Final Mock II Flashcards
Kim, a 7-year-old girl, is brought to therapy by her mother, Jane. They were referred by Kim’s teacher because Kim had started crying excessively at morning drop-off and is continually asking when her mom is going to pick her up. Jane also reports that Kim is refusing to sleep alone. Jane shakes her head and says, “I just don’t understand what is wrong with her. She was never like this before.” Which of the following actions should the therapist take to assess this client?
A. Provide psychoeducation about separation anxiety; identify familial communication patterns; identify somatic symptoms
B. Identify recent changes in family; identify coping strategies; identify familial communication patterns
C. Provide psychoeducation about separation anxiety; identify coping strategies; identify somatic symptoms
D. Identify recent changes in family; identify coping strategies; identify support systems
A. Provide psychoeducation about separation anxiety; identify familial communication patterns; identify somatic symptoms
Correct
B. Identify recent changes in family; identify coping strategies; identify familial communication patterns
Rationale: The goal of assessment is to gather information, not provide psychoeducation. Answers A and C can immediately be ruled out as options because the therapist would focus on information gathering, rather than educating the client about separation anxiety. Answer D is incorrect because the 3rd part of the answer - identifying support systems is not as relevant, based on the information provided in the vignette, to understanding the presenting issue as family communication patterns. (Clinical Evaluation)
C. Provide psychoeducation about separation anxiety; identify coping strategies; identify somatic symptoms
D. Identify recent changes in family; identify coping strategies; identify support systems
A therapist has been working with a client for 4 years. The client has a history of major depression, with periods of sustained remission. The client excitedly informs the therapist that she just learned she is 7 weeks pregnant with her first child and intends to stop taking her medication because she and her husband researched the potential negative effects it could have on the fetus. The therapist is concerned for the client to stop her medication because she experienced significant decompensation last time she went off of them. Which of the following actions should the therapist take in this case?
A. Encourage the client to consider staying on medications while recognizing client’s right to self-determination.
B. Contact the psychiatrist and share concerns to ensure proper collaboration between psychiatrist and therapist.
C. Inform the client that the possible side effects do not outweigh the risk of going into a depression.
D. Invite the client’s husband for a collateral session to help the couple process the pros and cons of taking the medication.
A. Encourage the client to consider staying on medications while recognizing client’s right to self-determination.
Correct
B. Contact the psychiatrist and share concerns to ensure proper collaboration between psychiatrist and therapist.
Rationale: The issue presented is outside the therapist’s scope of practice, so it would be important to consult with the psychiatrist to discuss concerns and coordinate care, making B the best answer. This could lead to answer A, but we would want to ensure that we work within our scope of practice and avoid providing medical advice–if this is what the psychiatrist recommends, we could convey what the psychiatrist stated with the client. Answer C is outside the therapist’s scope of practice and should come from her MD. If the client noted a desire to bring the husband in for a collateral session, the therapist could do so, but based on the information provided, this step is not indicated. (Treatment)
C. Inform the client that the possible side effects do not outweigh the risk of going into a depression.
D. Invite the client’s husband for a collateral session to help the couple process the pros and cons of taking the medication.
A therapist specializing in sex therapy is meeting with a new client referred by his wife. The client, a 53-year-old man, shares that he and his wife have experienced intimacy issues that developed approximately 5 months earlier. The man explains that he never had problems in bed, but started to experience difficulty sustaining an erection. The therapist asks if anything in their relationship changed, but the client cannot identify anything noteworthy. What is the most important factor the therapist should consider during the initial assessment with this client:
A. Determine if client had prior difficulties with past partners or in his current relationship.
B. Refer client for medical evaluation to rule out any biological basis for sexual dysfunction.
C. Conduct a collateral session with client’s partner to evaluate sexual communication and any potential problems.
D. Evaluate the client’s social and sexual history for potential trauma-induced dysfunction.
A therapist specializing in sex therapy is meeting with a new client referred by his wife. The client, a 53-year-old man, shares that he and his wife have experienced intimacy issues that developed approximately 5 months earlier. The man explains that he never had problems in bed, but started to experience difficulty sustaining an erection. The therapist asks if anything in their relationship changed, but the client cannot identify anything noteworthy. What is the most important factor the therapist should consider during the initial assessment with this client:
Score: 1 of 1
A. Determine if client had prior difficulties with past partners or in his current relationship.
Correct
B. Refer client for medical evaluation to rule out any biological basis for sexual dysfunction.
Rationale: This question is asking what the most important factor that should be considered in assessing this client’s sexual dysfunction. It is always important for a therapist to rule out medical reasons for any physical symptoms reported by clients (B). After ruling out a biological basis for the sexual dysfunction, the therapist would gather information included in answers (A), (C), and (D). (Clinical Evaluation)
C. Conduct a collateral session with client’s partner to evaluate sexual communication and any potential problems.
D. Evaluate the client’s social and sexual history for potential trauma-induced dysfunction.
A non-profit agency supervisor is assigned a new supervisee. During the initial supervisory session, the supervisee is asked to describe past practice experience, perceived strengths and weaknesses, and goals for supervision. The supervisor discusses the purpose of supervision, the role of the supervisor, and the expectations for the supervisee. Which of the following statements accurately reflects the professions legal and ethical guidelines regarding supervision?
A. the supervisor is the one who holds responsibility.
B. the supervisee is the one who holds responsibility.
C. both supervisor and supervisee are held equally responsible.
D. the agency’s clinical director solely holds responsibility.
A non-profit agency supervisor is assigned a new supervisee. During the initial supervisory session, the supervisee is asked to describe past practice experience, perceived strengths and weaknesses, and goals for supervision. The supervisor discusses the purpose of supervision, the role of the supervisor, and the expectations for the supervisee. Which of the following statements accurately reflects the professions legal and ethical guidelines regarding supervision?
A. the supervisor is the one who holds responsibility.
B. the supervisee is the one who holds responsibility.
Should have chosen
C. both supervisor and supervisee are held equally responsible.
Rationale: (C) Both the supervisor and the supervisee hold equal responsibility. The supervisor is responsible for telling the supervisee how to handle paperwork, agency procedures, how to deal with difficult situations, and clinical matters. The supervisee, however, is also responsible for his/her actions. We all hold individual responsibility to know when to break confidentiality for instance and lack of knowledge of such guidelines is not an acceptable excuse. The clinical director holds responsibility as the employer, but does not solely hold responsibility (D). (Law and Ethics)
D. the agency’s clinical director solely holds responsibility.
A 12-year-old Chinese-American student is referred to therapy because she’s been acting out in school. During the second family therapy session, the student angrily states that her mother slapped her across the face and she shows you a mark. The father confirms this occurred but explains the daughter is frequently defiant and verbally abusive toward the mother. Which of the following actions would a Structural Family Therapist use to address the family dynamics described by the daughter and father?
Score: 1 of 1
A. Demonstrate cultural competency by exploring the family’s cultural beliefs related to parenting and discipline.
B. Inform the family that a child abuse report must be filed and process their reactions.
C. Determine the nature and severity of the slap and file a report.
D. File an anonymous report after the completion of the session.
A 12-year-old Chinese-American student is referred to therapy because she’s been acting out in school. During the second family therapy session, the student angrily states that her mother slapped her across the face and she shows you a mark. The father confirms this occurred but explains the daughter is frequently defiant and verbally abusive toward the mother. Which of the following actions would a Structural Family Therapist use to address the family dynamics described by the daughter and father?
Score: 1 of 1
A. Demonstrate cultural competency by exploring the family’s cultural beliefs related to parenting and discipline.
Correct
B. Inform the family that a child abuse report must be filed and process their reactions.
Rationale: In this question, the best answer is B. Ethically, therapists should inform the family when they will report and process this with the clients. This ethical responsibility would be necessary regardless of theoretical orientation. As a mandated reporter, we would not file the report anonymously, ruling out answer D. There is enough to trigger a report so both answers C and A can be ruled out. (Crisis Management)
C. Determine the nature and severity of the slap and file a report.
D. File an anonymous report after the completion of the session.
A 29-year-old graduate student is recommended to therapy by her roommate. She states that she has never been to therapy before and does not want for it to last too long. The therapist and the client make a decision that short-term therapy is most appropriate. During the intake interview, Her chief complaint is general dissatisfaction with life. During the first few sessions the therapist attempts to narrow down the focus of therapy, but the client skirts answers to questions and avoids issues. Each time the therapist picks a topic the client changes the subject. Upon observing these behaviors, the therapist finds himself to be rather annoyed and dreads sessions with the client. Which of the following interventions should the therapist take to address the observed dynamic?
Score: 1 of 1
A. Explore how client deals with problems outside of session and document personal feelings in the client’s record.
B. Respect the client’s pace and style of relating and seek consultation in order to prevent personal feelings interfering with treatment.
C. Confront the client with regards to this pattern and seek consultation regarding countertransference.
D. Process personal feelings via journaling and remain silent in order to allow the client to bring up the material.
A 29-year-old graduate student is recommended to therapy by her roommate. She states that she has never been to therapy before and does not want for it to last too long. The therapist and the client make a decision that short-term therapy is most appropriate. During the intake interview, Her chief complaint is general dissatisfaction with life. During the first few sessions the therapist attempts to narrow down the focus of therapy, but the client skirts answers to questions and avoids issues. Each time the therapist picks a topic the client changes the subject. Upon observing these behaviors, the therapist finds himself to be rather annoyed and dreads sessions with the client. Which of the following interventions should the therapist take to address the observed dynamic?
Score: 1 of 1
A. Explore how client deals with problems outside of session and document personal feelings in the client’s record.
B. Respect the client’s pace and style of relating and seek consultation in order to prevent personal feelings interfering with treatment.
Correct
C. Confront the client with regards to this pattern and seek consultation regarding countertransference.
Rationale: This is a treatment question where there is no crisis issue. Thus we are going to meet the client where they are at, as that is the best way to handle a clinical concern. Short-term therapy indicates a limited number of sessions to work on issues with the client. Because the client is being avoidant, the best intervention would be to confront the client regarding this pattern and process feelings of countertransference in consultation (C). Attempting to explore how client deals with problems outside of session (A) would be ineffective based on client’s avoidance. Answers (B) and (D) could be appropriate for long-term but not short-term therapy. (Ethics)
D. Process personal feelings via journaling and remain silent in order to allow the client to bring up the material.
A therapist is called to a hospital emergency room to assist with a woman who was brought in with her deceased baby. The baby has just died of sudden infant death syndrome. The mother, who has no history of mental illness, is refusing the let go of the baby and insists that the baby is still alive. What actions should the therapist take in this case?
A. Ask the doctors to sedate the woman while the baby is removed.
B. Allow the woman to let go of the baby in her own time.
C. Admit the woman to the psychiatric unit.
D. Involve family members in helping to reorient the woman.
A therapist is called to a hospital emergency room to assist with a woman who was brought in with her deceased baby. The baby has just died of sudden infant death syndrome. The mother, who has no history of mental illness, is refusing the let go of the baby and insists that the baby is still alive. What actions should the therapist take in this case?
Score: 1 of 1
A. Ask the doctors to sedate the woman while the baby is removed.
Correct
B. Allow the woman to let go of the baby in her own time.
Rationale: The client is engaging in denial, which is the first stage of grieving. Allowing the mother to let go of the baby in her own time (B) would allow the mother to engage in this stage of grief. Asking the doctor to sedate the woman (A) or admitting the woman to the psychiatric ward (C) would be overreactions based on the information in the stem. The therapist could choose to involve family members (D) but only at a later stage. (Treatment)
C. Admit the woman to the psychiatric unit.
D. Involve family members in helping to reorient the woman.
Maria, a Mexican-American 40-year-old divorced mother of four, is referred by her minister. Maria shares that she has been very overwhelmed. She is growing increasingly worried because her oldest child, a 19-year-old son named Enrique, has been sleeping with a knife under his pillow, is acting out of control, and even threatened her. Maria reports a recent promotion at work, but adds that she is having a hard time concentrating and worries she may get in trouble. She says, “I don’t want my family to know how bad it is; they would be so upset if they knew I came to therapy. I keep praying that he will get better.” What human diversity issues should the therapist consider when developing a comprehensive treatment plan?
Score: 1 of 1
A. Maria’s level of family support and her motivation for treatment.
B. Maria’s recent promotion and the severity of Maria’s anxiety.
C. Maria’s spiritual beliefs and the safety of the other children in the home.
D. Maria’s cultural views of therapy and her spiritual beliefs.
Maria, a Mexican-American 40-year-old divorced mother of four, is referred by her minister. Maria shares that she has been very overwhelmed. She is growing increasingly worried because her oldest child, a 19-year-old son named Enrique, has been sleeping with a knife under his pillow, is acting out of control, and even threatened her. Maria reports a recent promotion at work, but adds that she is having a hard time concentrating and worries she may get in trouble. She says, “I don’t want my family to know how bad it is; they would be so upset if they knew I came to therapy. I keep praying that he will get better.” What human diversity issues should the therapist consider when developing a comprehensive treatment plan?
Score: 1 of 1
A. Maria’s level of family support and her motivation for treatment.
B. Maria’s recent promotion and the severity of Maria’s anxiety.
C. Maria’s spiritual beliefs and the safety of the other children in the home.
Correct
D. Maria’s cultural views of therapy and her spiritual beliefs.
Rationale: (D) is the only answer that has only human diversity issues. Levels of social support, motivation for treatment, severity of symptoms, her promotion and the safety of the children are all present in the vignette and could be part of the treatment plan, but the question is specifically asking about human diversity issues that will be part of the treatment plan. (Treatment Planning)
A therapist receives a school-based referral for a female 14-year-old. Her teacher told the therapist that the student has been increasingly volatile in interactions with peers and school staff. The student’s mother, who brought her daughter in for the first session, insists that she would like to be a part of treatment as she has also noticed behavioral problems at home. The mother informs the therapist her daughter was sexually abused at an early age and has never talked about it with anyone. Upon further inquiry, the daughter denies any memory of the abuse. She states that she does not want to see herself as broken or damaged in any way. What of the following actions should the therapist take when developing a treatment plan in this situation?
Score: 1 of 1
A. Discuss the impact of the abuse on the family and the daughter’s behavior; gather more information regarding the daughter’s symptoms both at home and at school.
B. Clearly identify the treatment unit before developing a treatment plan; gather additional information regarding the abuse.
C. Discuss the impact of the abuse on the family and Lara’s behaviors; clearly identify the treatment unit before developing treatment plan.
D. File a child abuse report; gather more information regarding the daughter’s symptoms both at home and at school.
A therapist receives a school-based referral for a female 14-year-old. Her teacher told the therapist that the student has been increasingly volatile in interactions with peers and school staff. The student’s mother, who brought her daughter in for the first session, insists that she would like to be a part of treatment as she has also noticed behavioral problems at home. The mother informs the therapist her daughter was sexually abused at an early age and has never talked about it with anyone. Upon further inquiry, the daughter denies any memory of the abuse. She states that she does not want to see herself as broken or damaged in any way. What of the following actions should the therapist take when developing a treatment plan in this situation?
Score: 1 of 1
A. Discuss the impact of the abuse on the family and the daughter’s behavior; gather more information regarding the daughter’s symptoms both at home and at school.
B. Clearly identify the treatment unit before developing a treatment plan; gather additional information regarding the abuse.
C. Discuss the impact of the abuse on the family and Lara’s behaviors; clearly identify the treatment unit before developing treatment plan.
Correct
D. File a child abuse report; gather more information regarding the daughter’s symptoms both at home and at school.
Rationale: The question is asking what actions the therapist should take in this case. The information shared in the session indicates the need for the therapist to immediately file a child abuse report since the victim is still a minor, regardless of whether or not the daughter acknowledges the abuse; the therapist has enough for reasonable suspicion. This is a good example of a question where the answers are all correct, but the priority is to report the child abuse report. We can then move on to the actions identified in answers A, B, and C. (Law)
A therapist works with a university student who reports compulsive exercise, as well as binging and purging several times per week. This has been going on for four months and, in addition, the client reports having nightmares, worrying about everything, and continually feeling “on edge.” The client has missed classes because she loses track of time and is sometimes afraid to walk across campus. The client says she broke up with her boyfriend over a month ago after a violent fight during which he tried to choke her. Which of the following provisional diagnoses should the therapist consider in this case?
Score: 1 of 1
A. Nightmare disorder; Anorexia Nervosa; Adjustment disorder with anxiety
B. Adjustment disorder; Bulimia Nervosa; Unspecified Anxiety Disorder
C. Acute Stress Disorder; Unspecified Eating Disorder; Generalized Anxiety Disorder
D. Posttraumatic Stress Disorder; Bulimia Nervosa; Unspecified Anxiety Disorder
A therapist works with a university student who reports compulsive exercise, as well as binging and purging several times per week. This has been going on for four months and, in addition, the client reports having nightmares, worrying about everything, and continually feeling “on edge.” The client has missed classes because she loses track of time and is sometimes afraid to walk across campus. The client says she broke up with her boyfriend over a month ago after a violent fight during which he tried to choke her. Which of the following provisional diagnoses should the therapist consider in this case?
Score: 1 of 1
A. Nightmare disorder; Anorexia Nervosa; Adjustment disorder with anxiety
B. Adjustment disorder; Bulimia Nervosa; Unspecified Anxiety Disorder
C. Acute Stress Disorder; Unspecified Eating Disorder; Generalized Anxiety Disorder
Correct
D. Posttraumatic Stress Disorder; Bulimia Nervosa; Unspecified Anxiety Disorder
Rationale: According to the DSM, the symptoms described in the stem are indicative of PTSD, Bulimia Nervosa and Unspecified Anxiety Disorder (D). The symptoms listed are better accounted for by PTSD than Nightmare Disorder or Adjustment Disorder and do not meet the criteria for Anorexia Nervosa (A) and (B). In answer C, the timeline is too long for Acute Stress Disorder, and symptoms are better accounted for by Bulimia Nervosa and Unspecified Anxiety Disorder than Unspecified Eating Disorder or Generalized Anxiety Disorder. (Clinical Evaluation)
A woman who has been in therapy for a couple of years finds herself at a crossroads in her life. She feels unhappy in her current career and relationship. She tells the therapist, “I feel confused and I’m having a difficult time making sense of things. I think I want to sell all my possessions and go live on a boat and travel the world.” Which of the following interventions would a Depth-Oriented psychotherapist use to address the client’s presenting issues?
A. Engage the client by asking her why she has discontent in her current situation and explore the lack of meaning in her life.
B. Ask the client what she feels her life purpose is and if she is fulfilling that purpose in her life.
C. After acknowledging her feelings of unhappiness and confusion, invite the client to imagine her life on the boat and ask her what feelings or thoughts arise as she thinks about this life that she desires.
D. After acknowledging her feelings of unhappiness and confusion, explore her various options to help her make decision about her life’s purpose.
A woman who has been in therapy for a couple of years finds herself at a crossroads in her life. She feels unhappy in her current career and relationship. She tells the therapist, “I feel confused and I’m having a difficult time making sense of things. I think I want to sell all my possessions and go live on a boat and travel the world.” Which of the following interventions would a Depth-Oriented psychotherapist use to address the client’s presenting issues?
Score: 0 of 1
Incorrect
A. Engage the client by asking her why she has discontent in her current situation and explore the lack of meaning in her life.
B. Ask the client what she feels her life purpose is and if she is fulfilling that purpose in her life.
Should have chosen
C. After acknowledging her feelings of unhappiness and confusion, invite the client to imagine her life on the boat and ask her what feelings or thoughts arise as she thinks about this life that she desires.
Rationale: (C) is the correct answer. As a depth psychotherapist, you would want to engage with the image that the client has brought to the session of living on the boat. Exploration of this image would deepen the client’s awareness of how she is feeling. (A) is a good option but it doesn’t engage with the image. (B) may come later but it is not meeting the client where she is in the moment. (D) is a more directive approach. (Treatment)
D. After acknowledging her feelings of unhappiness and confusion, explore her various options to help her make decision about her life’s purpose.
A therapist admits to an intimate relationship with one of his former clients. The therapist is the subject of regulatory board investigation. He tells the board investigator that the therapeutic relationship ended not quite two years ago, he truly loves this woman and they are engaged to get married. When the client is interviewed, she reports that she initiated the sexual contact with the therapist and reciprocates his feelings. The therapist terminated therapy to avoid any conflict once they realized they had emotions for each other. Which of the following descriptions most accurately represents the therapist’s actions?
Score: 1 of 1
A. It is considered a boundary violation, but not something the board will pursue due to the couple’s reciprocal feelings and lack of harm to client
B. The actions of the therapist are legal due to the amount of time that has passed, yet it continues to be unethical.
C. The therapist’s actions are both legal and ethical since the client initiated the relationship, the therapist ended the therapeutic relationship, and no harm or exploitation is indicated.
D. The therapist’s actions are considered illegal and unethical due to termination of therapy and the amount of time that has lapsed.
A therapist admits to an intimate relationship with one of his former clients. The therapist is the subject of regulatory board investigation. He tells the board investigator that the therapeutic relationship ended not quite two years ago, he truly loves this woman and they are engaged to get married. When the client is interviewed, she reports that she initiated the sexual contact with the therapist and reciprocates his feelings. The therapist terminated therapy to avoid any conflict once they realized they had emotions for each other. Which of the following descriptions most accurately represents the therapist’s actions?
Score: 1 of 1
A. It is considered a boundary violation, but not something the board will pursue due to the couple’s reciprocal feelings and lack of harm to client
B. The actions of the therapist are legal due to the amount of time that has passed, yet it continues to be unethical.
C. The therapist’s actions are both legal and ethical since the client initiated the relationship, the therapist ended the therapeutic relationship, and no harm or exploitation is indicated.
Correct
D. The therapist’s actions are considered illegal and unethical due to termination of therapy and the amount of time that has lapsed.
Rationale: The actions described in this stem are both illegal and unethical (D). The therapist’s behavior is considered a violation of boundaries, but the second part is incorrect because the board would pursue action against the therapist regardless of the couple’s ongoing relationship. Answer (B) is inaccurate as the actions not just unethical, but illegal as well. Answer (C) is inaccurate because it would not matter if the therapist or client initiated the relationship. (Law and Ethics)
A therapist meets with the parents of an 18-year-old boy. The father complains that their son is too rebellious and he wants him to move out of the house immediately. The mother disagrees with her husband, defending her son by claiming he is just being a normal teen and complains the husband is too strict. The husband tells the therapist he is offended when his son talks back, leaves the house a mess, and ignores any directions given. Which of the following actions would a Systems therapist use to address the conflict presented in this case?
A. Teach the parents how to discuss and address problems between themselves and their son.
B. Teach the entire family how to discuss and address problems to avoid maintaining homeostasis.
C. Assist the entire family to better understand how circular communication exacerbates the son’s negative behaviors and increase positive interactions.
D. Utilize role play to increase the parent’s level of empathy toward each other.
A therapist meets with the parents of an 18-year-old boy. The father complains that their son is too rebellious and he wants him to move out of the house immediately. The mother disagrees with her husband, defending her son by claiming he is just being a normal teen and complains the husband is too strict. The husband tells the therapist he is offended when his son talks back, leaves the house a mess, and ignores any directions given. Which of the following actions would a Systems therapist use to address the conflict presented in this case?
Score: 1 of 1
Correct
A. Teach the parents how to discuss and address problems between themselves and their son.
Rationale: This question highlights the importance of identifying the treatment unit. While Systems focuses on the entire family, the therapist’s actions would still need to be directed toward the parents since they are the ones in the room. Teaching the parents how to communicate and problem solve between themselves and also their son (A) would be the main goal of a systems family therapist. Plus, they are complaining of having problems with their son, so teaching them how to resolve them would address their concerns. Answer (B) assumes the son is part of the treatment unit, which is not accurate, so we would rule it out. In addition, while homeostasis is a term used with systems therapy, the stem does not talk about how family members are maintaining homeostasis- it only talks about the problem they face. The exam will sometimes include the keywords linked to a theory, but inappropriately so, to ensure you are understanding the question and not automatically choosing an answer solely because it includes key terminology of the theory. Answer C is also addressing the wrong treatment unit. Answer D is not as strong as answer A because it is only focused on the couple while disregarding the role of the son in the presenting issue. (Treatment)
B. Teach the entire family how to discuss and address problems to avoid maintaining homeostasis.
C. Assist the entire family to better understand how circular communication exacerbates the son’s negative behaviors and increase positive interactions.
D. Utilize role play to increase the parent’s level of empathy toward each other.
A therapist who specializes in play therapy and is certified in art therapy meets first time with a 6-year-old girl. The parents are nervous about taking their daughter to a therapist, but feel it’s necessary due to ongoing concerns regarding their daughter’s behavior at home and in school. During an initial session, while utilizing play therapy, the girl exhibits knowledge of sexual organs and how they function. The therapist believes such knowledge is unusual for her age. The therapist’s most appropriate actions in this case are to:
Score: 1 of 1
A. File a child abuse report since the girl’s behavior combined with her knowledge of sexual organs is sufficient for reasonable suspicion of sexual abuse; recommend that the child be scheduled for a physical exam.
B. Schedule to meet with the girl’s parents and ask if the child has been sexually abused; get a signed authorization to speak to the girl’s teacher
C. Explore the parents concerns about the girl’s behavior; recommend that the child be scheduled for a physical exam.
D. Explore with the parents what types of behaviors the girl is exhibiting; ask the child about the source of her knowledge.
A therapist who specializes in play therapy and is certified in art therapy meets first time with a 6-year-old girl. The parents are nervous about taking their daughter to a therapist, but feel it’s necessary due to ongoing concerns regarding their daughter’s behavior at home and in school. During an initial session, while utilizing play therapy, the girl exhibits knowledge of sexual organs and how they function. The therapist believes such knowledge is unusual for her age. The therapist’s most appropriate actions in this case are to:
Score: 1 of 1
A. File a child abuse report since the girl’s behavior combined with her knowledge of sexual organs is sufficient for reasonable suspicion of sexual abuse; recommend that the child be scheduled for a physical exam.
B. Schedule to meet with the girl’s parents and ask if the child has been sexually abused; get a signed authorization to speak to the girl’s teacher
C. Explore the parents concerns about the girl’s behavior; recommend that the child be scheduled for a physical exam.
Correct
D. Explore with the parents what types of behaviors the girl is exhibiting; ask the child about the source of her knowledge.
Rationale: The therapist needs to get clarification from the parents about what type of behaviors concern them and understand the origins of the client’s knowledge before determining if there is reasonable suspicion of abuse, answer D. Answer A makes assumptions about the girl’s behavior and origin of knowledge, neither are known based on information in the vignette. Answer B is again jumping to conclusions without first gathering basic information. Answer C ignores the girl’s sexual knowledge, which is explicitly noted as unusual by the therapist. (Crisis Management)
At a low fee clinic, therapists receive new clients based on availability. A new client who identifies as gay is assigned to a younger male therapist whom the client assumes is heterosexual. The client, who has an extensive history of receiving mental health counseling adamantly insists on working with a homosexual therapist. Which actions should the therapist take to address the client’s request?
A. Explore the client’s reasons for this request and determine how to proceed.
B. Validate client’s concerns and provide referral to an openly gay clinician, if one is available.
C. Explain to the client that while the therapist understands the client’s request, the therapist’s sexual orientation will not affect their work together.
D. Explore the client’s concerns, disclose therapist’s sexual orientation, and discuss how the therapist and client can most effectively work together.
At a low fee clinic, therapists receive new clients based on availability. A new client who identifies as gay is assigned to a younger male therapist whom the client assumes is heterosexual. The client, who has an extensive history of receiving mental health counseling adamantly insists on working with a homosexual therapist. Which actions should the therapist take to address the client’s request?
Score: 0 of 1
Should have chosen
A. Explore the client’s reasons for this request and determine how to proceed.
Rationale: The therapist must first understand why the request was made by the client (A) in order to determine the appropriate course of action. A referral may be made (B) and the therapist could choose to disclose their own sexuality answer D, but only after understanding the client’s reason for the request. We do not even know the therapist’s sexual orientation based on the vignette. Answer C, explaining that the therapist’s sexual orientation is irrelevant would inappropriately dismiss the client’s concern. (Ethics)
B. Validate client’s concerns and provide referral to an openly gay clinician, if one is available.
C. Explain to the client that while the therapist understands the client’s request, the therapist’s sexual orientation will not affect their work together.
Incorrect
D. Explore the client’s concerns, disclose therapist’s sexual orientation, and discuss how the therapist and client can most effectively work together.
A 6-year-old girl is brought to therapy by her parents. Parents have noticed that their daughter is much quieter and less interactive at home and with family. The girl’s teacher has also notified the parents to tell them she is concerned about their daughter because in the last 6 months, she seems much more withdrawn and isolated at school. The parents feel that something may have happened to their little girl that they don’t know about and that she is not telling them. After completing the assessment, what would the initial goals be in working psychodynamically with this child?
A. To build rapport and a safe environment for the child; for the child to express feelings through projective techniques such as art, play, or sand play.
B. For the child and parents to verbalize an accurate understanding of PTSD; to develop coping strategies when she is feeling isolated.
C. For the parent and child to develop the capacity to discuss the nature of the problem; to increase positive interaction between child and peers.
D. To obtain a history of the child’s early childhood behavior; to create a holding environment for discussing past events with the child.
A 6-year-old girl is brought to therapy by her parents. Parents have noticed that their daughter is much quieter and less interactive at home and with family. The girl’s teacher has also notified the parents to tell them she is concerned about their daughter because in the last 6 months, she seems much more withdrawn and isolated at school. The parents feel that something may have happened to their little girl that they don’t know about and that she is not telling them. After completing the assessment, what would the initial goals be in working psychodynamically with this child?
Score: 1 of 1
Correct
A. To build rapport and a safe environment for the child; for the child to express feelings through projective techniques such as art, play, or sand play.
Rationale: Answer A is the correct answer for initial goals in working with the child psychodynamically. (B) is out because there is not enough in the stem to assume there is PTSD. The goals identified in answer C may come later but first the therapist needs to build rapport and understanding. The question stem notes an assessment has been completed, so answer D is incorrect because obtaining history is part of the assessment. (Treatment Planning)
B. For the child and parents to verbalize an accurate understanding of PTSD; to develop coping strategies when she is feeling isolated.
C. For the parent and child to develop the capacity to discuss the nature of the problem; to increase positive interaction between child and peers.
D. To obtain a history of the child’s early childhood behavior; to create a holding environment for discussing past events with the child.
A therapist has been meeting with a family for a couple of months. The family started therapy after the father spent 3 months in a rehab facility following a disturbing incident in which he drove home drunk, hit a tree, completely destroyed a family car and got badly injured himself. The family participated in some family therapy sessions in rehab. During those sessions the family learned that there has been a lot of lying going on in the last several years. At this point they continue to work on building trust. During one of the sessions with this therapist, the parents reveal that they have been reading their 16-year-old daughter’s emails and have become aware of her sexual activity. The daughter begins crying while the 13-year-old son appears disengaged. Which action should the therapist take to address the parental admission?
Score: 1 of 1
A. Acknowledge the inappropriateness of reading daughter’s email and explore the parents concerns regarding their daughter’s sexual activity
B. Empathize with the daughter and advise the parents that they were wrong to invade her privacy.
C. Encourage the daughter to respond to her parents’ disclosure and engage the entire family.
D. Schedule a separate session with the daughter and parents to discuss their disclosure and the daughter’s sexual activity.
A therapist has been meeting with a family for a couple of months. The family started therapy after the father spent 3 months in a rehab facility following a disturbing incident in which he drove home drunk, hit a tree, completely destroyed a family car and got badly injured himself. The family participated in some family therapy sessions in rehab. During those sessions the family learned that there has been a lot of lying going on in the last several years. At this point they continue to work on building trust. During one of the sessions with this therapist, the parents reveal that they have been reading their 16-year-old daughter’s emails and have become aware of her sexual activity. The daughter begins crying while the 13-year-old son appears disengaged. Which action should the therapist take to address the parental admission?
Score: 1 of 1
A. Acknowledge the inappropriateness of reading daughter’s email and explore the parents concerns regarding their daughter’s sexual activity
B. Empathize with the daughter and advise the parents that they were wrong to invade her privacy.
Correct
C. Encourage the daughter to respond to her parents’ disclosure and engage the entire family.
Rationale: The daughter’s privacy has been violated and she should be provided with an opportunity to express her feelings and talk about the impact the parental disclosure had on her (C). In addition, the entire family is addressing issues of trust so engaging everyone is important. Answer A is incorrect, because the therapist should allow the daughter to respond to the disclosure. Answer B is incorrect because the therapist would be aligning with the daughter and would likely prevent the family from processing the disclosure. Answer D excludes the son, which would undermine efforts to build trust in the entire family. (Treatment)
D. Schedule a separate session with the daughter and parents to discuss their disclosure and the daughter’s sexual activity.
A therapist is working with a senior who has recently moved into an assisted living facility after a lifetime of living in one house. Before the move the client was outgoing but now is reclusive and refuses to attend meals or other activities. In the Bowen-Extended Family Systems therapy, the appropriate sequence of treatment would be:
A. normalize the client’s feelings and allow the resident time for grieving; teach “I” statements; map out family tree as part of the life review.
B. offer to attend events together with the client; gather family information; request a psychiatric evaluation.
C. offer to attend events together with the client; normalize the client’s feelings and allow the resident time for grieving; suggest bibliotherapy.
D. normalize the client’s feelings and allow the resident time for grieving; find another facility to transfer the resident; teach client the difference between thoughts and feelings.
A therapist is working with a senior who has recently moved into an assisted living facility after a lifetime of living in one house. Before the move the client was outgoing but now is reclusive and refuses to attend meals or other activities. In the Bowen-Extended Family Systems therapy, the appropriate sequence of treatment would be:
Score: 1 of 1
Correct
A. normalize the client’s feelings and allow the resident time for grieving; teach “I” statements; map out family tree as part of the life review.
Rationale: In Bowenian therapy, normalizing a client’s feelings, teaching “I” statements and mapping out the family (genogram) would be the appropriate steps for a therapist to take (A). Answers (B) and (C) include the therapist attending events with the client, which would be boundary violations, ruling out each of those answers. Answer (D) includes transferring the client to a different residence, which is not indicated. (Treatment)
B. offer to attend events together with the client; gather family information; request a psychiatric evaluation.
C. offer to attend events together with the client; normalize the client’s feelings and allow the resident time for grieving; suggest bibliotherapy.
D. normalize the client’s feelings and allow the resident time for grieving; find another facility to transfer the resident; teach client the difference between thoughts and feelings.
A 43-year-old woman, who is the mother of two teenagers initiates therapy to work on becoming more assertive. She complains at the onset of therapy that no one listens to her, whether she is at home or at work, and she is tired of feeling insignificant. During the initial session she reports wanting concrete tools that will help her with this matter. Once therapy begins, she is unable to carry out treatment tasks or practice the tools provided by the therapist. She indicates she is fearful of initiating change particularly since her culture does not approve of assertive women. Which of the following interventions should be used in this situation?
Score: 1 of 1
A. Support the client’s efforts to pursue her original goal and offer to provide family therapy to address communication problems.
B. Acknowledge the difficulty in carrying out treatment tasks and reformulate treatment goals with the client.
C. Validate the client’s fears and explore her perception of the cultural conflict.
D. Seek consultation to address cultural considerations more effectively with client.
A 43-year-old woman, who is the mother of two teenagers initiates therapy to work on becoming more assertive. She complains at the onset of therapy that no one listens to her, whether she is at home or at work, and she is tired of feeling insignificant. During the initial session she reports wanting concrete tools that will help her with this matter. Once therapy begins, she is unable to carry out treatment tasks or practice the tools provided by the therapist. She indicates she is fearful of initiating change particularly since her culture does not approve of assertive women. Which of the following interventions should be used in this situation?
Score: 1 of 1
A. Support the client’s efforts to pursue her original goal and offer to provide family therapy to address communication problems.
B. Acknowledge the difficulty in carrying out treatment tasks and reformulate treatment goals with the client.
Correct
C. Validate the client’s fears and explore her perception of the cultural conflict.
Rationale: Validating the client’s fears and exploring her perception of the cultural conflict (C) would allow the therapist to address the client’s expressed concerns and start where the client is. Supporting the client’s efforts to pursue her original goal and offering family therapy(A) as well as seeking consultation (D) ignores the client’s perceived impediments to achieving the goals. Reformulating the goal with the client (B) would be premature and should not be considered until after the cultural component is explored. (Treatment)
D. Seek consultation to address cultural considerations more effectively with client.
A therapist sees a client who was referred after a conviction of embezzlement. The client has an extensive history of gambling but denies that it is a problem for him or his family. Which of the following referrals should the therapist consider for this client?
A. Individual therapy; Family therapy; Gamblers Anonymous
B. Individual therapy; Physician; Al-Anon for the client
C. Family therapy; Gamblers Anonymous; Psychiatrist
D. Individual therapy; Al-Anon for client’s family; Physician
A therapist sees a client who was referred after a conviction of embezzlement. The client has an extensive history of gambling but denies that it is a problem for him or his family. Which of the following referrals should the therapist consider for this client?
Score: 1 of 1
Correct
A. Individual therapy; Family therapy; Gamblers Anonymous
Rationale: The most appropriate referrals would be individual therapy to work directly with the client, family therapy since addiction affects the entire family, and Gamblers Anonymous since group therapy is important modality in the treatment of addiction. While we generally say that referrals to Alcoholics Anonymous or other support groups are not ideal when a client is in denial, this is still the best answer option that is available to you. Answers (B) and (D) must be ruled out since referral to a physician is not indicated by the information provided in the vignette and Al-Anon would be more appropriate for the family if they were also involved in the treatment (remember treatment unit is the man). Answer (C) can be ruled out since referral to a psychiatrist is not indicated. (Treatment)
B. Individual therapy; Physician; Al-Anon for the client
C. Family therapy; Gamblers Anonymous; Psychiatrist
D. Individual therapy; Al-Anon for client’s family; Physician
Loreen, an adult client with developmental disabilities, has been coming to see a therapist at the community mental health agency. She has been making progress in addressing the impact of her disability both on her life as well as on her family. In addition, she has been learning various tools that help her cope with her disability. In the last session Loreen confides to the therapist that the receptionist at the community center she frequents often treats her like a child and she doesn’t know what to do. What actions should the therapist take to help the client address the receptionist’s behavior?
Score: 1 of 1
A. Document instances of inappropriate behavior and process need to report the receptionist’s behavior.
B. Explore past interactions with the receptionist and role-play alternative responses.
C. Discuss the client’s concerns with the receptionist privately and provide psychoeducation to the receptionist.
D. Help the client process this and any other instance when the client was mistreated.
Loreen, an adult client with developmental disabilities, has been coming to see a therapist at the community mental health agency. She has been making progress in addressing the impact of her disability both on her life as well as on her family. In addition, she has been learning various tools that help her cope with her disability. In the last session Loreen confides to the therapist that the receptionist at the community center she frequents often treats her like a child and she doesn’t know what to do. What actions should the therapist take to help the client address the receptionist’s behavior?
Score: 1 of 1
A. Document instances of inappropriate behavior and process need to report the receptionist’s behavior.
Correct
B. Explore past interactions with the receptionist and role-play alternative responses.
Rationale: The client clearly states that she does not know what to do. The situation described in the stem provides the therapist with an opportunity to help the client develop important social skills and role-playing would achieve this task (B). Documenting inappropriate behavior (A) or confronting the receptionist privately/providing psychoeducation (C) would not directly help the client. Helping the client process this and other instances of mistreatment (D) does not give the client tools to deal with this situation. (Treatment)
C. Discuss the client’s concerns with the receptionist privately and provide psychoeducation to the receptionist.
D. Help the client process this and any other instance when the client was mistreated.
Kyle, age 6, is brought to therapy by his mother, Lynn, because he has been acting out at school. The school told Lynn that Kyle won’t stay in his seat and frequently interrupts the class. Lynn shares that she and Kyle recently moved into a new apartment after separating from Kyle’s father. She has sole legal custody of Kyle, but on alternate weekends Kyle visits his father at their old house. After these visits, Kyle becomes more disruptive at home and at school. Lynn says that Kyle’s father gives Kyle energy drinks and takes him to watch cage fighting. Lynn appears very anxious in session and shares timidly, “I’m having a really hard time with him. I’m frustrated and don’t know what do anymore. His dad and I are always fighting; I think it has taken a toll on him.” As Lynn reports this, Kyle is throwing toys around in the office. What initial treatment goals should the therapist consider in this case?
A. Increase family supports; Set clear limits and consequences for Kyle; Improve consistency in parenting styles
B. Decrease Kyle’s behavioral problems at school; Reduce mother’s anxiety; Improve Kyle’s transitions between homes
C. Decrease Kyle’s behavioral problems at school; Increase father’s involvement in Kyle’s life; Improve communication between the parents
D. Determine whether Kyle has ADHD; Reduce mother’s anxiety; Improve communication between the parents
Kyle, age 6, is brought to therapy by his mother, Lynn, because he has been acting out at school. The school told Lynn that Kyle won’t stay in his seat and frequently interrupts the class. Lynn shares that she and Kyle recently moved into a new apartment after separating from Kyle’s father. She has sole legal custody of Kyle, but on alternate weekends Kyle visits his father at their old house. After these visits, Kyle becomes more disruptive at home and at school. Lynn says that Kyle’s father gives Kyle energy drinks and takes him to watch cage fighting. Lynn appears very anxious in session and shares timidly, “I’m having a really hard time with him. I’m frustrated and don’t know what do anymore. His dad and I are always fighting; I think it has taken a toll on him.” As Lynn reports this, Kyle is throwing toys around in the office. What initial treatment goals should the therapist consider in this case?
Score: 1 of 1
A. Increase family supports; Set clear limits and consequences for Kyle; Improve consistency in parenting styles
Correct
B. Decrease Kyle’s behavioral problems at school; Reduce mother’s anxiety; Improve Kyle’s transitions between homes
Rationale: The goals in (B) align with the presenting issues. (A) can be ruled out since there is no indication that there is a lack of social support. (C) is out because it is not clear that increasing the father’s involvement would be beneficial. (D) is out because determining whether Kyle has ADHD is part of the assessment, not a goal. (Treatment planning)
C. Decrease Kyle’s behavioral problems at school; Increase father’s involvement in Kyle’s life; Improve communication between the parents
D. Determine whether Kyle has ADHD; Reduce mother’s anxiety; Improve communication between the parents
Joanne, a 42-year-old woman has been attending weekly therapy for six months. She began therapy following a divorce and initially reported symptoms of severe depression. The client had a good relationship with the therapist and was making some progress, but had not achieved all goals. After six months of treatment, the client misses a scheduled appointment and abruptly stops coming to see the therapist. The therapist’s most appropriate action to address the ethical issues presented in this case would include:
A. Call the client to check-in and request payment for missed session in accordance with office policies.
B. Respect the client’s right to self-determination, send invoice for missed session and close the file.
C. Send letter to client including invoice for missed session and include appropriate referrals.
D. Send letter to client discussing missed session and offer to schedule termination session with client.
Joanne, a 42-year-old woman has been attending weekly therapy for six months. She began therapy following a divorce and initially reported symptoms of severe depression. The client had a good relationship with the therapist and was making some progress, but had not achieved all goals. After six months of treatment, the client misses a scheduled appointment and abruptly stops coming to see the therapist. The therapist’s most appropriate action to address the ethical issues presented in this case would include:
Score: 1 of 1
Correct
A. Call the client to check-in and request payment for missed session in accordance with office policies.
Rationale: The abrupt termination warrants further inquiry by the therapist (A). The therapist may bill the client for a missed session, if office policies permit. Respecting the client’s self-determination (B), sending out a letter regarding termination (D), or providing referrals (C) may be appropriate actions but only after attempting to gather more information. (Ethics)
B. Respect the client’s right to self-determination, send invoice for missed session and close the file.
C. Send letter to client including invoice for missed session and include appropriate referrals.
D. Send letter to client discussing missed session and offer to schedule termination session with client.
A therapist has been working with a client for over two years with a focus on the client’s social anxiety. The therapist believes the client has successfully completed therapy and begins the process of termination. The client’s initial reaction is one of surprise. The client states a lack of readiness and appears to feel rejected by the therapist. What actions should the therapist take to address the client’s reaction?
Score: 1 of 1
A. Normalize the client’s feelings toward termination and contract for additional sessions.
B. Process client’s feelings of rejection and collaborate with client to develop new treatment goals.
C. Normalize client’s reaction to termination and review client’s strengths and weaknesses.
D. Process client’s feelings in response to termination and focus on goals accomplished.
A therapist has been working with a client for over two years with a focus on the client’s social anxiety. The therapist believes the client has successfully completed therapy and begins the process of termination. The client’s initial reaction is one of surprise. The client states a lack of readiness and appears to feel rejected by the therapist. What actions should the therapist take to address the client’s reaction?
Score: 1 of 1
A. Normalize the client’s feelings toward termination and contract for additional sessions.
B. Process client’s feelings of rejection and collaborate with client to develop new treatment goals.
C. Normalize client’s reaction to termination and review client’s strengths and weaknesses.
Correct
D. Process client’s feelings in response to termination and focus on goals accomplished.
Rationale: It is common for clients to lose sight of the reason for treatment (symptom reduction and improvement of functioning) and it is therefore important to keep the client aware of the goals of treatment and stay focused on them (D). It would also be important to process their feelings to alleviate feelings of rejection. If therapy is successful and goals have been achieved, it would not be appropriate to contract for additional sessions (A) or develop new treatment goals without a clear need (B). Reviewing client’s strengths and weaknesses is not wrong, but it is not as helpful to the termination process as directly reflecting on goals achieved (C). (Treatment)
A 45-year-old gay man seeks therapy because of a long history of depression. He states that “in most areas of my life things are fine, but I have never had an emotional relationship that felt intimate.” He is estranged from his family, most of whom live in a different state and has few friends. He also reports being distanced from the gay community because he is not political and “after all, it is no different from being straight, except I have sex with guys.” Which of the following actions should the therapist take in this situation?
A. Conduct a comprehensive assessment to develop a treatment plan and determine need for referrals.
B. Explore the client’s estrangement from family, disconnection from the gay community and provide referrals
C. Conduct a comprehensive assessment and refer to psychiatrist for a medication evaluation to address depression.
D. Normalize client’s feelings and provide referrals for medication evaluation and support group.
A 45-year-old gay man seeks therapy because of a long history of depression. He states that “in most areas of my life things are fine, but I have never had an emotional relationship that felt intimate.” He is estranged from his family, most of whom live in a different state and has few friends. He also reports being distanced from the gay community because he is not political and “after all, it is no different from being straight, except I have sex with guys.” Which of the following actions should the therapist take in this situation?
Score: 0 of 1 Marked
Should have chosen
A. Conduct a comprehensive assessment to develop a treatment plan and determine need for referrals.
Rationale: A comprehensive assessment (A) is the next step in this situation, before any kinds of explorations, referrals, or suggestions would be made. The therapist needs to have a comprehensive understanding of the presenting complaint prior to making treatment interventions. Answer (B) would be pieces of the comprehensive assessment, making A a better answer. Both (C) and (D) might happen after the assessment is complete, but we do not have enough information to warrant these referrals with the information currently provided in the vignette. (Clinical Evaluation)
Incorrect
B. Explore the client’s estrangement from family, disconnection from the gay community and provide referrals
C. Conduct a comprehensive assessment and refer to psychiatrist for a medication evaluation to address depression.
D. Normalize client’s feelings and provide referrals for medication evaluation and support group.
A couple brings in their 13-year-old daughter to see a therapist in private practice. During the first session the mother tells the therapist that they have been wanting to bring the daughter in to see someone for a couple of years now, but she has been refusing to come to therapy until now. The parents complain their daughter is moody, irritable, and she reports no one at school likes her. Although these things have been going on for some time, it is the daughter’s recent demands that made the parents decide the situation was intolerable and brought the family to therapy. About two weeks ago she told her parents she wants to quit some of her extracurricular activities, as well as change schools. What would be the goal of an initial assessment for a Cognitive Behavioral Therapist versus a Solution Focused Therapist?
Score: 1 of 1
A. The CBT therapist would collaborate with the client to identify the cognitive distortions; the solution focused therapist would collaborate with the client to identify reasons she believes no one likes her
B. The CBT therapist would identify the problems confronting the client and collaborate to develop treatment plan; the solution focused therapist would ask the client how they will know things are better
C. The CBT therapist would collaborate with client to identify the symptoms; the solution focused therapist would ask the client how they would know things are better
D. The CBT therapist would collaborate with the client to define the problem; the solution focused therapist would ask the client how she would know things were better
A couple brings in their 13-year-old daughter to see a therapist in private practice. During the first session the mother tells the therapist that they have been wanting to bring the daughter in to see someone for a couple of years now, but she has been refusing to come to therapy until now. The parents complain their daughter is moody, irritable, and she reports no one at school likes her. Although these things have been going on for some time, it is the daughter’s recent demands that made the parents decide the situation was intolerable and brought the family to therapy. About two weeks ago she told her parents she wants to quit some of her extracurricular activities, as well as change schools. What would be the goal of an initial assessment for a Cognitive Behavioral Therapist versus a Solution Focused Therapist?
Score: 1 of 1
A. The CBT therapist would collaborate with the client to identify the cognitive distortions; the solution focused therapist would collaborate with the client to identify reasons she believes no one likes her
B. The CBT therapist would identify the problems confronting the client and collaborate to develop treatment plan; the solution focused therapist would ask the client how they will know things are better
C. The CBT therapist would collaborate with client to identify the symptoms; the solution focused therapist would ask the client how they would know things are better
Correct
D. The CBT therapist would collaborate with the client to define the problem; the solution focused therapist would ask the client how she would know things were better
Rationale: Answers (A) is out because identifying cognitive distortions is not a goal of initial assessments for CBT and solution focused does not focus on the problem. Answer B is incorrect because the therapist would not identify the problem and developing the treatment plan is not an initial goal of assessment. That leaves answers C and D. (D) is a better answer because the first part of the answer for CBT gives a fuller picture of the issue than just the identifying the symptoms. In CBT, it is called a functional analysis when the therapist understands when and where someone has symptoms so that the therapist can really understand and “define the problem.” (Treatment Planning)
A client presents to therapy with symptoms of fearfulness to leave the house, an avoidance of buses, and anxiety around other people. She adds that while she’s struggled with these issues her whole adult life it has gotten worse since her mother died five months ago. Which DSM 5 diagnoses should be considered in this case?
A. Agoraphobia; Generalized Anxiety Disorder; V. Uncomplicated Bereavement
B. Panic Disorder; Separation Anxiety; Adjustment Disorder
C. Agoraphobia; Separation Anxiety; Adjustment Disorder
D. Panic Disorder; Generalized Anxiety Disorder; V. Uncomplicated Bereavement
A client presents to therapy with symptoms of fearfulness to leave the house, an avoidance of buses, and anxiety around other people. She adds that while she’s struggled with these issues her whole adult life it has gotten worse since her mother died five months ago. Which DSM 5 diagnoses should be considered in this case?
Score: 1 of 1
Correct
A. Agoraphobia; Generalized Anxiety Disorder; V. Uncomplicated Bereavement
Rationale: Agoraphobia is our top answer here because she is afraid to go out. It is in (A) and (C). Both (B) and (D) have Panic Disorder and there is no indication of panic attacks so those are out. (C) has Separation Anxiety, which mainly happens with children and is not indicated here. Answer (A) also has Generalized Anxiety Disorder, which is possible with the anxiety around other people and V. Uncomplicated Bereavement is also possible with the death of her mother. So (A) is the best answer. (Clinical Evaluation)
B. Panic Disorder; Separation Anxiety; Adjustment Disorder
C. Agoraphobia; Separation Anxiety; Adjustment Disorder
D. Panic Disorder; Generalized Anxiety Disorder; V. Uncomplicated Bereavement
An African-American couple brings in their adult daughter, age 24, to therapy. The daughter has been living with them since she graduated from college a few years ago. The couple reports their daughter has been experiencing episodes of decompensation. In formatting an initial treatment plan, what would be the initial goals for treatment in this case?
A. An improvement in symptoms; increased ability to adapt to stress; ability to engage in everyday activities.
B. An improvement in symptoms; maintenance of social relationships; medication compliance.
C. Ability to articulate fears; willingness to leave the home; openness to trying new things.
D. Ability to articulate fears; reduction in cognitive distortions; increased socialization.
An African-American couple brings in their adult daughter, age 24, to therapy. The daughter has been living with them since she graduated from college a few years ago. The couple reports their daughter has been experiencing episodes of decompensation. In formatting an initial treatment plan, what would be the initial goals for treatment in this case?
Score: 1 of 1
Correct
A. An improvement in symptoms; increased ability to adapt to stress; ability to engage in everyday activities.
Rationale: Episodes of decompensation include: a temporary worsening of symptoms, a loss of the ability to adapt to normal changes and stress, and difficulty with normal activities of life. In short, an episode of decompensation refers to a time when you experience an increase in symptoms and a loss of function. With this definition in mind the best answer is (A). Even without knowing the definition, (B) would be knocked out because of the medication compliance; we don’t know if she’s on medication. (C) and (D) are out because there’s nothing about her being afraid, so “Ability to articulate fears” doesn’t make sense. (Treatment Planning)
B. An improvement in symptoms; maintenance of social relationships; medication compliance.
C. Ability to articulate fears; willingness to leave the home; openness to trying new things.
D. Ability to articulate fears; reduction in cognitive distortions; increased socialization.
A Middle Eastern family consisting of father Abir, mother Narin, mother’s sister Gulnar, 12-year-old Nadina, and her little brother Arman seek family therapy. They state that recently Nadina’s behavior has been a bit strange. She has become withdrawn, uninterested in things she used to love, and almost completely disengaged in family activities. “We decided to try family therapy this time, since last time, when Nadina was in therapy by herself it seemed to have made matters worse,” said Abir. When the therapist turns her attention to Nadina, she appears very shy and uncomfortable talking in front of her entire family. The therapist suggests an individual assessment during the first half of the next session. During that time, Nadina tells the therapist that her previous therapist used to masturbate in front of her. “He also said that I should also play with myself in front of him in order to loosen up and know my body better. So I did that a few times and now I feel completely ashamed of myself.” What action should the therapist take?
Score: 0 of 1
A. Inform Nadina that her parents must be told about the incident immediately.
B. Contact protective authorities.
C. Provide the brochure from the BBS and discuss the option of reporting the previous therapist to the licensing board.
D. Maintain confidentiality and deal with this as a clinical issue only.
A Middle Eastern family consisting of father Abir, mother Narin, mother’s sister Gulnar, 12-year-old Nadina, and her little brother Arman seek family therapy. They state that recently Nadina’s behavior has been a bit strange. She has become withdrawn, uninterested in things she used to love, and almost completely disengaged in family activities. “We decided to try family therapy this time, since last time, when Nadina was in therapy by herself it seemed to have made matters worse,” said Abir. When the therapist turns her attention to Nadina, she appears very shy and uncomfortable talking in front of her entire family. The therapist suggests an individual assessment during the first half of the next session. During that time, Nadina tells the therapist that her previous therapist used to masturbate in front of her. “He also said that I should also play with myself in front of him in order to loosen up and know my body better. So I did that a few times and now I feel completely ashamed of myself.” What action should the therapist take?
Score: 0 of 1
Incorrect
A. Inform Nadina that her parents must be told about the incident immediately.
Should have chosen
B. Contact protective authorities.
Rationale: The best answer is (B). The client is a minor and the therapist exposed himself to her. This constitutes a mandated report. (A) is wrong because the parents don’t HAVE to be informed, though the therapist may do it. (C) would be fine if the client were not a minor. And (D) is wrong because this is a case that qualifies as a mandated report. (Law)
C. Provide the brochure from the BBS and discuss the option of reporting the previous therapist to the licensing board.
D. Maintain confidentiality and deal with this as a clinical issue only.
44-year-old Angela comes to therapy with her 47-year-old husband, Ron, and their 14-year-old son. The wife has a bruise on her cheekbone and further questioning reveals presence of domestic violence in the family. The son comments, “My parents have been fighting ever since I was little. They hit each other but never hurt me or anything.” As the session progresses, Ron becomes more and more agitated and begins to yell at Angela while she is describing her view of the situation. The best course of action clinically would be:
A. interrupt current discussion; conduct separate individual assessments with each family member; refer the parents to individual therapists.
B. get up and open the door of the office; refer the wife to anger management group; refer the husband to a support group for batterers.
C. interrupt current discussion; refer the son to a support group for victims of DV; treat the couple conjointly.
D. get up and open the door of the office; refer parents to individual therapists; make a child protective services report.
44-year-old Angela comes to therapy with her 47-year-old husband, Ron, and their 14-year-old son. The wife has a bruise on her cheekbone and further questioning reveals presence of domestic violence in the family. The son comments, “My parents have been fighting ever since I was little. They hit each other but never hurt me or anything.” As the session progresses, Ron becomes more and more agitated and begins to yell at Angela while she is describing her view of the situation. The best course of action clinically would be:
Score: 0 of 1
Should have chosen
A. interrupt current discussion; conduct separate individual assessments with each family member; refer the parents to individual therapists.
Rationale: When there is a history of DV and the situation becomes heated in the session, the first thing a therapist can do to clinically manage the situation is to call a time out and interrupt current discussion. Since this is still an assessment stage, the presence of DV calls for separating family members and conducting individual assessment. Couples therapy is not recommended with couples that experience DV. Thus, answer (A) contains all of correct options. There is not enough information to suspect child abuse, thus (D) is wrong. A child witnessing DV is not enough to make a CPS report. The stem needs to indicate that the child is suffering as a result of witnessing DV. For instance, they are now depressed or suicidal. Treating the couple conjointly is not recommended, thus (C) is out. Opening the door would only be necessary if the time out technique did not work. Thus (B) is out as well. (Crisis Management)
Incorrect
B. get up and open the door of the office; refer the wife to anger management group; refer the husband to a support group for batterers.
C. interrupt current discussion; refer the son to a support group for victims of DV; treat the couple conjointly.
D. get up and open the door of the office; refer parents to individual therapists; make a child protective services report.
A 32-year-old male with an extensive criminal history has been in therapy for several months. His probation officer strongly encouraged him to receive therapy because of ongoing anger management and impulse control issues. The client informed the therapist at the onset of treatment that he was concerned about sharing information that could be used against him with his probation officer. In a session, he reveals the fact that he robbed a store 3 days ago. Legally, the therapist should:
Score: 1 of 1
A. Determine if the client physically threatened anyone and consider making a police report.
B. Inform the client that his probation officer must be informed since it is a violation of his probation.
C. Maintain confidentiality and process the consequences of the client’s criminal activity.
D. Maintain confidentiality and process the incident with the client.
A 32-year-old male with an extensive criminal history has been in therapy for several months. His probation officer strongly encouraged him to receive therapy because of ongoing anger management and impulse control issues. The client informed the therapist at the onset of treatment that he was concerned about sharing information that could be used against him with his probation officer. In a session, he reveals the fact that he robbed a store 3 days ago. Legally, the therapist should:
Score: 1 of 1
A. Determine if the client physically threatened anyone and consider making a police report.
B. Inform the client that his probation officer must be informed since it is a violation of his probation.
C. Maintain confidentiality and process the consequences of the client’s criminal activity.
Correct
D. Maintain confidentiality and process the incident with the client.
Rationale: Making a police report, even if someone was harmed (A) or informing the probation officer (B) would break the client’s confidentiality that we are legally required to maintain. A would only be true if the stem indicated the client harmed someone and that victim were a minor/elder or dependent. Answer C is incorrect because we would want to more generally process the incident with the client rather than focus on the specific consequences. Therapists are not legally required to break confidentiality and report past acts of violence, thus answer option (D) is correct. (Law)
57-year-old Nolan and 54-year-old Luisa seek treatment due to marital discord. Luisa complains “Nolan is always quiet when he gets home from work. It’s as if we have nothing to talk about, nothing in common.” Nolan utters “Ever since the kids went off to college, all Luisa does is rearrange their rooms and tries to rent them out on Airbnb. She is bored and disinterested with me.” How should the therapist proceed during the first session?
Score: 1 of 1
A. Conduct an inventory of the couple’s attachment style; ask the couple what brought them together; figure out what conflict looks like between the two of them
B. Conduct an inventory of the couple’s attachment style; provide psychoeducation to the couple about the life stages; discuss their relational history
C. Ask the couple to each put themselves into the shoes of their partner and describe their experience; figure out what conflict looks like between the two of them; conduct an inventory of the couple’s attachment style
D. Schedule individual sessions with each member of the couple; provide psychoeducation to the couple about the life stages; ask the couple what brought them together
57-year-old Nolan and 54-year-old Luisa seek treatment due to marital discord. Luisa complains “Nolan is always quiet when he gets home from work. It’s as if we have nothing to talk about, nothing in common.” Nolan utters “Ever since the kids went off to college, all Luisa does is rearrange their rooms and tries to rent them out on Airbnb. She is bored and disinterested with me.” How should the therapist proceed during the first session?
Score: 1 of 1
A. Conduct an inventory of the couple’s attachment style; ask the couple what brought them together; figure out what conflict looks like between the two of them
Correct
B. Conduct an inventory of the couple’s attachment style; provide psychoeducation to the couple about the life stages; discuss their relational history
Rationale: The first thing for the therapist to do when the couple presents with a life stage issue is to provide psychoeducation, normalize their feelings, and conduct a comprehensive assessment (B). Answer (A) describes various assessment questions that we might use, but it does not address the issue of the life stages, which makes (B) a better answer. The first part of answer (C) is not going to be something we do right away. This might be an intervention we use during later sessions. The first part of answer (D) is unnecessary since the only time we would have to separate the couple would be if we suspect DV or abuse. Neither of those are indicated in the stem, thus we will not separate Nolan and Luisa. (Clinical Evaluation)
C. Ask the couple to each put themselves into the shoes of their partner and describe their experience; figure out what conflict looks like between the two of them; conduct an inventory of the couple’s attachment style
D. Schedule individual sessions with each member of the couple; provide psychoeducation to the couple about the life stages; ask the couple what brought them together
Nathan, age 5, is brought to therapy by his mother Linda because he has been acting out at kindergarten. The school told Linda that Nathan won’t stay in his seat, frequently interrupts the class, and has been aggressive with his peers. Linda shares that the family recently moved across country to live with Linda’s parents because Nathan’s father was physically abusive toward both her and Nathan. Linda starts to cry and says, “I know why he’s acting this way.” After informing Linda that a child abuse report must be filed, how should the therapist proceed in this case?
Score: 1 of 1
A. Process her feelings about the report and refer her to a domestic violence support group.
B. Explore the nature of the abuse and obtain a release to speak to the school.
C. Explore the nature of the abuse and observe how Linda interacts with her son.
D. Process her feelings about the report and instill hope that therapy can help her son process the trauma he has experienced.
Nathan, age 5, is brought to therapy by his mother Linda because he has been acting out at kindergarten. The school told Linda that Nathan won’t stay in his seat, frequently interrupts the class, and has been aggressive with his peers. Linda shares that the family recently moved across country to live with Linda’s parents because Nathan’s father was physically abusive toward both her and Nathan. Linda starts to cry and says, “I know why he’s acting this way.” After informing Linda that a child abuse report must be filed, how should the therapist proceed in this case?
Score: 1 of 1
A. Process her feelings about the report and refer her to a domestic violence support group.
B. Explore the nature of the abuse and obtain a release to speak to the school.
C. Explore the nature of the abuse and observe how Linda interacts with her son.
Correct
D. Process her feelings about the report and instill hope that therapy can help her son process the trauma he has experienced.
Rationale: The best answer is (D). You would want to start by processing the client’s feelings and then instill hope that you can help her son. All the other components in the other answers could be done at some point, but instilling hope would be important in this case. It’s important to note that the answer is not claiming the therapist can make everything better, but is just saying that the son will have a place where he can process what has happened. (Treatment)
A therapist is treating a client who is 5 months pregnant. The woman experienced postpartum depression after the birth of her first child and fears she is likely to experience it again once her second child is born. She recently informed her employer that she was pregnant and planning to take maternity leave following the birth of the child. Shortly after sharing her intentions, she received written notice of termination from employment due to “personnel conflicts.” What action should the therapist take in this case?
Score: 1 of 1
A. Encourage the client to request disability insurance and refer to psychiatrist to address risk of postpartum depression.
B. Explore what coping skills helped the client after birth of first child and refer to psychiatrist
C. Refer client to legal services regarding termination and explore appropriate support for postpartum depression.
D. Encourage her to confront the manager about her termination and refer for legal services.
A therapist is treating a client who is 5 months pregnant. The woman experienced postpartum depression after the birth of her first child and fears she is likely to experience it again once her second child is born. She recently informed her employer that she was pregnant and planning to take maternity leave following the birth of the child. Shortly after sharing her intentions, she received written notice of termination from employment due to “personnel conflicts.” What action should the therapist take in this case?
Score: 1 of 1
A. Encourage the client to request disability insurance and refer to psychiatrist to address risk of postpartum depression.
B. Explore what coping skills helped the client after birth of first child and refer to psychiatrist
Correct
C. Refer client to legal services regarding termination and explore appropriate support for postpartum depression.
Rationale: The client has presented a legal issue to the therapist, which is outside the therapist’s scope of practice. Therefore, the therapist would best serve the client by encouraging her to seek legal advice by someone qualified to provide those services. Answer C addresses both the legal needs and postpartum depression making it the best answer. Encouraging the client to request disability insurance does not address the potential legal issues that arise in this case and the psychiatrist may or may not be appropriate at this time (B). Confronting the manager could be detrimental to the client if she is to pursue legal action (D). (Ethics)
D. Encourage her to confront the manager about her termination and refer for legal services.
Rosaria, a 70-year-old woman, is referred by her doctor. On the phone with the therapist, Rosaria discloses that for some time now she has been experiencing trouble recalling recent events or recognizing people and places. “I cannot remember what I ate yesterday or where I put my keys for the life of me. I am so frustrated all the time. And I am really terrified that there will come a day when I will not recognize my husband or my kids. What is going to happen to me?!” she exclaims with tears in her voice. The doctor gave her the diagnosis of dementia. Rosaria is upset and scared. She says that she wants to involve her entire family in therapy with the therapist. What should the therapist do first?
Score: 0 of 1
A. Conduct research on dementia in order to gain knowledge of the disease; make an initial appointment just for Rosaria; consult with her doctor regarding the best course of treatment
B. Obtain a release to speak with her doctor and determine the stage of her disease; make an initial appointment for Rosaria’s entire family; make sure that this case is within the therapist’s scope of competence
C. Make an initial appointment just for Rosaria; make sure that this case is within the therapist’s scope of competence; obtain a release to speak with her doctor during the initial appointment
D. Make an initial appointment for Rosaria’s entire family; obtain a release to speak with Rosaria’s doctor; conduct research on dementia in order to gain knowledge of the disease
Rosaria, a 70-year-old woman, is referred by her doctor. On the phone with the therapist, Rosaria discloses that for some time now she has been experiencing trouble recalling recent events or recognizing people and places. “I cannot remember what I ate yesterday or where I put my keys for the life of me. I am so frustrated all the time. And I am really terrified that there will come a day when I will not recognize my husband or my kids. What is going to happen to me?!” she exclaims with tears in her voice. The doctor gave her the diagnosis of dementia. Rosaria is upset and scared. She says that she wants to involve her entire family in therapy with the therapist. What should the therapist do first?
Score: 0 of 1
A. Conduct research on dementia in order to gain knowledge of the disease; make an initial appointment just for Rosaria; consult with her doctor regarding the best course of treatment
Incorrect
B. Obtain a release to speak with her doctor and determine the stage of her disease; make an initial appointment for Rosaria’s entire family; make sure that this case is within the therapist’s scope of competence
Should have chosen
C. Make an initial appointment just for Rosaria; make sure that this case is within the therapist’s scope of competence; obtain a release to speak with her doctor during the initial appointment
Rationale: Meeting just with the client (C) would be what the therapist should do first in order to complete assessment and come up with a treatment plan. It would also be important to make sure that the therapist has experience working with someone with such a diagnosis. Since there is another provider involved, it is best practice to obtain a release right away to coordinate care. Both answers (B) and (D) will be out since we are going to meet with our client first before involving her family. She was not referred for family therapy, so we will see her individually first, build rapport, conduct assessment and then determine the best way and time to involve the family–she does not specify how she wants the family involved so this does not interfere with self-determination. Answer (A) is not the best here, since we will initially meet with Rosaria, conduct our own assessment, and only then consult with her doctor. Plus the option of having Rosaria sign a release that is present in (C) is better than the option of speaking with her doctor right away. One would come before the other. (Clinical Evaluation)
D. Make an initial appointment for Rosaria’s entire family; obtain a release to speak with Rosaria’s doctor; conduct research on dementia in order to gain knowledge of the disease
A therapist is conducting an intake interview with Athena, a 48-year-old woman. Athena has experienced episodes of depression throughout her life. When she was 6 year old her older brother died in a car accident. According to her, this event completely pulled her family apart and she was lost between her mother’s grief and her father’s depression. At the end of the session she asks, “How would I know when therapy is over?” How would a Cognitive Behavioral Therapist respond to this inquiry?
Score: 1 of 1
A. You will tell me what your goals for therapy are, and when you reach those goals we will terminate.
B. We will collaborate on formulating our treatment goals, and I will tell you when it is time to terminate.
C. I will determine what the treatment goals are based on what you told me, and once you feel that you have reached them we will terminate.
D. We will collaborate on formulating the treatment goals and once we’ve determined you are close to reaching your goals we will discuss maintaining progress and begin termination.
A therapist is conducting an intake interview with Athena, a 48-year-old woman. Athena has experienced episodes of depression throughout her life. When she was 6 year old her older brother died in a car accident. According to her, this event completely pulled her family apart and she was lost between her mother’s grief and her father’s depression. At the end of the session she asks, “How would I know when therapy is over?” How would a Cognitive Behavioral Therapist respond to this inquiry?
Score: 1 of 1
A. You will tell me what your goals for therapy are, and when you reach those goals we will terminate.
B. We will collaborate on formulating our treatment goals, and I will tell you when it is time to terminate.
C. I will determine what the treatment goals are based on what you told me, and once you feel that you have reached them we will terminate.
Correct
D. We will collaborate on formulating the treatment goals and once we’ve determined you are close to reaching your goals we will discuss maintaining progress and begin termination.
Rationale: One of the tenets of CBT therapy is a collaborative stance. Answer (D) reflects such collaboration and includes proper protocol for termination, which is spreading out the sessions. Answers (A), (B), and (C) do not suggest collaboration and give either client or the therapist too much control. (Treatment)
A therapist is meeting with a 37-year-old computer programmer. The client was encouraged to attend therapy by his brother who is seeing another therapist in the same counseling center. The client tells the therapist that he is very content at his job and actually is in charge of a big project at his firm. “The improvement I am working on would reinvent the entire system of how we do things at the company. This is a huge responsibility and people are looking to me to develop the best way to move forward. So I have been working around the clock.” During an intake interview a therapist also learns that the client has 6-7 alcoholic beverages a night. In addition, client tells the therapist that he has been experiencing headaches and blurry vision. Which of the following referrals is most important in this case? What should be the therapist’s first referral for the client?
Score: 1 of 1
A. Alcoholics Anonymous because the client is abusing alcohol regularly and is not indicating any level of denial.
B. A general medical practitioner because the client is abusing alcohol and is experiencing physical symptoms.
C. An outpatient substance abuse treatment facility because the client is abusing alcohol, but is functional at work.
D. A neurologist to assess for head trauma because the physical symptoms listed are commonly linked to head trauma injuries.
A therapist is meeting with a 37-year-old computer programmer. The client was encouraged to attend therapy by his brother who is seeing another therapist in the same counseling center. The client tells the therapist that he is very content at his job and actually is in charge of a big project at his firm. “The improvement I am working on would reinvent the entire system of how we do things at the company. This is a huge responsibility and people are looking to me to develop the best way to move forward. So I have been working around the clock.” During an intake interview a therapist also learns that the client has 6-7 alcoholic beverages a night. In addition, client tells the therapist that he has been experiencing headaches and blurry vision. Which of the following referrals is most important in this case? What should be the therapist’s first referral for the client?
Score: 1 of 1
A. Alcoholics Anonymous because the client is abusing alcohol regularly and is not indicating any level of denial.
Correct
B. A general medical practitioner because the client is abusing alcohol and is experiencing physical symptoms.
Rationale: AA might be an appropriate referral after dealing with the physical issues (A). The client’s symptoms require immediate medical attention and most likely in-patient detox so (C) is out. If the client had bizarre symptoms, such as smelling a tangerine all the time, then we would refer him to the neurologist, but he is not having those symptoms so (D) is out. Thus, the correct answer is (B), which will include sending the client to an emergency room if he does not have a regular doctor. The main thing is for him to see a doctor due to the symptoms of headaches and blurry vision. (Crisis Management)
C. An outpatient substance abuse treatment facility because the client is abusing alcohol, but is functional at work.
D. A neurologist to assess for head trauma because the physical symptoms listed are commonly linked to head trauma injuries.
Natalia, a 47-year-old, and Igor, a 49-year-old, come in with their 16-year-old daughter Olga. They are referred by Olga’s school. The initial assessment indicates that Olga has all the symptoms of anorexia. Natalia complains that all their attention is focused on Olga. Who should the therapist’s unit of treatment be?
Score: 0 of 1 Marked
A. The parents to strengthen their relationship in light of the mother’s expressed concern about the family dynamics.
B. The daughter alone since the assessment indicates she has symptoms of anorexia that must be addressed.
C. The entire family in light of the mother’s expressed concern about the family dynamics.
D. The mother alone in light of her expressed concern about the family dynamics.
Natalia, a 47-year-old, and Igor, a 49-year-old, come in with their 16-year-old daughter Olga. They are referred by Olga’s school. The initial assessment indicates that Olga has all the symptoms of anorexia. Natalia complains that all their attention is focused on Olga. Who should the therapist’s unit of treatment be?
Score: 0 of 1 Marked
A. The parents to strengthen their relationship in light of the mother’s expressed concern about the family dynamics.
Incorrect
B. The daughter alone since the assessment indicates she has symptoms of anorexia that must be addressed.
Should have chosen
C. The entire family in light of the mother’s expressed concern about the family dynamics.
Rationale: One of the best ways to determine the unit of treatment is to see who is in the room with you. Since the whole family is here right now, and one of the presenting complaints is that the family’s complete focus is on the daughter, it is safe to say that the entire family should be the unit of treatment. Seeing the daughter (B), the mother (D), or the parents (A) alone will not help the family deal with the complaint that was brought up. (Clinical Evaluation)
D. The mother alone in light of her expressed concern about the family dynamics.
A therapist received a phone call from a concerned mother regarding her 15-year-old son. She states that he is withdrawn and is exhibiting bizarre symptoms like staying up all night, not eating, and grinding his teeth constantly. What is the most likely diagnosis?
Score: 1 of 1
A. Bipolar II
B. Amphetamine abuse
C. Unspecified Depressive Disorder
D. Cannabis abuse
A therapist received a phone call from a concerned mother regarding her 15-year-old son. She states that he is withdrawn and is exhibiting bizarre symptoms like staying up all night, not eating, and grinding his teeth constantly. What is the most likely diagnosis?
Score: 1 of 1
A. Bipolar II
Correct
B. Amphetamine abuse
Rationale: The combination of indicated symptoms, particularly grinding teeth, point to Amphetamine abuse (B). There are no symptoms, such as impaired coordination, or sensation of slowed time to indicate Cannabis use (D). There are not enough symptoms to indicate hypomania, thus (A) is out. One might consider a Depression NOS diagnosis (C), due to impaired sleeping and eating, but teeth grinding would point towards Amphetamine use. (Clinical Evaluation)
C. Unspecified Depressive Disorder
D. Cannabis abuse
A therapist is working with Gregory, an 82-year-old Irish American man, who now lives in assisted living housing. When the therapist first approached the client he was resistant and unwilling to talk. “You are so much younger than me. What is it that you have to offer me?” he asks the therapist. During the third session, when the therapist asked Gregory to look back at his life and share any highlights that come to mind, the client suddenly perked up and willingly shared a number of stories. In working with the elderly, what is the objective of employing a Life Review as an intervention?
A. Provide clients with an opportunity for closure; communicate a sense of respect; and help clients recognize the sense of meaning developed over the course of for their lives.
B. Help clients recognize the meaning developed over the course of their lives; assess clients for possible signs of dementia; provide clients with an opportunity for closure.
C. Develop appropriate goals for treatment; provide clients with an opportunity for closure; communicate a sense of respect
D. Communicate a sense of respect; review client’s movement through various developmental stages; help clients recognize the meaning developed over the course of their lives
A therapist is working with Gregory, an 82-year-old Irish American man, who now lives in assisted living housing. When the therapist first approached the client he was resistant and unwilling to talk. “You are so much younger than me. What is it that you have to offer me?” he asks the therapist. During the third session, when the therapist asked Gregory to look back at his life and share any highlights that come to mind, the client suddenly perked up and willingly shared a number of stories. In working with the elderly, what is the objective of employing a Life Review as an intervention?
Score: 1 of 1
Correct
A. Provide clients with an opportunity for closure; communicate a sense of respect; and help clients recognize the sense of meaning developed over the course of for their lives.
Rationale: A Life Review is a supportive tool for client’s mental health. It is an opportunity to communicate a sense of respect and reverence to the clients regarding their past accomplishments and sorrows. It provides clients with a possibility to gain closure. Thus (A) is the correct answer. A Life Review is not used as an assessment tool, thus (B) and (D) are out. Goals for treatment (C) might come out of the Life Review, but that is not the main function of such an intervention. (Treatment)
B. Help clients recognize the meaning developed over the course of their lives; assess clients for possible signs of dementia; provide clients with an opportunity for closure.
C. Develop appropriate goals for treatment; provide clients with an opportunity for closure; communicate a sense of respect
D. Communicate a sense of respect; review client’s movement through various developmental stages; help clients recognize the meaning developed over the course of their lives
Sally, a 66-year-old widow who lost her husband five months ago, is self-referred. Sally recently retired from her job at the post office. Lately, she has lost her appetite and has been having trouble sleeping and concentrating. She reports that the only thing she enjoys anymore is spending time with her 8-year-old granddaughter. She takes her to school and to ballet practice. Otherwise, Sally just feels useless and is concerned that she will become a burden to her daughter’s family. She tears up when she says, “I’m having a hard time getting old. I hate being alone. I still pretend my husband is just at work. I keep praying that he’ll come back. I now know why my husband used to refer to his drink as ‘old faithful.’” What initial interventions should the therapist consider in the case provided in the vignette?
A. Acknowledge the changes that have occurred in her life and assess her safety.
B. Identify potential volunteer opportunities and assess her level of alcohol use.
C. Provide psychoeducation about life stages and assess her safety.
D. Determine her level of social support and provide psychoeducation about grief and loss.
Sally, a 66-year-old widow who lost her husband five months ago, is self-referred. Sally recently retired from her job at the post office. Lately, she has lost her appetite and has been having trouble sleeping and concentrating. She reports that the only thing she enjoys anymore is spending time with her 8-year-old granddaughter. She takes her to school and to ballet practice. Otherwise, Sally just feels useless and is concerned that she will become a burden to her daughter’s family. She tears up when she says, “I’m having a hard time getting old. I hate being alone. I still pretend my husband is just at work. I keep praying that he’ll come back. I now know why my husband used to refer to his drink as ‘old faithful.’” What initial interventions should the therapist consider in the case provided in the vignette?
Score: 1 of 1
Correct
A. Acknowledge the changes that have occurred in her life and assess her safety.
Rationale: Answer (A) is the best answer. You’d want to start by acknowledging what she’s been through and finding out if she has any thoughts of harming herself. (B) is jumping too quickly to having her volunteer. Psychoeducation about life stages could be done, but acknowledging the changes would come first (C). Determining her level of social support is more of an assessment activity than an intervention (D). (Crisis Management)
B. Identify potential volunteer opportunities and assess her level of alcohol use.
C. Provide psychoeducation about life stages and assess her safety.
D. Determine her level of social support and provide psychoeducation about grief and loss.
Maria, a Mexican American, brings her 58-year-old mother, Ana, in for therapy. Maria says that she is very concerned about her mother, because she has not been the same since her husband died four weeks ago. Maria relays that her mother hasn’t been able to get out of bed. Ana reports seeing and hearing her husband everywhere. According to Maria, her mother never had any type of psychological symptoms previously. What is the therapist’s priority in this case?
Score: 1 of 1
A. Refer Ana to a general medical practitioner for a physical and medical evaluation.
B. Refer Ana to a psychiatrist for evaluation due to symptoms of delusional disorder.
C. Explore the family’s cultural views about grief and dying.
D. Refer Ana to a psychiatrist if symptoms persist after two months.
Maria, a Mexican American, brings her 58-year-old mother, Ana, in for therapy. Maria says that she is very concerned about her mother, because she has not been the same since her husband died four weeks ago. Maria relays that her mother hasn’t been able to get out of bed. Ana reports seeing and hearing her husband everywhere. According to Maria, her mother never had any type of psychological symptoms previously. What is the therapist’s priority in this case?
Score: 1 of 1
A. Refer Ana to a general medical practitioner for a physical and medical evaluation.
B. Refer Ana to a psychiatrist for evaluation due to symptoms of delusional disorder.
Correct
C. Explore the family’s cultural views about grief and dying.
Rationale: A complete assessment is the first thing that the therapist should do. Exploring family’s cultural views about grief and dying (C) should be part of the assessment process. If communicating with the spirit of the dead is a normal part of the culture, then referring Ana to an M.D. (A) or a psychiatrist (B) would not be necessary and we risk pathologizing behavior that is normal in the cultural context. The therapist might refer Ana to an M.D. (D) if the symptoms are persistent and abnormal for the client but only after completing comprehensive assessment. (Clinical Evaluation)
D. Refer Ana to a psychiatrist if symptoms persist after two months.
Elizabeth, a 19-year-old college student, comes to therapy complaining of body image issues. She is average weight, which makes her unhappy and she wishes she were skinnier. “I am constantly on a diet,” she states “and once a week I feel so bad about eating even a little bit of food that I have to throw up to feel better.” Elizabeth’s likely diagnosis is:
Score: 1 of 1
A. Anorexia nervosa
B. Bulimia nervosa
C. Unspecified eating disorder
D. Body dysmorphic disorder
Elizabeth, a 19-year-old college student, comes to therapy complaining of body image issues. She is average weight, which makes her unhappy and she wishes she were skinnier. “I am constantly on a diet,” she states “and once a week I feel so bad about eating even a little bit of food that I have to throw up to feel better.” Elizabeth’s likely diagnosis is:
Score: 1 of 1
A. Anorexia nervosa
B. Bulimia nervosa
Correct
C. Unspecified eating disorder
Rationale: Since Elizabeth is of average weight, the diagnosis of anorexia nervosa is out (A). Elizabeth does not meet full criteria for bulimia nervosa (B) because for such diagnosis to be present one must engage in binging and compensatory behaviors at least once a week for three months. Thus, the correct answer is (C). (D) is out because her symptoms are better accounted for by the diagnosis of unspecified eating disorder. (Clinical Evaluation)
D. Body dysmorphic disorder
Justin is referred to therapy by his EAP for 6 sessions to work on issues of social isolation and poor job performance. Initial assessment indicates the fact that Justin will need more than 6 sessions to deal with his chief complaints. After contacting Justin’s EAP provider and advocating for additional sessions, the therapist learns that they will still only allow 6 sessions. How should the therapist proceed?
Score: 0 of 1
A. Focus on the underlying causes of behavior during 6 sessions then refer out or discuss payment options if continued support is indicated.
B. Explain the EAP’s restrictions to the client and provide client with referrals to a different therapist.
C. Explain the EAP’s restrictions to the client and collaboratively identify appropriate treatment goals for short-term therapy.
D. Explain the EAP’s restrictions and process referral limitations with client.
Justin is referred to therapy by his EAP for 6 sessions to work on issues of social isolation and poor job performance. Initial assessment indicates the fact that Justin will need more than 6 sessions to deal with his chief complaints. After contacting Justin’s EAP provider and advocating for additional sessions, the therapist learns that they will still only allow 6 sessions. How should the therapist proceed?
Score: 0 of 1
A. Focus on the underlying causes of behavior during 6 sessions then refer out or discuss payment options if continued support is indicated.
B. Explain the EAP’s restrictions to the client and provide client with referrals to a different therapist.
Should have chosen
C. Explain the EAP’s restrictions to the client and collaboratively identify appropriate treatment goals for short-term therapy.
Rationale: (A) would not be the way to proceed because we would want expectations to be clear at onset of therapy, not following the completion of 6 sessions. Answer (B) is incorrect because it would still leave him with the same amount of sessions with just a different therapist. Answer (D) is not as strong as the correct answer because we are just processing the limitations with the client rather than working within the clearly defined parameters noted in the vignette. Thus, talking to Justin and developing goals that are of appropriate depth and length (C) is the most optimal solution to the situation. (Ethics)
Incorrect
D. Explain the EAP’s restrictions and process referral limitations with client.
A therapist has been treating a client with schizophrenia who lives in a group home for those with severe mental illness. In one session, he states, “I feel like my conservator controls all of my life and financial decisions and I don’t like that; he is stealing my money.” How should the therapist proceed?
Score: 1 of 1
A. Maintain confidentiality and process with your client how he can no longer be under the control of the conservator.
B. Call the conservator and express your concern about how he manages your client’s financial matters.
C. Become familiar with parties involved and their respective rights and responsibilities as ordered by the court.
D. Ensure your client that his conservator is not stealing his money and practice reality testing techniques.
A therapist has been treating a client with schizophrenia who lives in a group home for those with severe mental illness. In one session, he states, “I feel like my conservator controls all of my life and financial decisions and I don’t like that; he is stealing my money.” How should the therapist proceed?
Score: 1 of 1
A. Maintain confidentiality and process with your client how he can no longer be under the control of the conservator.
B. Call the conservator and express your concern about how he manages your client’s financial matters.
Correct
C. Become familiar with parties involved and their respective rights and responsibilities as ordered by the court.
Rationale: (C) is the best answer. When working with a client who is a conservatee, you will need to work with both the conservator and conservatee. It is good to know what powers the conservator was granted by the court, as this can vary on a case-by-case basis. (A) is out because it isn’t the client’s choice to have a conservator or not. (B) is breaking your client’s confidentiality (a client with a conservator still has the right to confidentiality). (D) is out because there is no way we would not want to dismiss the claim outright without first receiving additional information. (Law and Ethics)
D. Ensure your client that his conservator is not stealing his money and practice reality testing techniques.
A therapist is meeting with a gender non-conforming teen. The teen tells the therapist that things have been tough for her recently. Even though she has a good group of friends at school, her parents at home just do not understand what she is all about. They want her to stop dying and cutting her hair and grow it out. They keep pressuring her to dress in a more traditional manner and do not allow her to be active in any of the LGBTQ community affairs. Meanwhile, she is trying to figure out her own sexual identity and gender preferences. “Having my family’s voice be so loud, drowns out my own,” she shares. What should a Solution Focused therapist do in formulating treatment goals?
Score: 0 of 1
A. Define the problem; break down the goals into small steps to focus on each week; identify client strengths.
B. Challenge the client’s definition of the problem; compliment client competencies; visualize client’s future
C. Ask how the client has coped in the past and help relocate the resources; compliment client competencies; visualize client’s future
D. Clarify achievable goals with the client; identify client strengths; compliment client competencies.
A therapist is meeting with a gender non-conforming teen. The teen tells the therapist that things have been tough for her recently. Even though she has a good group of friends at school, her parents at home just do not understand what she is all about. They want her to stop dying and cutting her hair and grow it out. They keep pressuring her to dress in a more traditional manner and do not allow her to be active in any of the LGBTQ community affairs. Meanwhile, she is trying to figure out her own sexual identity and gender preferences. “Having my family’s voice be so loud, drowns out my own,” she shares. What should a Solution Focused therapist do in formulating treatment goals?
Score: 0 of 1
A. Define the problem; break down the goals into small steps to focus on each week; identify client strengths.
B. Challenge the client’s definition of the problem; compliment client competencies; visualize client’s future
Incorrect
C. Ask how the client has coped in the past and help relocate the resources; compliment client competencies; visualize client’s future
Should have chosen
D. Clarify achievable goals with the client; identify client strengths; compliment client competencies.
Rationale: In the early stage of therapy, a Solution Focused therapist works with the client to clarify achievable goals and identifies the client strengths. Complimenting a client is a classic SF intervention (D). Solution focused therapists generally do not focus on client problems (A) or (B). Asking clients how they have coped in past and identifying resources (C) is a middle stage intervention. (Treatment Planning)
A therapist in private practice is conducting a weekly support group for postpartum mothers. During a group discussion about the challenges new mothers confront, one of the mothers begins to sob and says she is struggling to get through each day. She notes that she has lost interest in daily activities, spends most of the day in bed and feels disconnected from her husband and baby. How should the therapist clinically manage the client’s disclosure?
A. Provide psychoeducation to group about postpartum blues; explore if other group members feel the same; refer to individual therapy.
B. Meet with client after group: assess for suicide; refer to individual therapy.
C. Normalize the client’s experience; explore if other group members feel the same; refer to individual therapy.
D. Provide psychoeducation to group about postpartum blues; help client identify supports; explore ways to improve connection to family.
A therapist in private practice is conducting a weekly support group for postpartum mothers. During a group discussion about the challenges new mothers confront, one of the mothers begins to sob and says she is struggling to get through each day. She notes that she has lost interest in daily activities, spends most of the day in bed and feels disconnected from her husband and baby. How should the therapist clinically manage the client’s disclosure?
Score: 0 of 1
Incorrect
A. Provide psychoeducation to group about postpartum blues; explore if other group members feel the same; refer to individual therapy.
Should have chosen
B. Meet with client after group: assess for suicide; refer to individual therapy.
Rationale: What can we eliminate? (A) and (D) are out because this is more than “blues.” That leaves (B) and (C). (B) is the best because it meets with the client privately, assesses for risk, and refers her to individual therapy which is indicated. (C) is problematic because it normalizes something that, while common, is not “normal.” It also invites others to say if they have the same thing and there is a good chance that no one else is feeling as bad as this; so it could increase the client’s shame. (B) is the better option as it responds to the severity of the woman’s complaint. (Crisis Management)
C. Normalize the client’s experience; explore if other group members feel the same; refer to individual therapy.
D. Provide psychoeducation to group about postpartum blues; help client identify supports; explore ways to improve connection to family.
A 24-year-old Asian-American woman is referred to a therapist by her doctor. She tearfully reports that six months ago she was diagnosed with Lupus. She shares that her boyfriend of two years broke up with her a few months ago because he couldn’t deal with the news and that she has been having a hard time getting out of bed to get to work. She recently moved in with her parents and states, “My parents say that I am depressed but my doctor says it is part of the disease.” She appears clean but disheveled. What action should the therapist take first:
Score: 1 of 1
A. Provide the client with psychoeducation about how Lupus causes depression.
B. Obtain a signed release of information to consult with the referring doctor.
C. Ask how the client views the impact of Lupus on her mental health.
D. Explore how Lupus is viewed in Asian-American culture.
A 24-year-old Asian-American woman is referred to a therapist by her doctor. She tearfully reports that six months ago she was diagnosed with Lupus. She shares that her boyfriend of two years broke up with her a few months ago because he couldn’t deal with the news and that she has been having a hard time getting out of bed to get to work. She recently moved in with her parents and states, “My parents say that I am depressed but my doctor says it is part of the disease.” She appears clean but disheveled. What action should the therapist take first:
Score: 1 of 1
A. Provide the client with psychoeducation about how Lupus causes depression.
B. Obtain a signed release of information to consult with the referring doctor.
Correct
C. Ask how the client views the impact of Lupus on her mental health.
Rationale: The client has indicated that her parents and her doctor have different views of her symptoms. The best place to start would be asking her views on the problem (C). The client has had a lot of changes in the past few months that are likely to affect her mental health in addition to the Lupus. Answer (A) sides with the doctor without taking in to account the other issues. (B) could be done as some point, but not when the therapist is initially connecting with the client. (D) could also be done at some point once the therapist is cleared on how the client views her situation. (Clinical Evaluation)
D. Explore how Lupus is viewed in Asian-American culture.
A six-year-old child lives with a foster family. His father is in prison and his mother is in residential treatment for alcohol dependence. The child is small for his age, often has temper outbursts, and has difficulty completing schoolwork. The therapist notes that his speech is immature. What interventions should the therapist consider?
Score: 0 of 1
A. Request the child’s file from the social worker; work with the foster parents on a behavior modification plan; obtain a release to speak to the teacher
B. Suggest that the child’s teacher refer him for special education placement; have the parents sign a release authorizing the therapist to speak to a social worker; obtain a release to speak to the teacher
C. Refer the child for assessment for fetal alcohol syndrome; gather child’s history; request the child’s file from the social worker
D. Refer the child for assessment for fetal alcohol syndrome; work with the child’s biological mother toward reunification; suggest that the child’s teacher refer him for special education placement
A six-year-old child lives with a foster family. His father is in prison and his mother is in residential treatment for alcohol dependence. The child is small for his age, often has temper outbursts, and has difficulty completing schoolwork. The therapist notes that his speech is immature. What interventions should the therapist consider?
Score: 0 of 1
A. Request the child’s file from the social worker; work with the foster parents on a behavior modification plan; obtain a release to speak to the teacher
Incorrect
B. Suggest that the child’s teacher refer him for special education placement; have the parents sign a release authorizing the therapist to speak to a social worker; obtain a release to speak to the teacher
Should have chosen
C. Refer the child for assessment for fetal alcohol syndrome; gather child’s history; request the child’s file from the social worker
Rationale: Proper assessment is going to inform the treatment plan developed by the therapist. The child’s mother is in treatment for alcohol dependence and the child is exhibiting symptoms that might be accounted for by Fetal Alcohol syndrome. Therefore, the best first step would be to refer the child for assessment to rule out such disorder, gather history and get a hold of the child’s file. Thus, answer (C) is correct. Answer (A) jumps to creating a behavior modification plan, but we do not yet know what is going on with the child, so we cannot determine what plan he needs. Answer (B) ignores the therapist’s responsibility for proper assessment given the child’s presenting symptoms. Answer (D) is not indicated, since it is not stated in the stem that his biological mother wants reunification. (Clinical Evaluation)
D. Refer the child for assessment for fetal alcohol syndrome; work with the child’s biological mother toward reunification; suggest that the child’s teacher refer him for special education placement
Maricel, a 37-year-old single woman, is referred by her mother’s doctor. Maricel is a high school math teacher. She was born in the Philippines but moved to the United States when she was two. Recently, her elderly mother suffered a stroke and is currently in a coma on life support. Maricel has been the primary caregiver for her mother since her father died two years ago. Maricel has decided that she wants to terminate life support. However, her uncle, who is her mother’s brother, is against it. Tearfully, Maricel shares, “In front of the doctor, he says that I have the final say, but in private he is against me doing it. I’m sure that all his siblings are going to take his side in this matter. He doesn’t care that this is what my mom wanted.” She adds, “I just can’t concentrate at work; I’m snapping at my co-workers and friends and then I feel awful about it. I’m crying all the time, not sleeping, and I’m tense. I just don’t know what to do. I don’t want to get out of bed in the morning.” Which of the following human diversity issues should the therapist consider when developing the comprehensive treatment plan in the case presented in the vignette?
Score: 1 of 1
A. Maricel’s cultural and religious views of death and dying and the impact of being a single woman and sole caregiver of mother.
B. Maricel’s spiritual beliefs regarding end-of-life issues and the influence her Filipino culture plays in this situation.
C. Maricel’s departure from traditional Filipino roles and the impact of being a single woman and sole caregiver of mother.
D. Filipino attitudes towards Western medicine and the role of religion and spirituality in Maricel’s family.
Maricel, a 37-year-old single woman, is referred by her mother’s doctor. Maricel is a high school math teacher. She was born in the Philippines but moved to the United States when she was two. Recently, her elderly mother suffered a stroke and is currently in a coma on life support. Maricel has been the primary caregiver for her mother since her father died two years ago. Maricel has decided that she wants to terminate life support. However, her uncle, who is her mother’s brother, is against it. Tearfully, Maricel shares, “In front of the doctor, he says that I have the final say, but in private he is against me doing it. I’m sure that all his siblings are going to take his side in this matter. He doesn’t care that this is what my mom wanted.” She adds, “I just can’t concentrate at work; I’m snapping at my co-workers and friends and then I feel awful about it. I’m crying all the time, not sleeping, and I’m tense. I just don’t know what to do. I don’t want to get out of bed in the morning.” Which of the following human diversity issues should the therapist consider when developing the comprehensive treatment plan in the case presented in the vignette?
Score: 1 of 1
A. Maricel’s cultural and religious views of death and dying and the impact of being a single woman and sole caregiver of mother.
Correct
B. Maricel’s spiritual beliefs regarding end-of-life issues and the influence her Filipino culture plays in this situation.
Rationale: When developing a treatment plan, it is important to take into consideration matters that are both relevant to the presenting issues and that address diversity issues, making (B) the best answer. Maricel’s spiritual beliefs regarding end-of-life issues are important to take into consideration, since the presenting complaint is her mom’s dying wishes. In addition, what sets this case apart from other similar cases is the fact that Maricel is heavily influenced by her culture and her Filipino family in making this decision. Answer (A) is not the best answer because we do not see evidence of Maricel’s religious views in the stem or that her being a single woman is somehow impacting her decision making process in this case. Answer (C) is out since there is no evidence in the stem that Maricel has departed from traditional Filipino roles. There are no indicators of answer (D) in the stem either, as there is no mention of Filipino attitudes towards Western medicine or the role of religion in Maricel’s caregiving. (Treatment)
C. Maricel’s departure from traditional Filipino roles and the impact of being a single woman and sole caregiver of mother.
D. Filipino attitudes towards Western medicine and the role of religion and spirituality in Maricel’s family.
A therapist meets with a client who describes feelings of depression that began soon after her partner moved into the home. The client replies with a flat “fine” when asked about the new arrangement, but also mentions offhandedly that she has to go straight home after the session because the partner monitors the car mileage and time spent away from home. The client seems tense. Which of the following actions should the therapist take to address the relational dynamics discussed in the vignette?
Score: 1 of 1
A. Explore the possibility of a joint session to address the recent changes in the couple’s relationship.
B. Explore how the couple has dealt with conflict over the course of their relationship.
C. Role-play with client to enhance her ability to set boundaries with her partner and assert her needs.
D. Explore how the couple deals with conflict and develop a safety plan.
A therapist meets with a client who describes feelings of depression that began soon after her partner moved into the home. The client replies with a flat “fine” when asked about the new arrangement, but also mentions offhandedly that she has to go straight home after the session because the partner monitors the car mileage and time spent away from home. The client seems tense. Which of the following actions should the therapist take to address the relational dynamics discussed in the vignette?
Score: 1 of 1
A. Explore the possibility of a joint session to address the recent changes in the couple’s relationship.
Correct
B. Explore how the couple has dealt with conflict over the course of their relationship.
Rationale: The therapist’s best course of action would be to start by exploring how the couple deals with conflict (B). This would allow the therapist to gather additional information to determine if domestic violence is present in the relationship. The therapist should not suggest a joint session (A) or role play how to be more assertive with partner (C) if there is a likelihood of domestic violence. The therapist might want to collaboratively develop a safety plan (D), but only after determining it is appropriate for the client. (Crisis Management)
C. Role-play with client to enhance her ability to set boundaries with her partner and assert her needs.
D. Explore how the couple deals with conflict and develop a safety plan.
A therapist conducts an intake interview with a 19-year-old woman who was driven to the session by her father. During the interview she discloses her battle with depression, as well as her reservations regarding taking antidepressant medication. She also talks about her deeply rooted anger, which stems from her parents’ divorce when she was 7 years old. She says that she was caught completely off guard when her parents announced their divorce, since she has never seen them fight in front of her. Her mother left the state shortly after and they have barely seen each other since. At the end of the session, the client’s father enters the office and demands to see the therapist’s notes on the interview. What should the therapist do?
Score: 1 of 1
A. Schedule a joint meeting to discuss client’s wishes with regards to her records.
B. Ask the father to submit his request in writing since he is the one paying for the sessions.
C. Inform the father of the requirements associated with such disclosure.
D. Explain that records are the property of the agency and refer him to speak to the agency’s clinical director.
A therapist conducts an intake interview with a 19-year-old woman who was driven to the session by her father. During the interview she discloses her battle with depression, as well as her reservations regarding taking antidepressant medication. She also talks about her deeply rooted anger, which stems from her parents’ divorce when she was 7 years old. She says that she was caught completely off guard when her parents announced their divorce, since she has never seen them fight in front of her. Her mother left the state shortly after and they have barely seen each other since. At the end of the session, the client’s father enters the office and demands to see the therapist’s notes on the interview. What should the therapist do?
Score: 1 of 1
A. Schedule a joint meeting to discuss client’s wishes with regards to her records.
B. Ask the father to submit his request in writing since he is the one paying for the sessions.
Correct
C. Inform the father of the requirements associated with such disclosure.
Rationale: The therapist must protect the adult client’s confidentiality and would need consent from the client prior to sharing information with the father (C). The therapist would be breaking confidentiality by scheduling a meeting with the father (A) or releasing records based on the father’s written request (B). Explaining that the records are the property of the agency (D) does not directly address the request. (Law)
D. Explain that records are the property of the agency and refer him to speak to the agency’s clinical director.
A therapist is working with a family consisting of a mother, father, and 15-year-old daughter. The mother and daughter are arguing with each other about her curfew while the father sits in silence. The daughter says, “Every time I come home a little bit late, my mom yells at me. I can’t take it anymore.” The dad says to the therapist, “See what I have to deal with?” Which of the following questions demonstrates the Systems theory concept of circular causality?
Score: 1 of 1
A. To the mother, “What feelings arise for you when your daughter yells at you?”
B. To the daughter, “When you arrive late, what happens after your mother yells at you?”
C. To the father, “How do you respond when your wife yells at your daughter?”
D. To the mother, “How do you think your yelling affects your husband?”
A therapist is working with a family consisting of a mother, father, and 15-year-old daughter. The mother and daughter are arguing with each other about her curfew while the father sits in silence. The daughter says, “Every time I come home a little bit late, my mom yells at me. I can’t take it anymore.” The dad says to the therapist, “See what I have to deal with?” Which of the following questions demonstrates the Systems theory concept of circular causality?
Score: 1 of 1
A. To the mother, “What feelings arise for you when your daughter yells at you?”
B. To the daughter, “When you arrive late, what happens after your mother yells at you?”
Correct
C. To the father, “How do you respond when your wife yells at your daughter?”
Rationale: Circular causality, an intervention used in family therapy, tries to determine patterns in family dynamics. By asking the father how he responds to the wife yelling at the daughter (C), the therapist is able to understand how the entire system functions together. Asking the mother what it feels like when her daughter yells (A), asking the daughter what happens when she comes home late (B), or asking the mother how her yelling affects the father (D), does not allow the therapist to understand how the different parts of the system work together.(Treatment)
D. To the mother, “How do you think your yelling affects your husband?”
A 34-year-old woman seeks treatment for increasing symptoms of anxiety. She is the single mother of a 4-year-old girl, after having divorced from her daughter’s father 3 months ago. She reports that their separation was mutual and they continue to be friends, but she states that her feelings of anxiety are increasing. She is increasingly concerned about her ability to be a single parent and has recently been considering sending her daughter to live with the father. She reports feeling disconnected from her daughter and unsure of how to “get things back to normal.” Which of the following interventions should the therapist consider when addressing the client’s anxiety?
Score: 1 of 1
A. Encourage the client to discuss the benefits of psychotropic medications with medical doctor.
B. Offer a joint session with the client’s ex-husband to identify co-parenting techniques that would address client’s concerns.
C. Assign the client to read psychoeducational books on divorce and co-parenting.
D. Teach the client calming skills and ways to better discriminate between a relaxed versus tense state of being.
A 34-year-old woman seeks treatment for increasing symptoms of anxiety. She is the single mother of a 4-year-old girl, after having divorced from her daughter’s father 3 months ago. She reports that their separation was mutual and they continue to be friends, but she states that her feelings of anxiety are increasing. She is increasingly concerned about her ability to be a single parent and has recently been considering sending her daughter to live with the father. She reports feeling disconnected from her daughter and unsure of how to “get things back to normal.” Which of the following interventions should the therapist consider when addressing the client’s anxiety?
Score: 1 of 1
A. Encourage the client to discuss the benefits of psychotropic medications with medical doctor.
B. Offer a joint session with the client’s ex-husband to identify co-parenting techniques that would address client’s concerns.
C. Assign the client to read psychoeducational books on divorce and co-parenting.
Correct
D. Teach the client calming skills and ways to better discriminate between a relaxed versus tense state of being.
Rationale: This question is asking for interventions that directly address the client’s anxiety, so we want to find an answer that specifically focuses on this issue–the more focused specifically on anxiety, the better. Answer (A) is incorrect because it’s not clear psychotropic medicine is appropriate and the way it is worded is not quite right, as it only encourages the client to discuss benefits, without providing a balanced approach. Answer (B) may or may not help the client’s anxiety, so while it may be something the therapist could do, it’s not a very strong option. Answer (C) is similar to (B), it could help, but does not specifically address anxiety. Answer (D) is the strongest option because it most directly addresses the client’s anxiety, which is what the question is asking about. (Treatment)
Jose, a 32–year-old accountant, is referred to therapy by his EAP. He is approved for 8 treatment sessions. The referral from the EAP states that Jose has poor time management skills and recently had issues with his productivity. Jose shares that his boyfriend was recently transferred to another city for work and it has caused a strain on their relationship and his overall health. He shares that he likes his job but just can’t concentrate like he used to. What action would a Solution Focused therapist take in the final phase of treatment?
Score: 0 of 1
Incorrect
A. Process Jose’s feelings about termination and compliment his progress and growth.
B. Identify Jose’s resources and strengths as well as identify possible setbacks and ways to stay on track.
C. Identify what “productive employment” would look like for Jose and compliment his progress and growth.
D. Compare Jose’s scale of current functioning to the initial scale and identify possible setbacks and ways to stay on track.
Jose, a 32–year-old accountant, is referred to therapy by his EAP. He is approved for 8 treatment sessions. The referral from the EAP states that Jose has poor time management skills and recently had issues with his productivity. Jose shares that his boyfriend was recently transferred to another city for work and it has caused a strain on their relationship and his overall health. He shares that he likes his job but just can’t concentrate like he used to. What action would a Solution Focused therapist take in the final phase of treatment?
Score: 0 of 1
Incorrect
A. Process Jose’s feelings about termination and compliment his progress and growth.
B. Identify Jose’s resources and strengths as well as identify possible setbacks and ways to stay on track.
C. Identify what “productive employment” would look like for Jose and compliment his progress and growth.
Should have chosen
D. Compare Jose’s scale of current functioning to the initial scale and identify possible setbacks and ways to stay on track.
Rationale: Answer (A) is a good answer, yet it is not specific to Solution Focused theory, and since that is what the question is asking, the ideal answer will include elements from the theory (if that option did not exist, this could be an acceptable option). Answer (B) is not the best answer since identifying strengths and resources are indicative of the middle stage of this theory. Answer (C) includes an intervention (“Identify what ‘productive’ would look like”) that would be better fitting in the beginning stage of treatment. Answer (D) is the best answer since, as a Solution Focused therapist, we would utilize scaling and compare how the client is doing now as compared to how he was doing when the treatment began. The second half of the answer is also a fitting Solution Focused final stage intervention. (Treatment)
Immediately following a group psychotherapy session, a group member, Clara, returned to the office of the therapist to privately discuss an incident that had occurred during the session. The client reported that another member, Mandy, had broken a group rule by being disrespectful. Clara complained, “I know at the very beginning we talked about not forming cliques in the group. Well Mandy sure did not hear this rule. She was openly talking about Clarissa and her weight to others and I know Clarissa could hear her. Then she invited some of the group members to her house for a party, but did not invite the rest of us. She is so rude! I want you to properly deal with this matter.” Which of the following would be the most appropriate therapeutic response?
Score: 1 of 1
A. Explore the client’s feelings about observing the group member’s disrespect individually with Clara and inquire if other group members shared this experience when the group meets next.
B. Separately process the client’s reasoning for not addressing the situation immediately in group and revisit group rules to ensure a safe environment during the next group meeting.
C. Assure the client that it is acceptable to privately report such concerns and maintain the client’s confidentiality.
D. Acknowledge client’s concerns and suggest the client consider bringing up this incident for discussion in the next group session.
Immediately following a group psychotherapy session, a group member, Clara, returned to the office of the therapist to privately discuss an incident that had occurred during the session. The client reported that another member, Mandy, had broken a group rule by being disrespectful. Clara complained, “I know at the very beginning we talked about not forming cliques in the group. Well Mandy sure did not hear this rule. She was openly talking about Clarissa and her weight to others and I know Clarissa could hear her. Then she invited some of the group members to her house for a party, but did not invite the rest of us. She is so rude! I want you to properly deal with this matter.” Which of the following would be the most appropriate therapeutic response?
Score: 1 of 1
A. Explore the client’s feelings about observing the group member’s disrespect individually with Clara and inquire if other group members shared this experience when the group meets next.
B. Separately process the client’s reasoning for not addressing the situation immediately in group and revisit group rules to ensure a safe environment during the next group meeting.
C. Assure the client that it is acceptable to privately report such concerns and maintain the client’s confidentiality.
Correct
D. Acknowledge client’s concerns and suggest the client consider bringing up this incident for discussion in the next group session.
Rationale: When a group member expresses concerns about group dynamics, it is always important to deal with the issue with the group as a whole (D). Answers (A) through (C) do not provide an opportunity for the group as a whole to deal with the issue so we would prioritize the answer that brings it back to the group. (Treatment)
A therapist meets with Claire, a client who has recently lost her husband. The client’s sister, Catherine, has been staying with the client during the month since the loss. Catherine telephones the therapist expressing concern about the client’s open expression of grief. She presses the therapist to learn whether the client has discussed these grief reactions. Which of the following actions should the therapist take in this case?
Score: 1 of 1
A. Provide psychoeducation on the grief process to address the sister’s concerns about the client’s grief reactions.
B. Explain that information cannot be disclosed without a client’s consent.
C. Discuss the sister’s concerns with the client at the next session.
D. Set up a joint meeting with the sister and the client to address the sister’s concerns about client’s safety.
A therapist meets with Claire, a client who has recently lost her husband. The client’s sister, Catherine, has been staying with the client during the month since the loss. Catherine telephones the therapist expressing concern about the client’s open expression of grief. She presses the therapist to learn whether the client has discussed these grief reactions. Which of the following actions should the therapist take in this case?
Score: 1 of 1
A. Provide psychoeducation on the grief process to address the sister’s concerns about the client’s grief reactions.
Correct
B. Explain that information cannot be disclosed without a client’s consent.
Rationale: The therapist must protect the confidentiality of her client and the only answer that does so is (B), explaining that information cannot be disclosed without client’s consent. Engaging in conversation with the sister (A) would breach client confidentiality. The therapist could discuss the sister’s concerns in the next session (C) or set up a joint meeting with the sisters (D) in the future (though safety concerns are not indicated), if the client expresses interest; however, these answers overlook the legal requirement of how the therapist should proceed. (Law)
C. Discuss the sister’s concerns with the client at the next session.
D. Set up a joint meeting with the sister and the client to address the sister’s concerns about client’s safety.
During an initial session, a mother tells a therapist that her three year-old son is stubborn, self-centered, doesn’t listen, and refuses to help her until she starts doing something, and then he wants to help. He tantrums when she tries to show him how to do things properly and insists on doing it his way. Which would be the most appropriate initial response to the client’s concerns?
A. Acknowledge and explore the mother’s feelings around parenting struggles and educate the mother about child development.
B. Schedule a biopsychosocial evaluation of the child and refer mom to a parenting group for parents of children with behavioral issues.
C. Review behavior modification techniques and examine the mother’s expectations of parenting.
D. Provide play therapy for the child and joint play therapy for mother and child.
During an initial session, a mother tells a therapist that her three year-old son is stubborn, self-centered, doesn’t listen, and refuses to help her until she starts doing something, and then he wants to help. He tantrums when she tries to show him how to do things properly and insists on doing it his way. Which would be the most appropriate initial response to the client’s concerns?
Score: 1 of 1
Correct
A. Acknowledge and explore the mother’s feelings around parenting struggles and educate the mother about child development.
Rationale: The therapist’s best response would be to acknowledge and explore the mother’s feelings and provide the mother with education about normal development (A) since the symptoms described appear to be signs of normal child development. If, after receiving information regarding normal development, the mother continues to express concern or identifies behavior outside the norm, it could be appropriate for the therapist to schedule an evaluation (B), review behavioral techniques (C), or provide play therapy (D). (Treatment)
B. Schedule a biopsychosocial evaluation of the child and refer mom to a parenting group for parents of children with behavioral issues.
C. Review behavior modification techniques and examine the mother’s expectations of parenting.
D. Provide play therapy for the child and joint play therapy for mother and child.
A therapist receives a call from his individual male client who is panicking after learning that he is HIV+. His girlfriend is scheduled to come in for a session but he says he does not want to tell her for fear of being abandoned. He asks his therapist not to share this information. The therapist knows the couple is trying to get pregnant. How should the therapist respond to the client’s disclosure?
Score: 1 of 1
A. Recommend he tell her in the session and offer to process the information.
B. Assure him that confidentiality will be maintained and encourage him to tell his partner.
C. Validate the client’s fears, but remind him of the “no secrets” policy.
D. Remind client of the limits of confidentiality and your mandate to protect the girlfriend and the possible unborn fetus.
A therapist receives a call from his individual male client who is panicking after learning that he is HIV+. His girlfriend is scheduled to come in for a session but he says he does not want to tell her for fear of being abandoned. He asks his therapist not to share this information. The therapist knows the couple is trying to get pregnant. How should the therapist respond to the client’s disclosure?
Score: 1 of 1
A. Recommend he tell her in the session and offer to process the information.
Correct
B. Assure him that confidentiality will be maintained and encourage him to tell his partner.
Rationale: As therapists, our duty is to protect the client’s confidentiality, and the girlfriend is not the client. We are also not mandated to break confidentiality when it comes to the client’s HIV status, thus (B) is the right answer. Answer (A) is only partially correct, since it omits the part about confidentiality. Answers (C) and (D) are wrong since “no secrets” policy does not apply in this case and neither do limits of confidentiality or mandates. (Law)
C. Validate the client’s fears, but remind him of the “no secrets” policy.
D. Remind client of the limits of confidentiality and your mandate to protect the girlfriend and the possible unborn fetus.
Kevin, a 48-year-old male, is in treatment for issues of depression. At the end of the sixth session, Kevin angrily states that his 18-year-old stepson is getting on his nerves and it is time Kevin showed him “who is the man in the house.” Two days after the session, the therapist receives a phone call from Kevin’s wife. She is concerned because Kevin left to go meet her son at the cabin in the woods for a “stern talking to.” His wife states that Kevin was very irritable when he left the house. The therapist’s responsibility is to:
Score: 1 of 1 Marked
A. Encourage Kevin’s wife to call 9-1-1.
B. Maintain confidentiality.
C. Call the police and warn Kevin’s stepson.
D. Contact Kevin and find out whether he has any means of hurting his stepson.
Kevin, a 48-year-old male, is in treatment for issues of depression. At the end of the sixth session, Kevin angrily states that his 18-year-old stepson is getting on his nerves and it is time Kevin showed him “who is the man in the house.” Two days after the session, the therapist receives a phone call from Kevin’s wife. She is concerned because Kevin left to go meet her son at the cabin in the woods for a “stern talking to.” His wife states that Kevin was very irritable when he left the house. The therapist’s responsibility is to:
Score: 1 of 1 Marked
A. Encourage Kevin’s wife to call 9-1-1.
Correct
B. Maintain confidentiality.
Rationale: The therapist’s responsibility in this case is to maintain confidentiality of the client. Kevin’s wife is not giving us enough information to substantiate Tarasoff. Therefore, on the phone with her, we are going to maintain confidentiality and not even acknowledge to her that Kevin is our client (B). Based on the information provided in the stem, the threat of harm is unclear. Encouraging the wife to call 911 (A), calling the police and warning Kevin’s stepson (C), or contacting Kevin to find out whether he has means of hurting step son (D) are overreactions based on the information provided. (Crisis Management / Law)
C. Call the police and warn Kevin’s stepson.
D. Contact Kevin and find out whether he has any means of hurting his stepson.
Francisco, a 32-year-old construction worker, is referred by his EAP because of troubles at work. Francisco tells that therapist that co-workers are constantly conspiring against him. He is convinced they are discussing the most profitable projects behind his back and intentionally leaving him out of important meetings. “I do not trust anyone in that company; they are just like my family. They are out to get me,” says Francisco at the end of the first session. His most likely diagnosis is:
Score: 1 of 1
A. Delusional Disorder
B. Paranoid Personality Disorder
C. Schizophrenia
D. Shared Psychotic Disorder
Francisco, a 32-year-old construction worker, is referred by his EAP because of troubles at work. Francisco tells that therapist that co-workers are constantly conspiring against him. He is convinced they are discussing the most profitable projects behind his back and intentionally leaving him out of important meetings. “I do not trust anyone in that company; they are just like my family. They are out to get me,” says Francisco at the end of the first session. His most likely diagnosis is:
Score: 1 of 1
A. Delusional Disorder
Correct
B. Paranoid Personality Disorder
Rationale: According to the DSM 5, Paranoid Personality Disorder (B) is characterized by a pervasive distrust and suspicion of others such that their motives are malevolent. Since the symptoms appear to be pervasive (“they are just like my family”), the symptoms better describe Paranoid Personality Disorder rather than Delusional Disorder (A). The client is not exhibiting any psychotic symptoms; ruling out Schizophrenia (C) and the symptoms do not appear to be developing in conjunction with another individual, ruling out Shared Psychotic Disorder (D). (Clinical Evaluation)
C. Schizophrenia
D. Shared Psychotic Disorder
Molly, a 23 year-old college student, comes to treatment complaining of constant and frequent mood swings. During the assessment phase, the therapist learns that Molly has been diagnosed with diabetes but has not been getting proper treatment for it. She exclaims, “If I monitor what I eat and maintain a proper diet, I am OK. I do not have health insurance and it is too expensive to pay for doctor’s visits out of pocket. Could you just help me figure out the number of sugar calories that I consume?” What would the treatment goals be during the initial stages of treatment for a Narrative therapist?
Score: 1 of 1
A. Separate the client from the problem; explore the story she is telling herself around her illness; assess client’s motivation for treatment
B. Explain that you are not trained to help her with managing her diabetes; assist the client in finding medical resources; identify ways in which Molly’s problem with diabetes impacts her life
C. Identify ways in which Molly’s problem with diabetes impacts her life; provide the client with specific tools that can help Molly monitor her diet; record progress of the client throughout treatment
D. Identify factors that enhance the problem; help client reduce harm inducing behaviors; talk about ways the diabetes tricks Molly into not maintaining a proper diet
Molly, a 23 year-old college student, comes to treatment complaining of constant and frequent mood swings. During the assessment phase, the therapist learns that Molly has been diagnosed with diabetes but has not been getting proper treatment for it. She exclaims, “If I monitor what I eat and maintain a proper diet, I am OK. I do not have health insurance and it is too expensive to pay for doctor’s visits out of pocket. Could you just help me figure out the number of sugar calories that I consume?” What would the treatment goals be during the initial stages of treatment for a Narrative therapist?
Score: 1 of 1
A. Separate the client from the problem; explore the story she is telling herself around her illness; assess client’s motivation for treatment
Correct
B. Explain that you are not trained to help her with managing her diabetes; assist the client in finding medical resources; identify ways in which Molly’s problem with diabetes impacts her life
Rationale: The symptoms being described and the goals of the client are outside the scope of practice for a therapist. The client requires medical services and the therapist’s initial goal would be to connect the client with those services. In addition the answer is appropriate because a Narrative therapist would initially focus on gathering a problem-saturated story from a client (B) . Although externalizing the problem is part of Narrative Therapy (A), it is not an appropriate intervention, because it does not address the client’s medical needs. Providing the client with tools to help her monitor diet (C) and identifying factors that enhance the problem (D) are outside the scope of practice of the therapist. (Treatment Planning)
C. Identify ways in which Molly’s problem with diabetes impacts her life; provide the client with specific tools that can help Molly monitor her diet; record progress of the client throughout treatment
D. Identify factors that enhance the problem; help client reduce harm inducing behaviors; talk about ways the diabetes tricks Molly into not maintaining a proper diet
A Structural Family therapist is in the middle phase of treatment with a family that has been in therapy for three months. The family sought therapy after the 36-year-old daughter and her 14-year-old son moved back home with her 66-year-old father and 65-year-old mother. The daughter had lost her job due to issues with alcohol and moved in after completing a treatment program. At the start of the session, the mother reports that three days ago the daughter relapsed and became violent when they confronted her. What action should the therapist take first?
Score: 0 of 1
A. Explore each family members perspective of the incident and create a safety plan.
B. Remind the family that the therapist is a mandated reporter and obtain more details about the violent episode.
C. Recommend that the daughter seek alcohol treatment immediately and create a safety plan.
D. Obtain more details about the nature of the violent episode and file an APS report if necessary.
A Structural Family therapist is in the middle phase of treatment with a family that has been in therapy for three months. The family sought therapy after the 36-year-old daughter and her 14-year-old son moved back home with her 66-year-old father and 65-year-old mother. The daughter had lost her job due to issues with alcohol and moved in after completing a treatment program. At the start of the session, the mother reports that three days ago the daughter relapsed and became violent when they confronted her. What action should the therapist take first?
Score: 0 of 1
A. Explore each family members perspective of the incident and create a safety plan.
Should have chosen
B. Remind the family that the therapist is a mandated reporter and obtain more details about the violent episode.
Rationale: The code of ethics states that therapists must inform the clients of the limits of confidentiality at the start of treatment and then remind them throughout the course of treatment when necessary. We are never going to trap the client into telling us the information that later can be used to make a report. So we are going to tell the client: “I am going to stop you right there and remind you that I am a mandated reporter.” Doing so goes in accordance with the code of ethics. In this scenario, there are two elders and a minor. If the violent episode were directed at one of them, a report would be required. So the best answer is (B) remind them of reporting duties then further assess. Neither (A) nor (C) acknowledge the possibility of reporting. (D) has only APS and it could be CPS. (Ethics)
C. Recommend that the daughter seek alcohol treatment immediately and create a safety plan.
Incorrect
D. Obtain more details about the nature of the violent episode and file an APS report if necessary.
Silvia, age 16, is referred by her probation officer for court-mandated therapy. She has been arrested three times for assault, stealing, and drug possession. She was recently released from a juvenile correction camp where she spent six months. She is currently residing in a group home. Silvia states, “Don’t expect me to share stuff with you. The only people I trust are my homies; my gang is my family.” Silvia has a history of marijuana, crystal meth, and alcohol abuse. She adds, “Can you help me sleep? I can’t shut my brain off at night. I just think of all the people who have wronged me and what I want to do to them. There’s a girl trying to get with my man and if she does, I’m going to cut her.” She is currently enrolled in a GED program but reports that she’s never been good at school and just can’t focus in class. She jumps in her seat when the office phone rings.
What additional information would help the therapist decide the course of treatment in this case?
Score: 1 of 1
A. Silvia’s arrest history and her family substance use history.
B. Silvia’s trauma history and past substance use.
C. Sylvia’s arrest history and current substance use.
D. Silvia’s trauma history and current substance use.
Silvia, age 16, is referred by her probation officer for court-mandated therapy. She has been arrested three times for assault, stealing, and drug possession. She was recently released from a juvenile correction camp where she spent six months. She is currently residing in a group home. Silvia states, “Don’t expect me to share stuff with you. The only people I trust are my homies; my gang is my family.” Silvia has a history of marijuana, crystal meth, and alcohol abuse. She adds, “Can you help me sleep? I can’t shut my brain off at night. I just think of all the people who have wronged me and what I want to do to them. There’s a girl trying to get with my man and if she does, I’m going to cut her.” She is currently enrolled in a GED program but reports that she’s never been good at school and just can’t focus in class. She jumps in her seat when the office phone rings.
What additional information would help the therapist decide the course of treatment in this case?
Score: 1 of 1
A. Silvia’s arrest history and her family substance use history.
B. Silvia’s trauma history and past substance use.
C. Sylvia’s arrest history and current substance use.
Correct
D. Silvia’s trauma history and current substance use.
Rationale: In order to decide on the course of treatment we need to identify this client’s diagnosis and any crisis issues that we might be dealing with. Answer (A) includes Silvia’s arrest history and we already know how many times and what she was arrested for, so there is no need to get more information about it. Plus, we are much more interested in her personal substance use history, as opposed to her family’s, since she is the client. The first part in answer (B) is correct – it is important to know client’s history of trauma in order to determine her diagnosis and appropriate treatment plan. We see that the client jumps when the phone rings, has history of violence, and has been involved in a gang, all of which point to a possible trauma history. The second part of Answer (B) is not as relevant as the second part of answer (D), since we would want to find out how much and what she is currently using; we already know her history with meth, alcohol, and marijuana. Answer (C) has the current substance use, but the first half, as discussed, is already known. Answer (D) is the best answer as it prompts us to find out more about her history of trauma and her current substance use, both of which while help in determining the course of treatment. (Clinical Evaluation)
A structural family therapist has been working with a family of six for several weeks. In the most recent session, Stephanie, the second to youngest member of the family tells the therapist about the “blow out” that happened the night before. Apparently two of the siblings got into a fight and the mom was trying to help them resolve it while bathing the youngest child and helping Stephanie with her homework. In the meantime, the dad was downstairs watching the football game. The therapist asked the family to replay the scenario from last night and encouraged the dad to participate in the management of the fight more actively. What was the purpose behind such intervention?
A. To help the family modify the problematic interaction and see it through to a satisfying completion.
B. To observe circular causality and communication patterns.
C. To increase “here-and-now” awareness.
D. To challenge family’s definition of the problem.
A structural family therapist has been working with a family of six for several weeks. In the most recent session, Stephanie, the second to youngest member of the family tells the therapist about the “blow out” that happened the night before. Apparently two of the siblings got into a fight and the mom was trying to help them resolve it while bathing the youngest child and helping Stephanie with her homework. In the meantime, the dad was downstairs watching the football game. The therapist asked the family to replay the scenario from last night and encouraged the dad to participate in the management of the fight more actively. What was the purpose behind such intervention?
Score: 1 of 1
Correct
A. To help the family modify the problematic interaction and see it through to a satisfying completion.
Rationale: The intervention described in the stem is re-enactment. It is frequently used by structural family therapists in order to help the family change problematic behaviors and experience a different, more effective outcome (A). Answer (B) describes a Systems family therapy intervention. Answer (C) describes a Gestalt intervention. Answer (D) does not fit because, even though challenging the definition of the problem is an early stage structural therapy intervention, in this case the therapist did not challenge the family’s definition of the problem but asked them to re-enact the problem instead. (Treatment)
B. To observe circular causality and communication patterns.
C. To increase “here-and-now” awareness.
D. To challenge family’s definition of the problem.
Nicholas, a 36-year-old lawyer, and his partner Gary, a 43-year-old accountant, are self-referred for couple’s therapy. The intake interview reveals that both Nicholas and Gary are in long-term recovery for cocaine addiction. They report having frequent arguments and misunderstandings with each other. “Every single conversation seems to turn into a fight,” said Nicholas. “Gary has been tremendously defensive lately,” he adds. “Oh it is all on me, isn’t it?” retorts Gary. “How about you? You have been completely absent lately. I cannot connect with you at all.” As part of the initial intervention the therapist should:
Score: 1 of 1
A. Teach the couple communication skills; examine relational history; discuss recent stressors
B. Discuss recent stressors; assess for relapse in either partner; teach the couple how to be empathetic with each other
C. Assign the couple intimacy exercises as homework; teach the couple how to be empathetic with each other; discuss recent stressors
D. Teach the couple how to be empathetic with each other; examine relational history; discuss recent stressors
Nicholas, a 36-year-old lawyer, and his partner Gary, a 43-year-old accountant, are self-referred for couple’s therapy. The intake interview reveals that both Nicholas and Gary are in long-term recovery for cocaine addiction. They report having frequent arguments and misunderstandings with each other. “Every single conversation seems to turn into a fight,” said Nicholas. “Gary has been tremendously defensive lately,” he adds. “Oh it is all on me, isn’t it?” retorts Gary. “How about you? You have been completely absent lately. I cannot connect with you at all.” As part of the initial intervention the therapist should:
Score: 1 of 1
A. Teach the couple communication skills; examine relational history; discuss recent stressors
Correct
B. Discuss recent stressors; assess for relapse in either partner; teach the couple how to be empathetic with each other
Rationale: Given the fact that substance abuse history is present in both clients, assessing whether either partner has relapsed is the most appropriate intervention to start with. Increased distance in the relationship and frequent arguments may be signs that one partner has relapsed, putting stress on the relationship. The only answer that includes assessment for relapse is answer B. The rest of the interventions are also good to do at some point, but checking for relapse would need to be part of the right answer. (Treatment)
C. Assign the couple intimacy exercises as homework; teach the couple how to be empathetic with each other; discuss recent stressors
D. Teach the couple how to be empathetic with each other; examine relational history; discuss recent stressors
A 24-year-old young man walks into a therapist’s office wearing a colorful headband, long purple scarf, and a fur coat. He states that he is happy with who he is, but he would like to better understand personal messages he receives from the newspaper and magazine articles. He adds that his strongly developed telepathic skills allow him to know what other people are thinking about him; thus he warns the therapist about the consequences of lying to him. What diagnosis should be considered initially?
Score: 0 of 1
A. Schizoid Personality Disorder
B. Schizotypal Personality Disorder
C. Delusional Disorder
D. Histrionic Personality Disorder
A 24-year-old young man walks into a therapist’s office wearing a colorful headband, long purple scarf, and a fur coat. He states that he is happy with who he is, but he would like to better understand personal messages he receives from the newspaper and magazine articles. He adds that his strongly developed telepathic skills allow him to know what other people are thinking about him; thus he warns the therapist about the consequences of lying to him. What diagnosis should be considered initially?
Score: 0 of 1
A. Schizoid Personality Disorder
Should have chosen
B. Schizotypal Personality Disorder
Rationale: This client is exhibiting odd, eccentric behavior, ideas of reference, and magical thinking. In addition, he is happy with who he is, which points to egosyntonic nature of the disorder. All of these symptoms are best accounted for by answer (B). Neither Schizoid PD, nor Histrionic PD have magical thinking or ideas of reference as their symptoms. Thus (A) and (D) are out. Since his behaviors are present across all aspects of his life and are egosyntonic, it cannot be Delusional Disorder (C). (Clinical Evaluation)
C. Delusional Disorder
Incorrect
D. Histrionic Personality Disorder
A frail 91-year-old female nursing home resident has begun to refuse some meals. A medical evaluation determined the need for a gastric feeding tube. Although her son is in favor of having the feeding tube placed, the resident refuses. The son demands that the therapist working in the hospital should get the doctor to put in a feeding tube. What initial step should the therapist take in this case?
A. Refer the son for treatment to cope with his mother’s refusal to eat.
B. Process the son’s feelings of powerlessness.
C. Explain to the son that his mother cannot be force-fed.
D. Refer the resident for a competency evaluation.
A frail 91-year-old female nursing home resident has begun to refuse some meals. A medical evaluation determined the need for a gastric feeding tube. Although her son is in favor of having the feeding tube placed, the resident refuses. The son demands that the therapist working in the hospital should get the doctor to put in a feeding tube. What initial step should the therapist take in this case?
Score: 0 of 1 Marked
A. Refer the son for treatment to cope with his mother’s refusal to eat.
Incorrect
B. Process the son’s feelings of powerlessness.
C. Explain to the son that his mother cannot be force-fed.
Should have chosen
D. Refer the resident for a competency evaluation.
Rationale: Each client has the right to self-determination, unless it is determined that he/she lacks competency to make decisions for themselves. In working with the elderly, one of the appropriate early stage interventions is to refer the client for competency evaluation (D), particularly since there is a reasonable suspicion that competency might be compromised. Referring the son for treatment (A), processing his feelings (B), or educating him (C) will not deal with the critical and potentially dangerous situation at hand. (Crisis Management / Ethics)
