chosen
A. Refer the client to an MD for a medical evaluation
Rationale: The correct answer is A. The vignette indicates the woman is pregnant and has been physically assaulted, so it would be important to start by referring her for medical assistance. Answer D can be eliminated since it runs counter to the client’s right to self-determination. Answer C is possible, but medical attention would take precedence. Answer B is also a good answer, but the need for a medical evaluation would trump any other referrals or actions. (Crisis Management)
Incorrect
B. Assist the client in developing a safety plan and refer her to a domestic violence group
C. Respect the client’s right to self-determination and her decision not to leave the situation
D. Inform the client of domestic violence shelters that could house her and her daughter
A therapist works for the county’s crisis hotline. The therapist receives a call from a young woman who is hysterically crying, breathing rapidly, and having difficulty speaking. How should the therapist manage this situation?
A. Encourage the woman to take deep breaths
Maintain a calm voice
Ask close-ended questions
B. Encourage the woman to take deep breaths
Ask close-ended questions
Direct the woman to relocate to safer location
C. Encourage the woman to take deep breaths
Ask open-ended questions
Remain on phone until woman is able to speak
D. Encourage the woman to take deep breaths
Ask open-ended questions
Direct the woman to relocate to safer location
A therapist works for the county’s crisis hotline. The therapist receives a call from a young woman who is hysterically crying, breathing rapidly, and having difficulty speaking. How should the therapist manage this situation?
Score: 1 of 1
Correct
A. Encourage the woman to take deep breaths
Maintain a calm voice
Ask close-ended questions
Rationale: The correct answer to this question is A. In crisis situations, therapists should prioritize asking close-ended questions. This allows therapists to gather clear information quickly and keep a specific focus. Answers C and D include open-ended questions, which are not appropriate in crisis situations and these answers can therefore be ruled out. Answer A and B are both strong options. However, it’s not clear if the woman needs to be directed to a safer location; in fact, we do not know the reason for her call and would not direct her to do anything until we had more information. Answer A meets the client where she is at; the therapist attempts to calm the caller by encouraging deep breathing and maintaining a calm voice. In addition, through the use of close-ended questions, the therapist can quickly gather information to understand the nature of the crisis and provide appropriate guidance accordingly. (Crisis Management)
B. Encourage the woman to take deep breaths
Ask close-ended questions
Direct the woman to relocate to safer location
C. Encourage the woman to take deep breaths
Ask open-ended questions
Remain on phone until woman is able to speak
D. Encourage the woman to take deep breaths
Ask open-ended questions
Direct the woman to relocate to safer location
A 17-year-old emancipated minor initiates therapy. The client reports he has been struggling with depression since his girlfriend broke up with him. The client discloses that his girlfriend was substantially older than him and they met when she was a substitute teacher at his school. The client expresses feelings of betrayal and isn’t sure how to “get over the heartbreak.” Which of the following goals would a Client-Centered therapist include in the treatment plan?
Score: 1 of 1
A. Decrease client’s self-induced constraints to move toward self-actualization
Empathize with client by highlighting he was taken advantage of by a person in a position of power
Increase level of congruence both within self and relationship with others
D. Decrease client’s self-induced constraints to move toward self-actualization
Empathize with client by highlighting he was taken advantage of by a person in a position of power
Challenge client to reclaim locus of control
C. Facilitate client’s awareness regarding view of self and relationship to others
Increase client’s level of trust in therapist through provision of empathy and genuine positive regard
Challenge client to reclaim locus of control
D. Facilitate client’s awareness regarding view of self and relationship to others
Increase client’s level of trust in therapist through provision of empathy and genuine positive regard
Increase level of congruence both within self and relationship with others
A 17-year-old emancipated minor initiates therapy. The client reports he has been struggling with depression since his girlfriend broke up with him. The client discloses that his girlfriend was substantially older than him and they met when she was a substitute teacher at his school. The client expresses feelings of betrayal and isn’t sure how to “get over the heartbreak.” Which of the following goals would a Client-Centered therapist include in the treatment plan?
Score: 1 of 1
A. Decrease client’s self-induced constraints to move toward self-actualization
Empathize with client by highlighting he was taken advantage of by a person in a position of power
Increase level of congruence both within self and relationship with others
D. Decrease client’s self-induced constraints to move toward self-actualization
Empathize with client by highlighting he was taken advantage of by a person in a position of power
Challenge client to reclaim locus of control
C. Facilitate client’s awareness regarding view of self and relationship to others
Increase client’s level of trust in therapist through provision of empathy and genuine positive regard
Challenge client to reclaim locus of control
Correct
D. Facilitate client’s awareness regarding view of self and relationship to others
Increase client’s level of trust in therapist through provision of empathy and genuine positive regard
Increase level of congruence both within self and relationship with others
Rationale: The correct answer is D. Answers A and B can be ruled out for two reasons. First, the first part of the answer requires an assumption; the vignette does not indicate the client is experiencing self-induced constraints. Second, a therapist would not demonstrate empathy by highlighting the client was taken advantage of by his girlfriend, as this may or may not align with his perception of the situation. Answer C and D are both strong options, but D is better for a Client-Centered approach since answer C includes the therapist challenging the client. (Treatment Planning)
A therapist who specializes in mood disorders has been providing individual counseling to a client for several months to address issues of depression. The therapist and client determine the client also has a co-occurring substance use disorder that must be addressed. The client requests a referral for a substance abuse counselor to provide adjunctive services. What are the therapist’s ethical responsibilities in this case?
Score: 1 of 1
A. Honor client’s self-determination and provide referral since it is acceptable to see multiple therapists if there is no overlap in services.
B. Refer client to substance abuse counselor and temporarily terminate therapy to avoid duplication of services.
C. Decline request and assure client therapist can incorporate substance abuse into treatment and collaboratively re-formulate goals.
D. Refer client to therapist specializing in co-occurring disorders and terminate with client.
A therapist who specializes in mood disorders has been providing individual counseling to a client for several months to address issues of depression. The therapist and client determine the client also has a co-occurring substance use disorder that must be addressed. The client requests a referral for a substance abuse counselor to provide adjunctive services. What are the therapist’s ethical responsibilities in this case?
Score: 1 of 1
Correct
A. Honor client’s self-determination and provide referral since it is acceptable to see multiple therapists if there is no overlap in services.
Rationale: The best answer is A. The therapist is not required to terminate treatment with the client, which means answers B and D can be eliminated. Answer C is incorrect because it disregards the client’s right to make treatment decisions. Answer A is the best remaining choice. The vignette clearly states the therapist specializes in mood disorders, not substance abuse. Our code of ethics states that therapists generally refrain from treating a person who is receiving therapy from another psychotherapist. However, it also notes that this can be done if agreement exists between the two therapists. In addition, in this scenario, it is clear the therapists will not be duplicating services and will each have a separate focus for treatment. (Ethics)
B. Refer client to substance abuse counselor and temporarily terminate therapy to avoid duplication of services.
C. Decline request and assure client therapist can incorporate substance abuse into treatment and collaboratively re-formulate goals.
D. Refer client to therapist specializing in co-occurring disorders and terminate with client.
A therapist meets with a new client who was referred to therapy by his employer for displaying inappropriate behaviors at work. The client informs the therapist that he had been dating a coworker for several months and following a break up, she falsely accused him of sexual harassment. The man appears nervous and avoids eye contact with the therapist. Which of the following should the therapist initially assess when working with this client?
Score: 0 of 1
A. Complete a mental status exam to determine current cognitive functioning
B. Identify the role the referral source will play in client’s treatment.
C. Gather information regarding client’s history of intimate relationships and attitude toward women.
D. Assess client for danger to self or others.
A therapist meets with a new client who was referred to therapy by his employer for displaying inappropriate behaviors at work. The client informs the therapist that he had been dating a coworker for several months and following a break up, she falsely accused him of sexual harassment. The man appears nervous and avoids eye contact with the therapist. Which of the following should the therapist initially assess when working with this client?
Score: 0 of 1
A. Complete a mental status exam to determine current cognitive functioning
Should have chosen
B. Identify the role the referral source will play in client’s treatment.
Rationale: The correct answer is B. The vignette states the client was referred by his employer, so we would need to know if this means short-term therapy or if there are predetermined goals for treatment before proceeding. Once the role of the referral is known, the therapist could assess other areas of clinical concerns, such as answer A and C. Answer D does not appear to be necessary based on the information provided in the vignette, there are no hints of being a danger to self or others that requires further assessment. (Clinical evaluation)
C. Gather information regarding client’s history of intimate relationships and attitude toward women.
Incorrect
D. Assess client for danger to self or others.
A therapist is meeting with Max, a 15-year-old high school student who is brought to therapy by his mother. On the intake form completed by Max’s mother, she indicates that he enjoys spending time with his friends, plays football, is loyal and determined in his character. The form also states Max regularly receives negative reports by teachers and administrators about his behavior at school and is frequently arguing with his mom at home. When asked to further clarify her statements, Max’s mom notes that he often curses at her in the house, stays out at night despite being told that he has a curfew, and initiates physical altercations at school. When asked, Max says that his mom is intentionally mean and rude to him and that it is her fault that he disregards her “stupid” rules. What preliminary diagnosis should the therapist consider in this case?
Score: 1 of 1
A. V Code Parent-Child Relational Problem
Oppositional Defiant Disorder Depressive Disorder Unspecified
B. Oppositional Defiant Disorder
Conduct disorder V Code Parent-Child Relational Problem
C. V Code Parent-Child Relational Problem
Conduct disorder ADHD
D. V Code Relational Problem
Oppositional Defiant Disorder Conduct disorder
A therapist is meeting with Max, a 15-year-old high school student who is brought to therapy by his mother. On the intake form completed by Max’s mother, she indicates that he enjoys spending time with his friends, plays football, is loyal and determined in his character. The form also states Max regularly receives negative reports by teachers and administrators about his behavior at school and is frequently arguing with his mom at home. When asked to further clarify her statements, Max’s mom notes that he often curses at her in the house, stays out at night despite being told that he has a curfew, and initiates physical altercations at school. When asked, Max says that his mom is intentionally mean and rude to him and that it is her fault that he disregards her “stupid” rules. What preliminary diagnosis should the therapist consider in this case?
Score: 1 of 1
A. V Code Parent-Child Relational Problem
Oppositional Defiant Disorder Depressive Disorder Unspecified
Correct
B. Oppositional Defiant Disorder
Conduct disorder V Code Parent-Child Relational Problem
Rationale: The correct answer is B. This is a DSM Diagnosis question. Let us recap the symptoms we see in the stem. There is clearly a conflict between Max and his mom. He is also swearing, refusing to comply with rules, blaming others, and being aggressive. For this exam we will never have a full list of symptoms, thus we are to come up with various preliminary diagnoses that might fit with these symptoms. The diagnoses that best fit this case are ODD, Conduct and Parent-Child Relational problem V code (B). Answer (A) is out since there is no symptomatic support for Depressive Disorder Unspecified. Answer (C) is not applicable since there are not symptoms of ADHD indicated. And answer (D) is incorrect, since Parent-Child Relational Problem V code is more applicable here than Relational Problem V code. (Clinical Evaluation)
C. V Code Parent-Child Relational Problem
Conduct disorder ADHD
D. V Code Relational Problem
Oppositional Defiant Disorder Conduct disorder
A 28-year-old woman initiates individual therapy, reporting a history of sexual abuse and a family history of alcoholism. She informs the therapist that she abused alcohol when she was a teenager, but stopped using after she was raped while passed out at a party. The client reports that she was recently involved in a car accident that left her with chronic back pain and subsequently her doctor prescribed opiate medication to treat her pain. She admits that she did not disclose her history to the prescribing doctor because she did not believe he would provide the prescription with this knowledge. How should the therapist clinically manage this case?
Score: 0 of 1
A. Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction
Request release of information to disclose client history to prescribing physician
Refer client to 12-step program due to history of substance abuse
B. Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction
Request release of information to disclose client history to prescribing physician
Discuss alternative nonpharmacological pain management treatments
C. Develop a medication management plan in collaboration with prescribing physician Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction
Explore alternative nonpharmacological pain management treatments
D. Explore alternative nonpharmacological pain management treatments
Develop a medication management plan in collaboration with prescribing physician Refer client to 12-step program due to history of substance abuse
A 28-year-old woman initiates individual therapy, reporting a history of sexual abuse and a family history of alcoholism. She informs the therapist that she abused alcohol when she was a teenager, but stopped using after she was raped while passed out at a party. The client reports that she was recently involved in a car accident that left her with chronic back pain and subsequently her doctor prescribed opiate medication to treat her pain. She admits that she did not disclose her history to the prescribing doctor because she did not believe he would provide the prescription with this knowledge. How should the therapist clinically manage this case?
Score: 0 of 1
A. Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction
Request release of information to disclose client history to prescribing physician
Refer client to 12-step program due to history of substance abuse
B. Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction
Request release of information to disclose client history to prescribing physician
Discuss alternative nonpharmacological pain management treatments
Incorrect
C. Develop a medication management plan in collaboration with prescribing physician Provide psychoeducation regarding client’s genetic and environmental susceptibility to addiction
Explore alternative nonpharmacological pain management treatments
Should have chosen
D. Explore alternative nonpharmacological pain management treatments
Develop a medication management plan in collaboration with prescribing physician Refer client to 12-step program due to history of substance abuse
Rationale: The correct answer is D. Based on the information in the stem, the client already has an awareness of her genetic predisposition and environmental susceptibility to addiction–she notes the family history of alcoholism, her personal history of alcohol abuse, and purposefully withheld this information from her doctor. Therefore, answers A, B and C can all be eliminated because psychoeducation is unnecessary. This leaves us with answer D as the strongest option. The priority in this case would be to collaborate with the prescribing physician; failure to do so would be detrimental to the well-being of the client. It would also benefit this client to discuss and explore alternative nonpharmacological pain management treatments, such as meditation, biofeedback or hypnosis. Finally, given the client’s history and her knowledge of the risks associated with narcotics, a 12-step program would be a useful preventative resource. (Treatment)
A therapist working in a homeless shelter meets with a resident for individual therapy. The client presents to the session showing signs of current substance use, including unsteady gait, confusion, and slurred speech. The client denies current use when confronted by the therapist, though the therapist believes there is faint odor of alcohol in the room. How should the therapist proceed?
Score: 0 of 1
A. Continue with the provision of therapy since client has denied current use.
B. Refer client for a medical evaluation to rule out organic factors for behavior.
C. Terminate session and refer client to inpatient treatment.
D. Refer client for a toxicology examination and discuss concerns with shelter staff.
A therapist working in a homeless shelter meets with a resident for individual therapy. The client presents to the session showing signs of current substance use, including unsteady gait, confusion, and slurred speech. The client denies current use when confronted by the therapist, though the therapist believes there is faint odor of alcohol in the room. How should the therapist proceed?
Score: 0 of 1
A. Continue with the provision of therapy since client has denied current use.
Incorrect
B. Refer client for a medical evaluation to rule out organic factors for behavior.
C. Terminate session and refer client to inpatient treatment.
Should have chosen
D. Refer client for a toxicology examination and discuss concerns with shelter staff.
Rationale: The correct answer to this question is D. The client’s presentation, along with suspected odor of alcohol, points to substance use. Since the therapist works in a homeless shelter, it is important to engage all members of the support team. Answer D allows the therapist to properly assess for substance use and involve the shelter staff. Answer A is inappropriate since providing therapy when a client is under the influence is contraindicated. Answer B is incorrect since the vignette notes the scent of alcohol in the room. If this were not mentioned in the vignette, then a medical evaluation would be indicated. Answer C is a possible option, but it does not fully address the current concern that the client is under the influence of substances, nor does it engage other members of the support staff in a discussion regarding ways to address this situation. In addition, answer C includes a referral to inpatient treatment, which is too extreme at this time. (Crisis Management)
A 63-year-old woman seeks individual therapy to address low-grade depression and body image issues. The woman characterizes herself as extremely overweight and informs the therapist she was diagnosed with diabetes approximately 5 years prior. She shares a history of struggling with diets and a tendency to overeat, especially when her depressive symptoms are more severe. Which of the following adjunctive services should the therapist consider to augment the client’s treatment?
A. Nutritionist for dietary assistance
Overeaters Anonymous for group support
Medical doctor to monitor medications
B. Nutritionist for dietary assistance
Overeaters Anonymous for group support
Psychiatrist for a psychotropic medication evaluation.
C. Overeaters Anonymous for group support
Medical doctor to monitor medications
Emotional eating support group
D. Overeaters Anonymous for group support
Nutritionist for dietary assistance
Emotional eating support group.
A 63-year-old woman seeks individual therapy to address low-grade depression and body image issues. The woman characterizes herself as extremely overweight and informs the therapist she was diagnosed with diabetes approximately 5 years prior. She shares a history of struggling with diets and a tendency to overeat, especially when her depressive symptoms are more severe. Which of the following adjunctive services should the therapist consider to augment the client’s treatment?
Score: 1 of 1
Correct
A. Nutritionist for dietary assistance
Overeaters Anonymous for group support
Medical doctor to monitor medications
Rationale: The strongest answer to this question is A. This question is worded in a way that may have confused you at first. This question is just asking what additional services would also assist the client while they are in therapy. We would want to prioritize an answer that includes a medical referral due to the client’s diagnosis of diabetes, which could be affecting her depression. Therefore, answers B and D can be eliminated. Answer B includes a psychiatric referral, which may have sounded good, but we would want a more general medical attention before considering referral for psychotropic medications. Answer C is not as strong as A because it is redundant to provide two support groups while overlooking the importance of involving a nutritionist. Answer A covers all bases. The nutritionist can assist the client with developing a healthy diet to address weight and diabetes; Overeaters anonymous can assist the client with her stated tendency to overeat; and the medical doctor can assess for any organic issues affecting her mood and weight. (Clinical evaluation)
B. Nutritionist for dietary assistance
Overeaters Anonymous for group support
Psychiatrist for a psychotropic medication evaluation.
C. Overeaters Anonymous for group support
Medical doctor to monitor medications
Emotional eating support group
D. Overeaters Anonymous for group support
Nutritionist for dietary assistance
Emotional eating support group.
A therapist meets with a teenage boy who was mandated by his probation officer to attend individual therapy. The client is also participating in family therapy with his mother, father, and younger brother. He reports that he was placed on probation following an altercation with a classmate and being caught in possession of illicit drugs. The client was adopted into his current family as an infant. He expresses feelings of rejection by his biological parents and resentment toward his younger brother who is the biological child of his adopted parents. He feels his parents always find fault in his behavior, while his brother is treated like a prince. Which of the following goals would a Bowenian therapist include in the treatment plan for this case?
Score: 1 of 1
A. Increase healthy expression of feelings regarding adoption and engagement within adoptive family
Increase client’s compliance with probationary requirements
Decrease anxiety by resolving emotional cut-off with biological parents
B. Increase healthy expression of feelings regarding adoption and engagement within adoptive family
Increase client’s compliance with probationary requirements
Decrease levels of emotional reactivity between all family members
C. Assist the client in moving toward resolution with feelings of abandonment and rejection
Improve client’s ability to verbally express emotions with family and societal members
Improve communication skills between the client, parents, and his sibling
D. Assist client in moving toward resolution with feelings of abandonment and rejection
Improve client’s ability to verbally express emotions with family and societal members
Increase level of self-acceptance and ability to accept love within adoptive family
A therapist meets with a teenage boy who was mandated by his probation officer to attend individual therapy. The client is also participating in family therapy with his mother, father, and younger brother. He reports that he was placed on probation following an altercation with a classmate and being caught in possession of illicit drugs. The client was adopted into his current family as an infant. He expresses feelings of rejection by his biological parents and resentment toward his younger brother who is the biological child of his adopted parents. He feels his parents always find fault in his behavior, while his brother is treated like a prince. Which of the following goals would a Bowenian therapist include in the treatment plan for this case?
Score: 1 of 1
A. Increase healthy expression of feelings regarding adoption and engagement within adoptive family
Increase client’s compliance with probationary requirements
Decrease anxiety by resolving emotional cut-off with biological parents
B. Increase healthy expression of feelings regarding adoption and engagement within adoptive family
Increase client’s compliance with probationary requirements
Decrease levels of emotional reactivity between all family members
C. Assist the client in moving toward resolution with feelings of abandonment and rejection
Improve client’s ability to verbally express emotions with family and societal members
Improve communication skills between the client, parents, and his sibling
Correct
D. Assist client in moving toward resolution with feelings of abandonment and rejection
Improve client’s ability to verbally express emotions with family and societal members
Increase level of self-acceptance and ability to accept love within adoptive family
Rationale: The correct answer is D. Answer A is incorrect for two reasons: first, the question stem does not mention lack of compliance with probationary requirements and second, it’s not clear the client wants to or would be able to connect with his biological parents. Answer B is incorrect because of the part regarding probationary requirements and the third part of the answer would require the entire family as treatment unit. Answer C is incorrect because the third part, improve communication skills would also require the entire family as treatment unit. Answer D takes into account that the boy is client, while it also incorporates Bowen’s focus on the family system. (Treatment Planning)
A therapist has been working in an agency setting for 2 years prior to licensure. Now that the therapist is licensed, she intends to leave the agency and start her own private practice in the community. Several clients have expressed a desire to continue receiving treatment with therapist in her private practice. What actions should the therapist take in this case?
Score: 0 of 1
A. Inform agency of plan to transfer clients to private practice
Copy client’s medical records
Complete new informed consent with clients
B. Inform agency of plan to transfer clients to private practice
Close client files and create new client charts
Complete new informed consent with clients
C. Ensure clients understand all available treatment options
Determine if transfer of client to private practice is appropriate
Properly document future treatment plans for all clients
D. Ensure clients understand all available treatment options
Determine if transfer of clients to private practice is appropriate
Properly document termination of clients discontinuing treatment in agency charts
A therapist has been working in an agency setting for 2 years prior to licensure. Now that the therapist is licensed, she intends to leave the agency and start her own private practice in the community. Several clients have expressed a desire to continue receiving treatment with therapist in her private practice. What actions should the therapist take in this case?
Score: 0 of 1
A. Inform agency of plan to transfer clients to private practice
Copy client’s medical records
Complete new informed consent with clients
B. Inform agency of plan to transfer clients to private practice
Close client files and create new client charts
Complete new informed consent with clients
Should have chosen
C. Ensure clients understand all available treatment options
Determine if transfer of client to private practice is appropriate
Properly document future treatment plans for all clients
Rationale: The correct answer to this question is C. Answer A is incorrect because the therapist would not be permitted to copy medical records; they are the property of the agency. Answer B is okay, but informing the agency of plan to transfer is not as important as addressing client needs. Answers C and D each focus on the clients by ensuring they understand the option to continue receiving treatment at the agency, transfer with the therapist, or follow a different course of action. Each of these answers also determines the appropriateness of transferring the clients from the agency to private practice. Answer C is a slightly stronger option than D because we would need to properly document transfer of all clients, regardless of whether or not they continue to receive treatment in private practice. (Ethics)
Incorrect
D. Ensure clients understand all available treatment options
Determine if transfer of clients to private practice is appropriate
Properly document termination of clients discontinuing treatment in agency charts
A woman from Mexico meets with a therapist after learning that her husband, who is also from Mexico, had an affair while she and her 15-year-old daughter were spending time abroad visiting their family. The woman is a devout Catholic, and doesn’t know how to reconcile the husband’s behavior with her religious beliefs. She is also uncertain how she can stay with him now that he has broken trust and the sacred vow between them, but fears how her family and church community would react if she were to separate from her husband. Which of the following goals addressing human diversity should be included in the treatment plan?
Score: 1 of 1
A. Develop a stronger sense of self and begin to shift focus away from role as mother and wife.
B. Reduce the level of guilt and shame the woman is experiencing as a result of the external pressures from her Mexican family and church.
C. Decrease fears of diminished socioeconomic level frequently linked to marital separation and divorce.
D. Increase the client’s understanding of how her Mexican heritage and religion influence her current situation.
A woman from Mexico meets with a therapist after learning that her husband, who is also from Mexico, had an affair while she and her 15-year-old daughter were spending time abroad visiting their family. The woman is a devout Catholic, and doesn’t know how to reconcile the husband’s behavior with her religious beliefs. She is also uncertain how she can stay with him now that he has broken trust and the sacred vow between them, but fears how her family and church community would react if she were to separate from her husband. Which of the following goals addressing human diversity should be included in the treatment plan?
Score: 1 of 1
A. Develop a stronger sense of self and begin to shift focus away from role as mother and wife.
B. Reduce the level of guilt and shame the woman is experiencing as a result of the external pressures from her Mexican family and church.
C. Decrease fears of diminished socioeconomic level frequently linked to marital separation and divorce.
Correct
D. Increase the client’s understanding of how her Mexican heritage and religion influence her current situation.
Rationale: The strongest answer for this question is D. The question is specifically asking for goals that incorporate human diversity, so you can quickly eliminate any answers that are not goals or do not address human diversity. With this in mind, we can quickly eliminate answer A. Answer B incorporates human diversity, but incorrectly states she is already experiencing external pressures; this is not accurate as she fears what the reaction would be from her family and church, but those pressures are not already present. Answer C is irrelevant based on the client’s stated fears; she does not express any concern regarding the effects of separation on socioeconomic levels. Answer D incorporates human diversity into the treatment goal and would allow the client an opportunity to expand on the themes specifically mentioned in the question stem. (Treatment Planning)
A therapist runs an open DUI (driving under the influence) group at a local community mental health agency. All of the clients in attendance are court-mandated to attend and all are first time offenders. The current group is comprised of four male and two female members, all of whom have attended for several weeks. During a session, the therapist observes that the men are dominating the group and at times exhibiting disrespectful behaviors toward the female members. During a discussion regarding triggers for drinking, a male member points at a female member and states, “It’s because of women like you that I drink!” Which of the following actions is most appropriate for the therapist to take in this case?
Score: 1 of 1
A. Confront the group member who made the inappropriate comment and encourage him to apologize to the female group members
B. Ask each group member to share their thoughts about the comment and how it made them feel
C. Encourage female group members to express their thoughts and feelings regarding the statement and explore their perception of group power structure
D. Revisit group rules and ensure all members of the group feel safe and supported
A therapist runs an open DUI (driving under the influence) group at a local community mental health agency. All of the clients in attendance are court-mandated to attend and all are first time offenders. The current group is comprised of four male and two female members, all of whom have attended for several weeks. During a session, the therapist observes that the men are dominating the group and at times exhibiting disrespectful behaviors toward the female members. During a discussion regarding triggers for drinking, a male member points at a female member and states, “It’s because of women like you that I drink!” Which of the following actions is most appropriate for the therapist to take in this case?
Score: 1 of 1
A. Confront the group member who made the inappropriate comment and encourage him to apologize to the female group members
Correct
B. Ask each group member to share their thoughts about the comment and how it made them feel
Rationale: The strongest answer to this question is B. More often than not, when you have a question regarding group therapy, the best answer will include engagement of the entire group. The exceptions to this general rule would include a group member who has a personal need that is unrelated to the group or if there are safety concerns. Answer A is incorrect because it would be better to empower group members to share how the incident affected them, rather than taking charge and forcing an apology. Answer C is incorrect because it only has the female members speaking up, excluding the other male clients from expressing their thoughts and feelings. Answer D is a decent answer, but B is more process-oriented and it addresses the situation more directly, making it the better option. Once B is completed, D could take place. (Treatment)
C. Encourage female group members to express their thoughts and feelings regarding the statement and explore their perception of group power structure
D. Revisit group rules and ensure all members of the group feel safe and supported
A 24-year-old woman from Nigeria meets with a therapist on the advice of a friend. The woman, who speaks limited English, shares that she arrived in the United States roughly four months earlier to join her fiance who is an American citizen. The woman has a K-1 visa and was required to marry her fiance within 90 days of arrival, but they did not fulfill the requirement so her visa is no longer valid. She explains that her family is Muslim and she met her fiance while he was visiting her country. Since arriving in the United States, she reports he has been physically abusive, but she cannot leave because her parents will not allow her back in their home. The client is visibly scared when speaking with the therapist about her situation and reveals recent injuries on her body. Which of the following actions should the therapist take in this situation?
Score: 0 of 1
Should have chosen
A. Provide information for a domestic violence shelter and encourage her to call while in the office
Provide referral for legal assistance regarding immigration status
Encourage the woman to seek medical attention
B. Provide information for a domestic violence shelter and encourage her to call while in the office
Encourage the woman to file a police report
Encourage the woman to seek medical attention
C. Encourage the woman to file a police report and obtain a restraining order
Develop a comprehensive safety plan including referral to a domestic violence shelter Provide a referral to a community medical center
D. Provide referral for legal assistance regarding immigration status
Provide psychoeducation regarding the cycle of violence
Provide referral to community medical center.
A 24-year-old woman from Nigeria meets with a therapist on the advice of a friend. The woman, who speaks limited English, shares that she arrived in the United States roughly four months earlier to join her fiance who is an American citizen. The woman has a K-1 visa and was required to marry her fiance within 90 days of arrival, but they did not fulfill the requirement so her visa is no longer valid. She explains that her family is Muslim and she met her fiance while he was visiting her country. Since arriving in the United States, she reports he has been physically abusive, but she cannot leave because her parents will not allow her back in their home. The client is visibly scared when speaking with the therapist about her situation and reveals recent injuries on her body. Which of the following actions should the therapist take in this situation?
Score: 0 of 1
Should have chosen
A. Provide information for a domestic violence shelter and encourage her to call while in the office
Provide referral for legal assistance regarding immigration status
Encourage the woman to seek medical attention
Rationale: The best answer to this question is A. The vignette presents you with multiple crisis issues at once; we have a woman who is in legal jeopardy due to an invalid visa and no home to return to if deported, as well as domestic violence that has resulted in physical harm. Ideally, we want to find an answer that addresses both of these issues. Answer B and C do not address the legal concerns presented in this case and can be eliminated. Answer D does not adequately address management of domestic violence, providing psychoeducation regarding the cycle of violence is an insufficient respond to what the client has described in the vignette. Answer A is the only option that addresses both the legal issues presented and the domestic violence. (Crisis Management)
B. Provide information for a domestic violence shelter and encourage her to call while in the office
Encourage the woman to file a police report
Encourage the woman to seek medical attention
Incorrect
C. Encourage the woman to file a police report and obtain a restraining order
Develop a comprehensive safety plan including referral to a domestic violence shelter Provide a referral to a community medical center
D. Provide referral for legal assistance regarding immigration status
Provide psychoeducation regarding the cycle of violence
Provide referral to community medical center.
The client, a 26-year-old Indian-American woman, has been meeting with a therapist for 6 months. The work has primarily focused on depression that is a byproduct of feeling caught between two cultures and not feeling a sense of belonging within either. The client is first generation American and refers to her parents as “traditional Indian parents with no tolerance for American culture.” Her parents would like her to settle down with an Indian man and have children. She is focused on her career and does not want to get married, nor does she care about the cultural background of men she dates. How would a Narrative therapist versus a Solution Focused therapist intervene in the early stages of treatment?
Score: 1 of 1
A. A Narrative therapist would help the client externalize the cultural pressures imposed on her by her parents
A Solution Focused therapist would explore how the client is able to fulfill her daily activities when coping with symptoms of depression.
B. A Narrative therapist would help the client externalize the cultural pressures imposed on her by her parents
A Solution Focused therapist would explore what the client’s life would look like if she were able to feel a sense of belonging.
C. A Narrative therapist would delve deeper into the client’s understanding of the depression and feeling caught between two cultures
A Solution Focused therapist would explore what the client’s life would look like if she were able to feel a sense of belonging.
D. A Narrative therapist would delve deeper into the client’s understanding of the depression and feeling caught between two cultures
A Solution Focused therapist would explore how the client is able to fulfill her daily activities when coping with symptoms of depression.
The client, a 26-year-old Indian-American woman, has been meeting with a therapist for 6 months. The work has primarily focused on depression that is a byproduct of feeling caught between two cultures and not feeling a sense of belonging within either. The client is first generation American and refers to her parents as “traditional Indian parents with no tolerance for American culture.” Her parents would like her to settle down with an Indian man and have children. She is focused on her career and does not want to get married, nor does she care about the cultural background of men she dates. How would a Narrative therapist versus a Solution Focused therapist intervene in the early stages of treatment?
Score: 1 of 1
A. A Narrative therapist would help the client externalize the cultural pressures imposed on her by her parents
A Solution Focused therapist would explore how the client is able to fulfill her daily activities when coping with symptoms of depression.
B. A Narrative therapist would help the client externalize the cultural pressures imposed on her by her parents
A Solution Focused therapist would explore what the client’s life would look like if she were able to feel a sense of belonging.
Correct
C. A Narrative therapist would delve deeper into the client’s understanding of the depression and feeling caught between two cultures
A Solution Focused therapist would explore what the client’s life would look like if she were able to feel a sense of belonging.
Rationale: The best answer for this question is C. Both answers A and B incorrectly use the Narrative concept of externalization. The therapist would externalize the depression or the anxiety caused by cultural pressures, but not externalize the cultural pressures themselves (they are already external to the client). Answers C and D include the same Narrative part, so we just need to focus on which Solution Focused answer is stronger. The question is not only asking about theory, but it is also focused on early stages of treatment. Answer C is stronger because the intervention linked to Solution Focused therapy is referring to the miracle question, something that is done in the earlier stages of treatment. It is also directly linking to the client’s stated concern. The second part of answer D is okay for Solution Focused and beginning stage, but there is nothing in the vignette that points to completion of daily activities being an issue. (Treatment)
D. A Narrative therapist would delve deeper into the client’s understanding of the depression and feeling caught between two cultures
A Solution Focused therapist would explore how the client is able to fulfill her daily activities when coping with symptoms of depression.
A therapist has been meeting with a couple that is working on rebuilding trust following an incident of marital infidelity. The therapist notices she sometimes becomes angry with the wife when the wife seems dismissive of her husband’s expressed feelings of hurt. In one session, the therapist lashes out at the wife and expresses how painful it is to watch the wife brush aside her husband’s feelings when he is willing to be vulnerable. The wife is surprised by the therapist’s reaction, but begins to open up and the couple experiences a breakthrough in their treatment. Which of the following actions should the therapist take in this case?
Score: 1 of 1
A. Refer the couple to a different therapist due to the unethical treatment of clients and inability to manage countertransference.
B. Seek consultation because the therapist’s behavior is considered unethical.
C. Seek consultation to address countertransference and process experience with clients
D. Process the experience with clients and determine appropriateness of continuing treatment or referring clients to new therapist.
A therapist has been meeting with a couple that is working on rebuilding trust following an incident of marital infidelity. The therapist notices she sometimes becomes angry with the wife when the wife seems dismissive of her husband’s expressed feelings of hurt. In one session, the therapist lashes out at the wife and expresses how painful it is to watch the wife brush aside her husband’s feelings when he is willing to be vulnerable. The wife is surprised by the therapist’s reaction, but begins to open up and the couple experiences a breakthrough in their treatment. Which of the following actions should the therapist take in this case?
Score: 1 of 1
A. Refer the couple to a different therapist due to the unethical treatment of clients and inability to manage countertransference.
B. Seek consultation because the therapist’s behavior is considered unethical.
Correct
C. Seek consultation to address countertransference and process experience with clients
Rationale: The best answer to this question is C. The therapist should first seek consultation since the vignette makes it clear that the therapist’s personal feelings are interfering with treatment. In addition, it would be important to process the experience with the clients to understand how it affected them and work to repair the therapeutic alliance.. Answer B is not as strong as C, because it does not include processing the experience with clients. Answer D is a strong option, but it would be important to seek consultation before processing the experience with the clients, plus consultation would help the therapist determine whether or not it would be appropriate to continue providing treatment to the couple. (Treatment)
D. Process the experience with clients and determine appropriateness of continuing treatment or referring clients to new therapist.
A Chinese woman is referred to therapy by her doctor. The woman recently underwent a botched cosmetic procedure on her eyes and is devastated by the results. The woman describes herself as clinically depressed and is considering a lawsuit against the plastic surgeon for emotional damages. The woman is wearing sunglasses that she refuses to remove during the therapy session. What human diversity issues should the therapist consider in developing a treatment plan?
Score: 1 of 1
A. The influence and perception of beauty within the dominant culture of America.
B. The role and expectations of Chinese women to differentiate themselves from members of their cultural group.
C. The woman’s perception of beauty and the origins of these perceptions.
D. The perception of depression within Chinese culture and how this influences the woman’s behaviors.
A Chinese woman is referred to therapy by her doctor. The woman recently underwent a botched cosmetic procedure on her eyes and is devastated by the results. The woman describes herself as clinically depressed and is considering a lawsuit against the plastic surgeon for emotional damages. The woman is wearing sunglasses that she refuses to remove during the therapy session. What human diversity issues should the therapist consider in developing a treatment plan?
Score: 1 of 1
A. The influence and perception of beauty within the dominant culture of America.
B. The role and expectations of Chinese women to differentiate themselves from members of their cultural group.
Correct
C. The woman’s perception of beauty and the origins of these perceptions.
Rationale: The correct answer is C. When it comes to human diversity questions, you want to prioritize questions that are more exploratory and allow for variations in individual’s understanding of and experiences within their culture. Answer A is incorrect because it assumes the client’s decision to have surgery was in response to the dominant culture of America. We have no evidence of this. Answer B also makes an assumption about the role and expectations of Chinese women. Answer D is possible, but the focus is incorrect. The woman clearly states the depression and behavior is in response to her surgery. Answer C addresses human diversity by exploring the client’s perceptions of beauty and their origins. This answer is client-centered, avoids false assumptions, and is focused on the presenting issue. (Treatment Planning)
D. The perception of depression within Chinese culture and how this influences the woman’s behaviors.
A therapist meets with an 11-year-old girl and her adoptive mother for family therapy. The mother adopted the girl shortly after marrying the girl’s biological father. The girl’s biological mother died when she was an infant. The mother and daughter historically got along, but the girl now complains that her mother is too controlling and the mother believes the daughter is defiant. After several sessions, the father asks to see the records. How should the therapist handle the legal obligation in this case?
Score: 0 of 1
A. Deny the father’s request if the therapist believes it would be detrimental to the therapeutic relationship or the well-being of the minor.
B. Inform the father that he can receive a redacted version of the medical record that limits information shared to the daughter.
Incorrect
C. Inform the father that both the daughter and his wife must sign a release before sharing records.
Should have chosen
D. Inform the father that his wife would be required to sign a release before the therapist can share records.
A therapist meets with an 11-year-old girl and her adoptive mother for family therapy. The mother adopted the girl shortly after marrying the girl’s biological father. The girl’s biological mother died when she was an infant. The mother and daughter historically got along, but the girl now complains that her mother is too controlling and the mother believes the daughter is defiant. After several sessions, the father asks to see the records. How should the therapist handle the legal obligation in this case?
Score: 0 of 1
A. Deny the father’s request if the therapist believes it would be detrimental to the therapeutic relationship or the well-being of the minor.
B. Inform the father that he can receive a redacted version of the medical record that limits information shared to the daughter.
Incorrect
C. Inform the father that both the daughter and his wife must sign a release before sharing records.
Should have chosen
D. Inform the father that his wife would be required to sign a release before the therapist can share records.
Rationale: The correct answer is D. Answer A could be tempting because typically, the father would have a right to the records of his child, unless it would be detrimental to the well-being of the minor or therapeutic relationship. However, the client is not just the daughter, the wife is also part of the treatment unit. The therapist cannot just not deny the request if they believe it would be detrimental to the minor, they would also deny the request if the mother refuses to sign a release. Answer B is incorrect because information shared by the daughter still runs the risk of breaking the mother’s confidentiality, so a release from the mother would be needed even in this case. Answer C is incorrect because the daughter legally does not need to sign a release for the father to access records. The best answer is D; the wife would need to sign the release before the father can access records. (Law)
Gladys, a 78-year-old woman with a mild neurocognitive disorder and diminished mobility resides in an extended care facility. An attendant in the facility reports that Gladys became distraught when the attendant attempted to bath her and was found to have bruises all over her body. The therapist observes a poverty of speech, but client is lucid and coherent during the session. When asked about the bruises on her body, Gladys informs the therapist that her roommate had a visitor who sexually assaulted her when the roommate exited the room. How should the therapist respond to this disclosure when accounting for legal responsibilities?
Score: 1 of 1
A. Inform Gladys that you must report the alleged sexual abuse to the facilities executive staff for an investigation to be started.
B. Consider Gladys’ cognitive deficits prior to determining if reasonable suspicion exists warranting an elder abuse report.
C. Immediately report physical abuse to law enforcement, and follow with written report to law enforcement, ombudsman, and the facility’s licensing agency.
D. Immediately report physical abuse to Adult Protective Services since the perpetrator of violence does not reside or work in the extended care facility.
Gladys, a 78-year-old woman with a mild neurocognitive disorder and diminished mobility resides in an extended care facility. An attendant in the facility reports that Gladys became distraught when the attendant attempted to bath her and was found to have bruises all over her body. The therapist observes a poverty of speech, but client is lucid and coherent during the session. When asked about the bruises on her body, Gladys informs the therapist that her roommate had a visitor who sexually assaulted her when the roommate exited the room. How should the therapist respond to this disclosure when accounting for legal responsibilities?
Score: 1 of 1
A. Inform Gladys that you must report the alleged sexual abuse to the facilities executive staff for an investigation to be started.
B. Consider Gladys’ cognitive deficits prior to determining if reasonable suspicion exists warranting an elder abuse report.
Correct
C. Immediately report physical abuse to law enforcement, and follow with written report to law enforcement, ombudsman, and the facility’s licensing agency.
Rationale: The correct answer is C. The scenario provided above is testing your knowledge of when to report elder abuse and when we would hold off on reporting because of cognitive deficiencies. Therapists do not report elder abuse if all of the following are true: 1. Client has dementia, 2. Client makes verbal report and there are no witnesses to the abuse, 3. There is no supporting evidence of abuse, and 4. The therapist does not have reasonable suspicion of abuse. In this case, the client does have dementia and there were no witnesses to the abuse. However, there is supporting evidence of abuse (bruises on her body) that leads to reasonable suspicion of abuse, so we must report. Answers A and B can be ruled out since they do not include the legal mandate to report. Answer D can also be ruled out since we do not report to APS when the abuse takes place inside a long-term care facility. Answer C correctly addresses our legal requirements of reporting elder abuse to law enforcement, the ombudsman and the licensing agency. (Law)
D. Immediately report physical abuse to Adult Protective Services since the perpetrator of violence does not reside or work in the extended care facility.
A therapist works on a multidisciplinary team in an inpatient psychiatric hospital. The therapist’s client, a 24-year-old female, entered treatment after suffering her second psychotic episode in two years. After completing a thorough assessment the team unanimously arrived at the diagnosis of Schizophrenia. The goal of treatment is to provide evidence-based individual therapy to this client. Which of the following adjuncts should the therapist consider in order to augment individual treatment with this client?
Score: 1 of 1
A. Group therapy to aid in social skills once client is considered stabilized through medication management.
B. Group therapy to aid in social skills development for all clients with diagnoses of schizophrenia.
C. Family therapy to assist client in understanding how the diagnosis affects family functioning.
D. Family therapy to improve communication for client once client is considered stabilized through medication management.
A therapist works on a multidisciplinary team in an inpatient psychiatric hospital. The therapist’s client, a 24-year-old female, entered treatment after suffering her second psychotic episode in two years. After completing a thorough assessment the team unanimously arrived at the diagnosis of Schizophrenia. The goal of treatment is to provide evidence-based individual therapy to this client. Which of the following adjuncts should the therapist consider in order to augment individual treatment with this client?
Score: 1 of 1
Correct
A. Group therapy to aid in social skills once client is considered stabilized through medication management.
Rationale: The correct answer is A. Group treatment for social skills is generally considered a strong adjunctive service for clients diagnosed with schizophrenia. Answer B is incorrect, because stabilization is an important prerequisite for participating in group treatment. Answer C and D are possible, but the vignette does not mention the client’s family. We do not know her relationship with them; is her family involved or is she estranged from them. This lack of information allows us to rule out these two answer choices. (Treatment Planning)
B. Group therapy to aid in social skills development for all clients with diagnoses of schizophrenia.
C. Family therapy to assist client in understanding how the diagnosis affects family functioning.
D. Family therapy to improve communication for client once client is considered stabilized through medication management.
A couple that has been married for five years was referred to couples counseling by the wife’s individual therapist. The wife was raped shortly after the couple married and has since struggled with symptoms of PTSD. The wife’s symptoms have not significantly abated and while the husband has tried to be supportive, the couple acknowledges their relationship is suffering. After completing the informed consent process, which of the following actions should the therapist take?
Score: 0 of 1
A. Ask the husband and wife to each share their hopes for couples counseling
Explore how the husband responds to the wife’s symptoms of PTSD
Ask the couple to share what they view as strengths in their relationship
B. Ask the husband and wife to each share their hopes for couples counseling
Explore how the husband responds to the wife’s symptoms of PTSD
Inquire about how the wife’s PTSD manifests itself in the context of the couple’s relationship
C. Ask the couple to share what they view as strengths in their relationship
Explore techniques utilized by the couple in an effort to overcome relational stressors Normalize the couple’s struggle and acknowledge the difficulties that still lay ahead
D. Ask the couple to share what they view as strengths in their relationship
Explore techniques utilized by the couple in an effort to overcome relational stressors
Explore the couple’s desired and perceived levels of intimacy
A couple that has been married for five years was referred to couples counseling by the wife’s individual therapist. The wife was raped shortly after the couple married and has since struggled with symptoms of PTSD. The wife’s symptoms have not significantly abated and while the husband has tried to be supportive, the couple acknowledges their relationship is suffering. After completing the informed consent process, which of the following actions should the therapist take?
Score: 0 of 1
A. Ask the husband and wife to each share their hopes for couples counseling
Explore how the husband responds to the wife’s symptoms of PTSD
Ask the couple to share what they view as strengths in their relationship
Incorrect
B. Ask the husband and wife to each share their hopes for couples counseling
Explore how the husband responds to the wife’s symptoms of PTSD
Inquire about how the wife’s PTSD manifests itself in the context of the couple’s relationship
Should have chosen
C. Ask the couple to share what they view as strengths in their relationship
Explore techniques utilized by the couple in an effort to overcome relational stressors Normalize the couple’s struggle and acknowledge the difficulties that still lay ahead
Rationale: The correct answer is C. The client is the couple, so it’s important to prioritize actions that include both the husband and the wife. Answers A and B are not strong because include an exploration of the husband’s response to the wife’s symptoms. Answer C is stronger than D because you want to prioritize normalizing their presenting issue before exploring their desired and perceived levels of intimacy. Through normalization of their struggles and an acknowledgement that it could take time to heal, the therapist provides a safe space for the clients to hold different feelings regarding perceived and desired levels of intimacy. (Clinical Evaluation)
D. Ask the couple to share what they view as strengths in their relationship
Explore techniques utilized by the couple in an effort to overcome relational stressors
Explore the couple’s desired and perceived levels of intimacy
Meredith, a 29-year-old environmental consultant and her 34-year-old husband, Patrick, seek treatment for relational issues. Patrick is an environmental engineer who grew up with three siblings, a stay-at-home mother and an alcoholic father. He reports witnessing violence between his parents, particularly when his father was under the influence of alcohol. Meredith’s parents divorced when she was 6-years-old and the most vivid memories from her childhood have to do with being shuttled between each of her mother’s homes. Meredith and Patrick have been together for seven years. They have struggled with jealousy and poor communication from the very beginning of their relationship, and these issues escalated after they married. Meredith states, “Patrick got a promotion at work and he turned to drinking to cope with the added stress.” She adds, “He would then come home and find something to fight about. Those fights often turned physical with him throwing things at me.” Patrick responds, “But we have since sought help and are now ready to work on our relationship.” How can the therapist ensure they can safely provide couples counseling in this case?
A. Ask Patrick to name his healthier coping mechanisms for when he becomes stressed
Identify Meredith’s safety plan and assess her adherence to it
Make sure both partners agree on the level of violence that occurred
B. Verify lack of violent episodes over the last two months
Gauge frequency and severity of Patrick’s substance use
Identify Meredith’s safety plan and assess her adherence to it
C. Ask Patrick to name his healthier coping mechanisms for when he
becomes stressed
Gauge frequency and severity of Patrick’s substance use
Verify lack of violent episodes over the last two months
D.Identify Meredith’s safety plan and assess her adherence to it
Make sure both partners agree on the level of violence that occurred
Appraise the current level of stress in the relationship.
Meredith, a 29-year-old environmental consultant and her 34-year-old husband, Patrick, seek treatment for relational issues. Patrick is an environmental engineer who grew up with three siblings, a stay-at-home mother and an alcoholic father. He reports witnessing violence between his parents, particularly when his father was under the influence of alcohol. Meredith’s parents divorced when she was 6-years-old and the most vivid memories from her childhood have to do with being shuttled between each of her mother’s homes. Meredith and Patrick have been together for seven years. They have struggled with jealousy and poor communication from the very beginning of their relationship, and these issues escalated after they married. Meredith states, “Patrick got a promotion at work and he turned to drinking to cope with the added stress.” She adds, “He would then come home and find something to fight about. Those fights often turned physical with him throwing things at me.” Patrick responds, “But we have since sought help and are now ready to work on our relationship.” How can the therapist ensure they can safely provide couples counseling in this case?
Score: 0 of 1
Should have chosen
A. Ask Patrick to name his healthier coping mechanisms for when he becomes stressed
Identify Meredith’s safety plan and assess her adherence to it
Make sure both partners agree on the level of violence that occurred
Rationale: It is OK to engage in couples therapy with a couple who have had a history of violence if the following three things are present: 1. Both partners agree on the level of violence that occurred between them; 2. The perpetrator takes responsibility for their actions and has an arsenal of alternative coping mechanisms that they regularly practice; 3. The victim takes responsibility for their safety and sticks to the safety plan if needed. The answer that has all three of these elements present is A. Answer B is a strong answer; however, it is not enough for us to assess how often and how hard Patrick drinks. The scope of our assessment with him needs to be broader and needs to include information about his coping skills. Answer C is lacking an important element of making sure that Meredith has a safety plan and sticks to it. Answer D does not explicitly assess for the presence of violent episodes. We must have that information before we can safely move forward with couples counseling. (Clinical Evaluation)
Incorrect
B. Verify lack of violent episodes over the last two months
Gauge frequency and severity of Patrick’s substance use
Identify Meredith’s safety plan and assess her adherence to it
C. Ask Patrick to name his healthier coping mechanisms for when he
becomes stressed
Gauge frequency and severity of Patrick’s substance use
Verify lack of violent episodes over the last two months
D.Identify Meredith’s safety plan and assess her adherence to it
Make sure both partners agree on the level of violence that occurred
Appraise the current level of stress in the relationship.
A client is referred by his EAP for six sessions of individual therapy to address symptoms of anxiety that are interfering with his level of productivity at work. During the initial assessment, the client tells the therapist that the reason he is unproductive at work is not due to anxiety, but because he is dissatisfied with his career. The client informs the therapist that he believes career counseling might be most helpful at this time. How would a Solution Focused therapist work with this client?
Score: 1 of 1
A. Ask client to think of times when he found his career fulfilling and what was different during that time.
B. Ask the client to identify on a scale of 1 to 10 how dissatisfied he is with his career and what would need to change to increase his level of satisfaction.
C. Acknowledge the client’s desire to focus on career counseling and determine if there are times the client does enjoy his career.
D. Acknowledge the client’s interest in a new career and ask him to identify issues at his current job that could improve his level of satisfaction
A client is referred by his EAP for six sessions of individual therapy to address symptoms of anxiety that are interfering with his level of productivity at work. During the initial assessment, the client tells the therapist that the reason he is unproductive at work is not due to anxiety, but because he is dissatisfied with his career. The client informs the therapist that he believes career counseling might be most helpful at this time. How would a Solution Focused therapist work with this client?
Score: 1 of 1
A. Ask client to think of times when he found his career fulfilling and what was different during that time.
B. Ask the client to identify on a scale of 1 to 10 how dissatisfied he is with his career and what would need to change to increase his level of satisfaction.
Correct
C. Acknowledge the client’s desire to focus on career counseling and determine if there are times the client does enjoy his career.
Rationale: The correct answer is C. The only answer that addresses the client’s stated desire of career counseling is answer C. Answers A and B are okay for Solution Focused therapy, but they are not as strong as answer C since they disregard the client’s stated interest in career counseling. Answer D assumes the client would like a new career, but that is not clearly stated in the vignette, so it can also be ruled out. (Treatment Planning)
D. Acknowledge the client’s interest in a new career and ask him to identify issues at his current job that could improve his level of satisfaction
A 49-year-old male is referred by his physician to a therapist working in a substance abuse treatment facility. The client immediately expresses his reluctance in seeing a therapist and shares that his level of drinking is not a problem because it is completely on par with that of his peers. During a routine blood test, his doctor detected elevated levels of liver enzymes in his blood. The client said the only reason he was attending the session was because his partner was scared by the test results and was pushing him to see the therapist and to change his drinking patterns before his health issues became more severe. Which initial action would a therapist using Motivational Interviewing take in the case presented in this vignette?
A. Acknowledge the client’s reluctance in attending therapy and explore the doctor and partner’s concerns regarding the dangers of continued drinking on the client’s overall health.
B. Utilize reflective listening to demonstrate an empathic understanding of the client’s presenting concerns and collaboratively develop treatment goals.
C. Acknowledge the difficulty of attending therapy when it doesn’t feel necessary and reflect on the social aspect of drinking as well as recent blood test results.
D. Utilize reflective listening to demonstrate an understanding of the client’s problem and inquire about frequency and quantity of alcohol consumption.
A 49-year-old male is referred by his physician to a therapist working in a substance abuse treatment facility. The client immediately expresses his reluctance in seeing a therapist and shares that his level of drinking is not a problem because it is completely on par with that of his peers. During a routine blood test, his doctor detected elevated levels of liver enzymes in his blood. The client said the only reason he was attending the session was because his partner was scared by the test results and was pushing him to see the therapist and to change his drinking patterns before his health issues became more severe. Which initial action would a therapist using Motivational Interviewing take in the case presented in this vignette?
Score: 0 of 1
Incorrect
A. Acknowledge the client’s reluctance in attending therapy and explore the doctor and partner’s concerns regarding the dangers of continued drinking on the client’s overall health.
B. Utilize reflective listening to demonstrate an empathic understanding of the client’s presenting concerns and collaboratively develop treatment goals.
Should have chosen
C. Acknowledge the difficulty of attending therapy when it doesn’t feel necessary and reflect on the social aspect of drinking as well as recent blood test results.
Rationale: The best answer to this question is C. Motivational interviewing emphasizes providing empathy and rolling with the client’s resistance. Answer A is incorrect because it emphasizes the doctor and partner’s concerns, which would likely make the client feel defensive and increase his level of resistance. Answer B is a possibility, but it would be important to build rapport first and acknowledge the client’s resistance to change prior to developing treatment goals. Answer D is also a possibility, but if we put the answers in order, it would be important to start with the Motivational Interviewing tools of affirmations and reflective listening. Answer C is illustrating the use of affirmation, (highlighting it is difficult to meet with the therapist, but the client is still there) and the use of reflective listening. (Treatment)
D. Utilize reflective listening to demonstrate an understanding of the client’s problem and inquire about frequency and quantity of alcohol consumption.
A 69-year-old therapist has maintained a private practice for 25 years while also working part-time at a county agency as a wraparound clinician and supervisor. His private practice typically includes a caseload of ten to fourteen clients and he works 20 hours a week at the agency. Over the past five years, the therapist finds he is slowing down and unable to keep up with the competing demands of his private practice and agency work. He shares with colleagues that he is possibly experiencing burnout. He constantly feels tired, is struggling to keep up with his paperwork, and occasionally feels resentful during sessions with some of his clients. Which of the following actions should the therapist take to manage the ethical obligations presented in this case?
Score: 1 of 1
A. Immediately refer private practice clients to appropriate services to ensure continuity of care and prioritize the well-being of clients.
B. Discontinue providing direct client care in private practice and in county agency to avoid causing harm to clients and identify appropriate referrals to avoid client abandonment.
C. Consult with colleagues and seek personal psychotherapy to identify changes necessary to improve personal mental health and maintain efficacy as a clinician and supervisor.
D. Decrease number of private practice clients and number of hours working at agency to mitigate feelings of burnout
A 69-year-old therapist has maintained a private practice for 25 years while also working part-time at a county agency as a wraparound clinician and supervisor. His private practice typically includes a caseload of ten to fourteen clients and he works 20 hours a week at the agency. Over the past five years, the therapist finds he is slowing down and unable to keep up with the competing demands of his private practice and agency work. He shares with colleagues that he is possibly experiencing burnout. He constantly feels tired, is struggling to keep up with his paperwork, and occasionally feels resentful during sessions with some of his clients. Which of the following actions should the therapist take to manage the ethical obligations presented in this case?
Score: 1 of 1
A. Immediately refer private practice clients to appropriate services to ensure continuity of care and prioritize the well-being of clients.
B. Discontinue providing direct client care in private practice and in county agency to avoid causing harm to clients and identify appropriate referrals to avoid client abandonment.
Correct
C. Consult with colleagues and seek personal psychotherapy to identify changes necessary to improve personal mental health and maintain efficacy as a clinician and supervisor.
Rationale: The correct answer is C. The best place to start would be to consult with colleagues and seek personal therapy. The therapist has identified clear concerns that are affecting his ability to provide adequate services to his clients, so he must act. It’s unclear what actions would be best for the therapist and his clients, so consulting with colleagues and processing his concerns with a therapist would help him sort this out. Once the therapist consults and seeks personal psychotherapy, he could choose to take the actions included in answer A, B, or D. (Ethics)
D. Decrease number of private practice clients and number of hours working at agency to mitigate feelings of burnou
A therapist is an administrator for an online mental health practitioner network. The therapist receives a request from a former client who is a social worker and would like to join the group. How should the therapist respond to the request?
Score: 0 of 1
A. Deny the request because it would create a conflict of interest
B. Deny the request because it would create a dual relationship
C. Accept the request if an appropriate amount of time has passed since termination
D. Accept the request and maintain healthy boundaries
A therapist is an administrator for an online mental health practitioner network. The therapist receives a request from a former client who is a social worker and would like to join the group. How should the therapist respond to the request?
Score: 0 of 1
Incorrect
A. Deny the request because it would create a conflict of interest
B. Deny the request because it would create a dual relationship
C. Accept the request if an appropriate amount of time has passed since termination
Should have chosen
D. Accept the request and maintain healthy boundaries
Rationale: The correct answer is D. The scenario described is considered an ethical dual relationship, as the code of ethics does not prohibit all dual relationships In fact some dual relationships can be beneficial for the client. The main thing the code of ethics cares about is that we discuss the boundaries with the client. It would be inappropriate and unnecessary to exclude this person from a professional network because they were a former client. The social worker has a right to join professional networks. Answers A and B can therefore be eliminated. Answer C is also wrong because this would be considered an ethical dual relationship, regardless of how much time has passed following termination. Answer D is the most appropriate option, the client has a right to join the network, but the therapist should still ensure healthy boundaries to avoid any conflicts or harm to former client. (Ethics)
A therapist participates in the Parent Teacher Association (PTA) at his youngest son’s school. A member of the PTA is an acupuncturist who specializes in prenatal care. The acupuncturist would like to refer clients struggling with anxiety to the therapist. What ethical obligations does the therapist have in this case?
Score: 1 of 1
A. Inform the acupuncturist that it would be unethical to accept referrals due to the potential conflict of interest.
B. Inform the acupuncturist that it would be unethical to accept referrals because it presents a dual relationship.
C. Accept the acupuncturist’s referrals since it is ethical, but ensure client confidentiality is maintained.
D. Accept the acupuncturists referrals since it is ethical and collaborate in services provided.
A therapist participates in the Parent Teacher Association (PTA) at his youngest son’s school. A member of the PTA is an acupuncturist who specializes in prenatal care. The acupuncturist would like to refer clients struggling with anxiety to the therapist. What ethical obligations does the therapist have in this case?
Score: 1 of 1
A. Inform the acupuncturist that it would be unethical to accept referrals due to the potential conflict of interest.
B. Inform the acupuncturist that it would be unethical to accept referrals because it presents a dual relationship.
Correct
C. Accept the acupuncturist’s referrals since it is ethical, but ensure client confidentiality is maintained.
Rationale: The correct answer is C. Answers A and B can be ruled out because accepting referrals is not unethical. In addition, the concepts of conflict of interest and dual relationship refer to the therapist/client relationship. They do not refer to relationships between therapist and other professionals. Answer D is not very strong since therapists are not required to collaborate with acupuncturists. Answer C is the strongest option because it correctly states the referrals would be ethical and addresses the importance of maintaining client confidentiality. (Ethics)
D. Accept the acupuncturists referrals since it is ethical and collaborate in services provided.
A therapist is conducting a comprehensive assessment with a new client. The client is an elderly woman who complains of sadness and feelings of loneliness. The therapist utilizes the mental status exam as part of the assessment. What is the benefit of using the mental status exam in this case?
Score: 1 of 1
A. The therapist will have a structured approach to observe and document the client’s current psychological functioning.
B. The therapist will be able to increase understanding of external factors affecting client’s current level of psychological functioning.
C. The mental status exam can assist the therapist in understanding the client’s current psychological functioning and history of mental health issues.
D. The mental status exam is helpful to differentiate depression from possible dementia in elderly clients.
A therapist is conducting a comprehensive assessment with a new client. The client is an elderly woman who complains of sadness and feelings of loneliness. The therapist utilizes the mental status exam as part of the assessment. What is the benefit of using the mental status exam in this case?
Score: 1 of 1
Correct
A. The therapist will have a structured approach to observe and document the client’s current psychological functioning.
Rationale: The correct answer is A. The purpose of the mental status exam (MSE) is to take a snapshot of the individual’s psychological functioning including their appearance, behavior, mental functioning, and general demeanor during the examination. Answer B is incorrect because the MSE does not ask about external stressors. Answer C is incorrect because the MSE focuses on present functioning, not the client’s history of mental health issues. Answer D is incorrect because it is too limited in scope. The MSE could be used to consider depression or dementia, but this is not its sole purpose. (Clinical Evaluation)
B. The therapist will be able to increase understanding of external factors affecting client’s current level of psychological functioning.
C. The mental status exam can assist the therapist in understanding the client’s current psychological functioning and history of mental health issues.
D. The mental status exam is helpful to differentiate depression from possible dementia in elderly clients.
A therapist meets with a 57-year-old married woman who initiates therapy to develop healthier coping skills. The woman has older parents who live close by, and while they are not dependent on her, she feels pressure to take care of them and fears what would happen if she stopped. Her husband has complained that she neglects him and their children. She shares that her parents live in a private home, but she thinks they need to move into an assisted living facility because her father has fallen several times and her mother recently started a small fire when she forgot to turn off the stove. How should the therapist proceed?
Score: 0 of 1
A. Assess current coping skills
Determine if an elder abuse report is required
Explore what balance would look like for the client
B. Inform the client an elder report is required and process
Assist client in identifying additional support for parents
Evaluate client’s ability to assert personal needs with husband and parents
C. Determine if an elder abuse report is required
Evaluate client’s ability to assert personal needs with husband and parents
Assist client in identifying additional support for parents
D. Inform the client an elder report is required and process
Assess current coping skills
Explore what balance would look like for the client
A therapist meets with a 57-year-old married woman who initiates therapy to develop healthier coping skills. The woman has older parents who live close by, and while they are not dependent on her, she feels pressure to take care of them and fears what would happen if she stopped. Her husband has complained that she neglects him and their children. She shares that her parents live in a private home, but she thinks they need to move into an assisted living facility because her father has fallen several times and her mother recently started a small fire when she forgot to turn off the stove. How should the therapist proceed?
Score: 0 of 1
Should have chosen
A. Assess current coping skills
Determine if an elder abuse report is required
Explore what balance would look like for the client
Rationale: The correct answer is A. Answers B and D can be ruled out because it is unclear that an elder abuse report is required. The stem is teasing at possible self-neglect, but the information shared does not meet the threshold for a mandated report. Answer A and C overlap with assessing for elder abuse report. However, answer A is stronger because it is more holistically approaching the client’s presenting concerns. Assessing coping skills, in answer A, would include the client’s ability to assert personal needs. In addition, exploring what balance would look like for client, also in answer A, is more appropriate than assisting client in identifying assisted living facilities for parents. This is a very narrow focus, it’s not clear the parents are open to moving into an assisted living facility, and the therapist should help clients identify supports for self, not others. Answer A is therefore the stronger option. (Clinical Evaluation)
B. Inform the client an elder report is required and process
Assist client in identifying additional support for parents
Evaluate client’s ability to assert personal needs with husband and parents
C. Determine if an elder abuse report is required
Evaluate client’s ability to assert personal needs with husband and parents
Assist client in identifying additional support for parents
Incorrect
D. Inform the client an elder report is required and process
Assess current coping skills
Explore what balance would look like for the client
A therapist conducts intake appointments at a prison. The prison superintendent requests intake records for the therapist’s new client. The superintendent is concerned the client might be a danger to other inmates. He has observed a marked shift in this inmate’s behaviors and believes a review of records would help him understand how to manage the situation. How should the therapist respond to the request?
Score: 1 of 1
A. Release the records to the superintendent as he is the holder of privilege in this case and there are safety concerns
B. Deny access to records and only release them in the event of a subpoena
C. Deny access to records and only release them if the client signs an authorization to release the information
D. Inform the superintendent that records are generally confidential and refuse to release them
A therapist conducts intake appointments at a prison. The prison superintendent requests intake records for the therapist’s new client. The superintendent is concerned the client might be a danger to other inmates. He has observed a marked shift in this inmate’s behaviors and believes a review of records would help him understand how to manage the situation. How should the therapist respond to the request?
Score: 1 of 1
A. Release the records to the superintendent as he is the holder of privilege in this case and there are safety concerns
B. Deny access to records and only release them in the event of a subpoena
Correct
C. Deny access to records and only release them if the client signs an authorization to release the information
Rationale: The correct answer is C. Answer A is incorrect because the client is the holder of privilege. This holds true even if the client is incarcerated. Answer B is too narrow in scope. We are also permitted to release records if a client signs a release. Answer D is again too narrow in scope. Answer C correctly indicates the therapist could share records with the prison superintendent if the client signs an authorization to release information. (Law)
D. Inform the superintendent that records are generally confidential and refuse to release them
A recently separated couple is referred to therapy by the mediator who is handling their divorce. The couple has two children, a 5-year-old and an 8-year-old. Since the separation, the 5-year-old has engaged in regressive behaviors, including nocturnal enuresis. The couple is on amicable terms and wants to develop a healthy co-parenting situation that minimizes stress on the children. What initial goals would a Systems therapist incorporate into the treatment plan?
Score: 0 of 1
A. Increase the family’s ability to develop new coalitions as a response to the parents’ separation.
B. Assist the family in developing new boundaries that allow for greater flexibility as the family adapts to new structures.
C. Strengthen the co-parenting subsystem and encourage the parents to re-establish and maintain clearly defined boundaries.
D. Assist the parents in creating greater structure for the children and refer the son for individual therapy.
A recently separated couple is referred to therapy by the mediator who is handling their divorce. The couple has two children, a 5-year-old and an 8-year-old. Since the separation, the 5-year-old has engaged in regressive behaviors, including nocturnal enuresis. The couple is on amicable terms and wants to develop a healthy co-parenting situation that minimizes stress on the children. What initial goals would a Systems therapist incorporate into the treatment plan?
Score: 0 of 1
A. Increase the family’s ability to develop new coalitions as a response to the parents’ separation.
Incorrect
B. Assist the family in developing new boundaries that allow for greater flexibility as the family adapts to new structures.
Should have chosen
C. Strengthen the co-parenting subsystem and encourage the parents to re-establish and maintain clearly defined boundaries.
Rationale: The correct answer is C. It’s always important to pay close attention to the treatment unit; in this case it is the couple that is the client, not the family. Answers A and B can therefore be eliminated, since they focus on the entire family. Answer D assists the parents, but it also includes a referral for the son, which is wrong for two reasons; one, we actually do not know the gender composition of the children and two, we do not need to provide referrals for someone who is not our client. Answer C is left as the strongest option available; it is appropriate for a Systems therapist and links back to the information provided in the vignette. (Treatment Planning)
D. Assist the parents in creating greater structure for the children and refer the son for individual therapy.
A 15-year-old boy and his family are referred to therapy by the boy’s school. The parents are distraught because they recently caught their son kissing another boy. The parents express strong disapproval of homosexuality and fear the consequences of their son’s immoral behaviors. They ask if the therapist is aware of reparative therapy and if she could help “fix” their son. Which of the following interventions would a Satir family therapist use in the beginning stage of treatment?
Score: 0 of 1
A. Validate parents concerns and provide psychoeducation regarding sexual exploration Inquire about family’s history with a particular focus on their religion
Provide the son with an opportunity to share his goals for therapy
B. Validate parents concerns and provide psychoeducation regarding sexual exploration Inquire about family’s history with a particular focus on their religion
Inform the family that reparative therapy is unethical and harmful
C. Create a safe holding environment that allows all family members an opportunity to be authentic
Provide the son with an opportunity to share his goals for therapy
Teach the family how to utilize “I” statements to avoid harmful communications
D. Create a safe holding environment that allows all family members an opportunity to be authentic
Provide the son with an opportunity to share his goals for therapy
Inquire about family’s history
A 15-year-old boy and his family are referred to therapy by the boy’s school. The parents are distraught because they recently caught their son kissing another boy. The parents express strong disapproval of homosexuality and fear the consequences of their son’s immoral behaviors. They ask if the therapist is aware of reparative therapy and if she could help “fix” their son. Which of the following interventions would a Satir family therapist use in the beginning stage of treatment?
Score: 0 of 1
A. Validate parents concerns and provide psychoeducation regarding sexual exploration Inquire about family’s history with a particular focus on their religion
Provide the son with an opportunity to share his goals for therapy
B. Validate parents concerns and provide psychoeducation regarding sexual exploration Inquire about family’s history with a particular focus on their religion
Inform the family that reparative therapy is unethical and harmful
Should have chosen
C. Create a safe holding environment that allows all family members an opportunity to be authentic
Provide the son with an opportunity to share his goals for therapy
Teach the family how to utilize “I” statements to avoid harmful communications
Rationale: The correct answer is C. Answers A and B can be ruled out because they include validation of parents concerns, which could be detrimental to the relationship with the son. Plus, based on the information in the vignette it is not clear if the child is engaging in sexual exploration or if he has already explored and established his sexual orientation. The final part in answer D is generic, whereas the final part of C is very specific to Satir therapy, thus making C the stronger answer. (Treatment)
Incorrect
D. Create a safe holding environment that allows all family members an opportunity to be authentic
Provide the son with an opportunity to share his goals for therapy
Inquire about family’s history
A therapist working in a community agency receives a call from a Child Protective Services investigator regarding the therapist’s 12-year-old female client. The client was brought to therapy by her parents, who consented to treatment, because they were concerned she was exhibiting signs of depression. The investigator informs the therapist that she received a child abuse report from a different agency regarding the therapist’s client and would like to gather additional information to help with the case. What actions should the therapist take to manage the legal obligations presented in this case?
Score: 1 of 1
A. Answer the investigator’s questions because as mandated reporters the therapist should comply with the CPS investigation.
B. Answer the investigator’s questions only without offering information beyond the CPS investigation.
C. Maintain the client’s confidentiality and inform the client of the request for information.
D. Maintain the client’s confidentiality and request a release of information from the client’s parents since they consented to treatment.
A therapist working in a community agency receives a call from a Child Protective Services investigator regarding the therapist’s 12-year-old female client. The client was brought to therapy by her parents, who consented to treatment, because they were concerned she was exhibiting signs of depression. The investigator informs the therapist that she received a child abuse report from a different agency regarding the therapist’s client and would like to gather additional information to help with the case. What actions should the therapist take to manage the legal obligations presented in this case?
Score: 1 of 1
A. Answer the investigator’s questions because as mandated reporters the therapist should comply with the CPS investigation.
B. Answer the investigator’s questions only without offering information beyond the CPS investigation.
Correct
C. Maintain the client’s confidentiality and inform the client of the request for information.
Rationale: The best answer for this question is C. Therapists are only permitted to break confidentiality when legally mandated or permitted to do so, or if the client provides written authorization. Answer A and B are incorrect because the information provided in the stem does not indicate the therapist has reasonable suspicion or knowledge of child abuse. Therefore the therapist does not have a legal mandate, nor do they have permission to break the client’s confidentiality. Now it is down to answers C and D. Answer D is incorrect because a minor who is 12 or older, regardless of who consents, has a right to confidentiality. We would not ask the client’s for permission to share information, but would discuss this request with the client directly, answer C. (Law)
D. Maintain the client’s confidentiality and request a release of information from the client’s parents since they consented to treatment.
A long-term client informs his therapist that he is starting a new job and will be moving out of state. The client wants to continue treatment via technology, but the therapist explains that the laws related to the practice of telemedicine make this request impossible. The client becomes extremely agitated and demands the therapist immediately provide him with his personal medical records. How should the therapist respond to the client’s request for records?
Score: 1 of 1
A. Explore the reason for client’s request
Inform client a written request for documentation is required
Inform client of fee for records in accordance with office policy
B. Explore the reason for client’s request
Inform client a written request for documentation is required
Discuss pros and cons of summary of treatment versus complete records
C. Determine if provision of records would be detrimental to client
Inform client of fee for records in accordance with office policy
Inform client of processing time for request
D. Determine if provision of records would be detrimental to client
Inform client of fee for records in accordance with office policy
Deny client’s request if therapist believes client’s emotional state is unstable
A long-term client informs his therapist that he is starting a new job and will be moving out of state. The client wants to continue treatment via technology, but the therapist explains that the laws related to the practice of telemedicine make this request impossible. The client becomes extremely agitated and demands the therapist immediately provide him with his personal medical records. How should the therapist respond to the client’s request for records?
Score: 1 of 1
A. Explore the reason for client’s request
Inform client a written request for documentation is required
Inform client of fee for records in accordance with office policy
B. Explore the reason for client’s request
Inform client a written request for documentation is required
Discuss pros and cons of summary of treatment versus complete records
Correct
C. Determine if provision of records would be detrimental to client
Inform client of fee for records in accordance with office policy
Inform client of processing time for request
Rationale: The correct answer is C. Answers A and B can each be eliminated because the client’s reason for the request is not as important as determining if access would be detrimental; the therapist must comply with the request regardless the reason. The final part of answer D is incorrect and allows you to rule out this option as well. A therapist is only permitted to deny a client’s request for records if they believe viewing or receiving the records would cause significant harm or be detrimental to the client. This may or may not be the case with a client whose emotional state is unstable. Answer C is the strongest option. The client must provide a written request for records, would be required to pay a fee for copies, and allow the therapist the legally permitted amount of time to process the request. (Law)
D. Determine if provision of records would be detrimental to client
Inform client of fee for records in accordance with office policy
Deny client’s request if therapist believes client’s emotional state is unstable
A 70-year-old man seeks therapy on the advice of his daughter. He is married, but has lived apart from his wife for nearly 10 years. He was diagnosed several months ago with lung cancer and the doctors believe his prognosis is good. However, he does not believe his medical team and is convinced they are “sugarcoating what they share,” because they think he is “too fragile to handle the truth.” Which of the following goals would a Narrative therapist establish for the middle stage of treatment?
Score: 1 of 1
A. Improve the client’s ability to externalize the effects of his cancer diagnosis on his health.
B. Provide client with the tools to develop an alternative story of the cancer and its effect on his ability to enjoy his life.
C. Help the client separate his diagnosis from who he is as a person and how he wants to live his life.
D. Increase his ability to integrate the role of cancer in his life and develop a new narrative that incorporates the disease.
A 70-year-old man seeks therapy on the advice of his daughter. He is married, but has lived apart from his wife for nearly 10 years. He was diagnosed several months ago with lung cancer and the doctors believe his prognosis is good. However, he does not believe his medical team and is convinced they are “sugarcoating what they share,” because they think he is “too fragile to handle the truth.” Which of the following goals would a Narrative therapist establish for the middle stage of treatment?
Score: 1 of 1
A. Improve the client’s ability to externalize the effects of his cancer diagnosis on his health.
B. Provide client with the tools to develop an alternative story of the cancer and its effect on his ability to enjoy his life.
Correct
C. Help the client separate his diagnosis from who he is as a person and how he wants to live his life.
Rationale: The strongest answer to this question is C. Once again, answer A is improperly using the Narrative concept of externalization. Although externalization is a middle stage goal, the incorrect use of it in A knocks that answer choice out. Answers B and D include appropriate goals for Narrative, but they would follow the goal of externalization that occurs in answer C. (Treatment Planning)
D. Increase his ability to integrate the role of cancer in his life and develop a new narrative that incorporates the disease.
A therapist has been working with a 34-year-old African American male for close to four years. Four and a half years ago, the client was arrested and treated very harshly while being detained. Even though his case was dismissed, the client began experiencing disturbing and persistent images of the way he was treated. He reported having frequent nightmares, feelings of intense fear, the need to remain hypervigilant, as well as difficulties concentrating. After four years of therapy the client reports feeling 90% better. His nightmares have dissipated, he is able to openly discuss the traumatic event without experiencing severe distress, and he no longer experiences intrusive event recollections. As the termination nears, which interventions should the therapist consider in order to help the client learn and implement strategies of PTSD relapse prevention?
Score: 1 of 1
A. Rehearse future circumstances in which temporary setbacks could occur
Instruct the client to regularly use coping strategies learned in therapy
Discuss the risks of relapse due to substance abuse
B. Aid the client in grasping the distinction between lapse and relapse
Rehearse future circumstances in which temporary setbacks could occur
Instruct the client to regularly use coping strategies learned in therapy
C. Aid the client in grasping the distinction between lapse and relapse
Instruct the client to regularly use coping strategies learned in therapy
Assign the client to keep a daily record of fearful self-talk
D. Rehearse future circumstances in which temporary setbacks could occur
Encourage the client to return for a periodic maintenance session
Teach the client ways to utilize self-dialogue in which he reinforces his accomplishments
A therapist has been working with a 34-year-old African American male for close to four years. Four and a half years ago, the client was arrested and treated very harshly while being detained. Even though his case was dismissed, the client began experiencing disturbing and persistent images of the way he was treated. He reported having frequent nightmares, feelings of intense fear, the need to remain hypervigilant, as well as difficulties concentrating. After four years of therapy the client reports feeling 90% better. His nightmares have dissipated, he is able to openly discuss the traumatic event without experiencing severe distress, and he no longer experiences intrusive event recollections. As the termination nears, which interventions should the therapist consider in order to help the client learn and implement strategies of PTSD relapse prevention?
Score: 1 of 1
A. Rehearse future circumstances in which temporary setbacks could occur
Instruct the client to regularly use coping strategies learned in therapy
Discuss the risks of relapse due to substance abuse
Correct
B. Aid the client in grasping the distinction between lapse and relapse
Rehearse future circumstances in which temporary setbacks could occur
Instruct the client to regularly use coping strategies learned in therapy
Rationale: The best answer here is B. It is the only answer that contains all late stage intervention techniques that aim at PTSD relapse prevention. Discussing with the client the difference between lapse and relapse is an important intervention to help the client know when and if he needs help in the future. Lapse is a term used to describe a temporary setback, while relapse is used to describe a return to a sustained pattern of thinking, feeling and behaving that is characteristic of PTSD. The last part of answer A has the therapist assessing the client for substance dependence and this should have been done in the initial stage of treatment. Answer C talks about assigning the client the task of maintaining a daily record, and is something that would have been initiated in the middle stage of treatment. Answer D also contains a middle stage intervention of teaching the client how to utilize positive self-dialogue. (Treatment)
C. Aid the client in grasping the distinction between lapse and relapse
Instruct the client to regularly use coping strategies learned in therapy
Assign the client to keep a daily record of fearful self-talk
D. Rehearse future circumstances in which temporary setbacks could occur
Encourage the client to return for a periodic maintenance session
Teach the client ways to utilize self-dialogue in which he reinforces his accomplishments
Alexandra, a US citizen and her husband Elias, a citizen of Nicaragua present for therapy. They met in Nicaragua 15 years earlier and Elias moved to the US to be with Alexandra. Elias has a green card, but has not applied for citizenship. They have two children, ages 3 and 7. They are seeking therapy because Elias was recently physically attacked in what was deemed a hate crime and Alexandra was harassed at a local park for speaking Spanish to her children. They report feeling on edge all of the time and scared for their family’s safety. They are considering moving to Nicaragua, but are uncertain if this would be best for their children. How would a therapist develop a complete clinical assessment in this case?
Score: 0 of 1
A. Observe how the couple interacts
Complete a PTSD screening for Alexandra and Elias
Identify the desired outcome of treatment
B. Complete a Beck Depression Inventory for Alexandra and Elias
Separate the couple to assess safety
Collaboratively develop a genogram of their family spanning back at least two generations
C. Observe how the couple interacts
Inquire about family and social supports in their community
Determine expectations of therapy
D. Complete a PTSD screening for Alexandra and Elias
Obtain information about cultural and religious backgrounds
Collaboratively develop a genogram of their family spanning back at least two generations
Alexandra, a US citizen and her husband Elias, a citizen of Nicaragua present for therapy. They met in Nicaragua 15 years earlier and Elias moved to the US to be with Alexandra. Elias has a green card, but has not applied for citizenship. They have two children, ages 3 and 7. They are seeking therapy because Elias was recently physically attacked in what was deemed a hate crime and Alexandra was harassed at a local park for speaking Spanish to her children. They report feeling on edge all of the time and scared for their family’s safety. They are considering moving to Nicaragua, but are uncertain if this would be best for their children. How would a therapist develop a complete clinical assessment in this case?
Score: 0 of 1
A. Observe how the couple interacts
Complete a PTSD screening for Alexandra and Elias
Identify the desired outcome of treatment
B. Complete a Beck Depression Inventory for Alexandra and Elias
Separate the couple to assess safety
Collaboratively develop a genogram of their family spanning back at least two generations
Incorrect
C. Observe how the couple interacts
Inquire about family and social supports in their community
Determine expectations of therapy
Should have chosen
D. Complete a PTSD screening for Alexandra and Elias
Obtain information about cultural and religious backgrounds
Collaboratively develop a genogram of their family spanning back at least two generations
Rationale: The correct answer to this question is D. The presenting issues relate to Elias being physically attacked, Alexandra being verbally attacked, and the ensuing anxiety and fear they are experiencing. We want to prioritize answers that include a PTSD screening since the symptoms and events causing them point in that direction. Answers B and C do not include the PTSD screening and can, therefore, be eliminated. Cultural issues are present in this stem; the vignette makes several references to culture and the couple reports they are being discriminated against because of their cultural backgrounds. Answer D is stronger because it addresses culture whereas answer A does not. In addition, A includes observation of how the couple interacts, which could be helpful, but is not as specific to the vignette as culture. (Clinical Evaluation)
A therapist meets with a 43-year-old Armenian-American male client who was just released from the hospital following a 72-hour involuntary hold. The client explains his parents called the police on him because his behavior was scaring them. He acknowledges that he had been binge drinking for several days after being fired from his job and was told by the attending psychiatrist that he had experienced alcohol-induced psychosis. He shares that he moved into his parents’ home because he cannot afford his own place now that he is divorced and has to pay child support. He is scared because he does not think he will find a job now that he’s been hospitalized and tells the therapist, “My ex-wife has destroyed my life. She won’t let me see my children but takes all of my money. It is her fault I am in this situation and I can’t wait for her to experience pain and suffering like she has caused me.” Which of the following issues presented in the vignette requires immediate assessment?
A. Current and prior level of substance use
Access to psychiatric resources
Level of risk client presents to self and family
B. Current and prior level of substance use
Current medication regimen and level of compliance
Level of risk client presents to self
C. Current medication regimen and level of compliance
Level of risk client presents to self
Access to employment resources
D. Level of risk client presents to self and family
Current level of substance use
Access to employment resources
A therapist meets with a 43-year-old Armenian-American male client who was just released from the hospital following a 72-hour involuntary hold. The client explains his parents called the police on him because his behavior was scaring them. He acknowledges that he had been binge drinking for several days after being fired from his job and was told by the attending psychiatrist that he had experienced alcohol-induced psychosis. He shares that he moved into his parents’ home because he cannot afford his own place now that he is divorced and has to pay child support. He is scared because he does not think he will find a job now that he’s been hospitalized and tells the therapist, “My ex-wife has destroyed my life. She won’t let me see my children but takes all of my money. It is her fault I am in this situation and I can’t wait for her to experience pain and suffering like she has caused me.” Which of the following issues presented in the vignette requires immediate assessment?
Score: 1 of 1
Correct
A. Current and prior level of substance use
Access to psychiatric resources
Level of risk client presents to self and family
Rationale: The best answer is A. There are several issues in this vignette that require immediate attention. The client’s statement, “My ex-wife has destroyed my life. She won’t let me see my children but takes all of my money. It is her fault I am in this situation and I can’t wait for her to experience pain and suffering like she has caused me,” makes it clear that we must assess the potential danger to others. Therefore, we can eliminate answer B and C, which only assess for risk to self. This leaves us with answers D and A. The vignette notes the client was just released from an involuntary hold, so psychiatric resources would take precedence over employment resources. We want to ensure the client is stabilized before we can connect him to other, less urgent resources. (Crisis Management)
B. Current and prior level of substance use
Current medication regimen and level of compliance
Level of risk client presents to self
C. Current medication regimen and level of compliance
Level of risk client presents to self
Access to employment resources
D. Level of risk client presents to self and family
Current level of substance use
Access to employment resources
Juanita, a 55-year-old Haitian-American woman attends therapy following the death of her husband. Juanita informs the therapist that she and her husband were fighting a lot before he suddenly died. She practices Voodoo and informs the therapist she believes in the afterlife. How should the therapist manage the client’s disclosure?
Score: 0 of 1
A. Normalize the desire for those grieving to hold onto the concept of the afterlife.
B. Ask the client to elaborate on her religious beliefs and demystify Voodoo for the therapist.
C. Research the Voodoo religion and ask client if she would like to incorporate it into treatment.
D. Determine the client’s goals of treatment and how her religious practice affects her presenting problem
Juanita, a 55-year-old Haitian-American woman attends therapy following the death of her husband. Juanita informs the therapist that she and her husband were fighting a lot before he suddenly died. She practices Voodoo and informs the therapist she believes in the afterlife. How should the therapist manage the client’s disclosure?
Score: 0 of 1
A. Normalize the desire for those grieving to hold onto the concept of the afterlife.
B. Ask the client to elaborate on her religious beliefs and demystify Voodoo for the therapist.
Incorrect
C. Research the Voodoo religion and ask client if she would like to incorporate it into treatment.
Should have chosen
D. Determine the client’s goals of treatment and how her religious practice affects her presenting problem
Rationale: The correct answer is D. Answer A normalizes something that is not necessarily a belief held by everyone, not everyone grieving holds on to the concept of the afterlife. If this answer were more focused on the client’s belief in the afterlife and what it meant to her, A would be a possible option. Answer B is incorrect because the client is not responsible for educating their therapist about their religion. Answer C is incorrect because the therapist does not practice Voodoo, so researching it and then trying to incorporate into treatment would be inappropriate. Answer D is the best option because it honors the client’s self-determination in determining the goals of treatment and inquires about the role of religion at a personal level. (Clinical Evaluation)
A therapist meets with a client diagnosed with Borderline Personality Disorder. The client informs the therapist that she cuts her wrists when her emotions become too intense. The therapist attempts to safety plan, but the client refuses to engage in safety planning, stating, “I don’t need to safety plan. I said I would not do it anymore.” Which of the following actions should the therapist take to assess the client’s safety?
Score: 0 of 1
A. Inquire about past suicide attempts
Identify alternative coping mechanisms Explore presence of substance use
B. Inquire about past suicide attempts
Identify social supports Identify potential triggers for emotional distress
C. Explore current lethality
Identify potential triggers for emotional distress Identify alternative coping skills
D. Explore current lethality
Explore presence of substance use Explore client’s family support system
A therapist meets with a client diagnosed with Borderline Personality Disorder. The client informs the therapist that she cuts her wrists when her emotions become too intense. The therapist attempts to safety plan, but the client refuses to engage in safety planning, stating, “I don’t need to safety plan. I said I would not do it anymore.” Which of the following actions should the therapist take to assess the client’s safety?
Score: 0 of 1
A. Inquire about past suicide attempts
Identify alternative coping mechanisms Explore presence of substance use
B. Inquire about past suicide attempts
Identify social supports Identify potential triggers for emotional distress
Should have chosen
C. Explore current lethality
Identify potential triggers for emotional distress Identify alternative coping skills
Rationale: The best answer choice is C. In crisis situations, we would prioritize current over past information about a client. While a past suicide attempt is a good indicator of future risk, exploring current lethality would still be an even stronger determining factor. We can therefore eliminate options A and B. (Side note: lethality is defined as someone having the ability to cause death or serious harm.) Answer C is stronger than D for the following reasons: 1. Identifying potential triggers for emotional distress is broader and would actually include substance use and 2. Identifying alternative coping skills is stronger than exploring client’s support system. Alternative coping skills would include external support systems. (Crisis Management)
Incorrect
D. Explore current lethality
Explore presence of substance use Explore client’s family support system
A therapist with a National Provider Identification meets with a new client who was referred for ongoing therapy following hospitalization after an attempted suicide. The client shares his psychiatric history with the therapist, including past suicide attempts, a history of severe depression, and childhood trauma. The therapist contacts the referring physician as part of the assessment. What legal obligations does the therapist have in this case?
Score: 0 of 1
A. The therapist does not need a release of information from the client since this was a crisis situation.
B. The therapist would need to obtain a release of information from the client prior to speaking with the physician.
C. The therapist would only need a release of information if discussing concerns beyond treatment and diagnosis with referring physician.
D. The therapist does not need a release of information to speak with the physician since the hospital is a HIPAA covered entity.
A therapist with a National Provider Identification meets with a new client who was referred for ongoing therapy following hospitalization after an attempted suicide. The client shares his psychiatric history with the therapist, including past suicide attempts, a history of severe depression, and childhood trauma. The therapist contacts the referring physician as part of the assessment. What legal obligations does the therapist have in this case?
Score: 0 of 1
A. The therapist does not need a release of information from the client since this was a crisis situation.
Incorrect
B. The therapist would need to obtain a release of information from the client prior to speaking with the physician.
Should have chosen
C. The therapist would only need a release of information if discussing concerns beyond treatment and diagnosis with referring physician.
Rationale: The correct answer is C. Answer A can be eliminated since the crisis already passed by the time the therapist meets with the client. Answer B is also incorrect since HIPAA covered entities are permitted to discuss diagnosis, treatment, and payment with other providers without a release. Answer C accurately reflects the law, making it the strongest answer. Answer D is not completely accurate, since the therapist would be limited in what information can be shared without a release.
D. The therapist does not need a release of information to speak with the physician since the hospital is a HIPAA covered entity.
A therapist referred a short-term client out to a colleague in order to hire the client as a nanny for her children. The referring therapist provided the colleague with the original client chart and continued meeting with the client until the new therapist took charge of the case. Which of the following statements most accurately describes the ethical issues presented in this case?
Score: 1 of 1
A. The therapist engaged in an unethical dual relationship that could have been avoided and risks exploitation of client.
B. The therapist engaged in unethical management of client records.
C. The therapist’s actions are considered ethical because client was short-term and received continuity of care through referral and sharing of records.
D. The therapist’s actions are considered unethical due to a breach of therapeutic boundaries and improper recordkeeping.
A therapist referred a short-term client out to a colleague in order to hire the client as a nanny for her children. The referring therapist provided the colleague with the original client chart and continued meeting with the client until the new therapist took charge of the case. Which of the following statements most accurately describes the ethical issues presented in this case?
Score: 1 of 1
A. The therapist engaged in an unethical dual relationship that could have been avoided and risks exploitation of client.
B. The therapist engaged in unethical management of client records.
C. The therapist’s actions are considered ethical because client was short-term and received continuity of care through referral and sharing of records.
Correct
D. The therapist’s actions are considered unethical due to a breach of therapeutic boundaries and improper recordkeeping.
Rationale: The correct answer is D. Our code of ethics prohibits us from terminating therapy with clients in order to pursue other relationships. Answer C can easily be eliminated. Answers A and B are both correct, but neither is as comprehensive as answer D. Answer D encompasses the problematic behavior with records as well as boundaries. (Ethics)
A couple in their mid-70s meets with a therapist to address sexual dysfunction in their relationship. The couple reports that the husband met with his primary care physician who ruled out any underlying organic issues. The couple shares that they had an active and healthy sex life until recently, when the husband began to struggle with sustaining an erection. Which of the following should the therapist emphasize when developing a treatment plan?
Score: 0 of 1
A. The couple’s ability to communicate their sexual pleasures to one another and the realities of aging on diminished sexual functioning.
B. The common characteristics of sexual dysfunction that develop in long-term marriages.
C. The husband’s thoughts on the underlying causes and the wife’s reaction to his inability to sustain an erection.
D. The couple’s strengths and pleasures that continue to thrive outside of their sexual relationship.
A couple in their mid-70s meets with a therapist to address sexual dysfunction in their relationship. The couple reports that the husband met with his primary care physician who ruled out any underlying organic issues. The couple shares that they had an active and healthy sex life until recently, when the husband began to struggle with sustaining an erection. Which of the following should the therapist emphasize when developing a treatment plan?
Score: 0 of 1
A. The couple’s ability to communicate their sexual pleasures to one another and the realities of aging on diminished sexual functioning.
B. The common characteristics of sexual dysfunction that develop in long-term marriages.
Should have chosen
C. The husband’s thoughts on the underlying causes and the wife’s reaction to his inability to sustain an erection.
Rationale: The correct answer is C. Answer A is incorrect because it makes assumptions about their communication and falsely states that aging automatically leads to diminished sexual functioning. Answer B is incorrect because it is promoting a false stereotype regarding long-term marriages and sexual dysfunction. Answer D can be ruled out since it does not connect to anything in the stem and does not address the presenting issue. Answer C is the best option since in creating a treatment plan we would want to explore the thoughts and emotions clients have about it. (Treatment Planning)
Incorrect
D. The couple’s strengths and pleasures that continue to thrive outside of their sexual relationship.
A 56-year-old man engages in treatment with a therapist who is on his family’s insurance panel. The man has a diagnosis of Obsessive Compulsive Disorder that increasingly interferes with his activities of daily living. The man would like his wife to participate in treatment with him and wants to use their insurance to pay for treatment. How should the therapist proceed to address legal obligations?
Score: 0 of 1
A. Only bill insurance if conjoint treatment is the most effective modality to treat the identified patients’ mental disorder and accurately represent diagnosis and treatment unit.
B. Review the identified patient’s insurance policy and only bill insurance if coverage includes marriage counseling.
C. Deny request for wife to participate in treatment and provide informed consent to client.
D. Determine if client’s insurance covers marriage counseling and provide informed consent to treatment unit.
A 56-year-old man engages in treatment with a therapist who is on his family’s insurance panel. The man has a diagnosis of Obsessive Compulsive Disorder that increasingly interferes with his activities of daily living. The man would like his wife to participate in treatment with him and wants to use their insurance to pay for treatment. How should the therapist proceed to address legal obligations?
Score: 0 of 1
Should have chosen
A. Only bill insurance if conjoint treatment is the most effective modality to treat the identified patients’ mental disorder and accurately represent diagnosis and treatment unit.
Rationale: The correct answer is A. Answer B and D can be eliminated because the client is the husband who is being treated for obsessive compulsive disorder, the presenting problem is not the couple’s relationship. Answer C is incorrect because it is possible to include the wife in treatment and bill insurance if it is considered an effective treatment option. Answer A acknowledges that conjoint treatment, if effective, is permitted and the therapist would need to provide accurate information regarding diagnosis and treatment to the insurance company. (Law)
B. Review the identified patient’s insurance policy and only bill insurance if coverage includes marriage counseling.
C. Deny request for wife to participate in treatment and provide informed consent to client.
Incorrect
D. Determine if client’s insurance covers marriage counseling and provide informed consent to treatment unit.
A family consisting of a mother, father and two teenage sons attend the first session of therapy. The parents explain they have a 22-year-old son who is estranged from the family. The son has a history of substance abuse and was removed from the home after physically assaulting the youngest child. The parents want to reunify with their son, but the children are not sure it is a good idea. How would a Bowenian therapist assess for the appropriateness of reunification in this case?
Score: 0 of 1
A. Assess estranged son’s current relationship with substances
Explore how the emotional cut-off is affecting all family members
Identify level of differentiation among family members
B. Assess estranged son’s current relationship with substances
Explore how the emotional cut-off is affecting all family members
Explore safety plans that have been established in the event of reunification
C. Explore how the family will address safety concerns in the event of family reunification
Ask family members what they envision if they open the cut-off relationship
Assess estranged son’s current relationship with substances
D. Explore how the family will address safety concerns in the event of family reunification; Ask family members what they envision if they open the cut-off relationship
Invite the son to join a future session
A family consisting of a mother, father and two teenage sons attend the first session of therapy. The parents explain they have a 22-year-old son who is estranged from the family. The son has a history of substance abuse and was removed from the home after physically assaulting the youngest child. The parents want to reunify with their son, but the children are not sure it is a good idea. How would a Bowenian therapist assess for the appropriateness of reunification in this case?
Score: 0 of 1
A. Assess estranged son’s current relationship with substances
Explore how the emotional cut-off is affecting all family members
Identify level of differentiation among family members
Incorrect
B. Assess estranged son’s current relationship with substances
Explore how the emotional cut-off is affecting all family members
Explore safety plans that have been established in the event of reunification
Should have chosen
C. Explore how the family will address safety concerns in the event of family reunification
Ask family members what they envision if they open the cut-off relationship
Assess estranged son’s current relationship with substances
Rationale: The correct answer is C. The question is not only asking you to consider how a Bowenian therapist would assess the family, but specifically how they would assess for the appropriateness of reunification. Answer A, identify the level of differentiation among family members is important for Bowen, but does not directly address appropriateness of reunification. In addition, answer A as with answer B includes exploration of how the emotional cut-off is affecting family members. This information would not help the therapist determine the appropriateness of reunification. Answer D, invite the son to join in a future session, is incorrect because it jumps to reunification before determining the appropriateness of it. (Treatment Planning)
D. Explore how the family will address safety concerns in the event of family reunification; Ask family members what they envision if they open the cut-off relationship
Invite the son to join a future session
The parents of a 4-year-old boy seek therapy to address their son’s behavioral issues. The couple reports feeling hopeless and are convinced they are failures as parents because they are unable to control their son. They report frequent yelling and temper tantrums that lead to their son hitting and kicking them. How would a Structural versus Strategic therapist intervene in the middle stage of treatment?
Score: 1 of 1
A. A Structural therapist would meet with the entire family and instigate conflict to modify family member responses and a Strategic therapist would instruct the parents to preemptively tantrum if conflict begins.
B. A Structural therapist would meet with the parents and assist them in solidifying their hierarchical position and a Strategic therapist would meet with the entire family and direct the parents to articulate clear boundaries with their son.
C. A Structural therapist would insist on meeting with the entire family and engage in role play with the family and a Strategic therapist would insist on meeting with the entire family and encourage family to schedule tantrums.
D. A Structural therapist would meet with the parents and challenge how the parents respond to their son’s tantrums and a Strategic therapist would meet with the entire family and direct the son to tantrum in session.
The parents of a 4-year-old boy seek therapy to address their son’s behavioral issues. The couple reports feeling hopeless and are convinced they are failures as parents because they are unable to control their son. They report frequent yelling and temper tantrums that lead to their son hitting and kicking them. How would a Structural versus Strategic therapist intervene in the middle stage of treatment?
Score: 1 of 1
A. A Structural therapist would meet with the entire family and instigate conflict to modify family member responses and a Strategic therapist would instruct the parents to preemptively tantrum if conflict begins.
B. A Structural therapist would meet with the parents and assist them in solidifying their hierarchical position and a Strategic therapist would meet with the entire family and direct the parents to articulate clear boundaries with their son.
Correct
C. A Structural therapist would insist on meeting with the entire family and engage in role play with the family and a Strategic therapist would insist on meeting with the entire family and encourage family to schedule tantrums.
Rationale: The correct answer is C. Answer A can be eliminated since a Structural therapist would not instigate conflict. Answer B can be ruled out since the second part of the answer is more Structural than Strategic. Finally, answer D can also be eliminated since the first part of the answer is too harsh for a Structural therapist; Structural therapists would not take the position of challenging clients, which would be more appropriate for Strategic. (Treatment)
D. A Structural therapist would meet with the parents and challenge how the parents respond to their son’s tantrums and a Strategic therapist would meet with the entire family and direct the son to tantrum in session.
