Highpass exam 1 Flashcards
An MFT uses comment cards, submitted anonymously in the waiting room, as a mechanism for receiving honest feedback from
clients. She receives two particularly positive reviews in the span of a week, from different clients. The comments are so positive
that the MFT would like to use them publicly if the clients will allow it. While the comment cards are anonymous, the MFT’s practice
is small enough that she believes she knows who submitted the cards. The MFT should:
Consider asking clients directly for testimonials that she can
share in marketing, if the clients are relatively well-functioning.
An MFT learns that his individual client, who is being seen for symptoms of Bipolar Disorder, is also interested in attending couple therapy with her spouse. The client asks the MFT whether the couple could see the MFT together for couple therapy separately from her individual sessions, and says she is willing to sign a release form such that information from her individual sessions could be discussed in couple therapy and vice versa. Ethically, the MFT should:
Continue individual treatment with the client and refer out for the couple therapy.
An MFT provided therapy to a 16-year-old boy for several months with his parents’ consent. A few months later, the MFT received a subpoena from the attorney for a classmate of the boy. The classmate accused the client of physical assault, and the classmate’s family is suing to recover medical expenses. The subpoena requests complete records of the boy’s treatment. The MFT attempts to contact the client and his parents but is unsuccessful. The MFT should
Respond to the subpoena by asserting privilege, and continue attempts to contact the client and his parents.
A new MFT is struggling with a difficult family case. The family consists of a same-sex couple with three children, and the parents of one of the partners. The family is experiencing behavioral problems with two of the children. The couple is deeply religious and is skeptical of therapy. The parents of one of the partners are pushing for therapy and even offering to pay for it, but the couple is concerned about the parents dictating the course of treatment or asking for services that they do not want the children to receive based on the couple’s religious values. The MFT should:
Consult with colleagues who have experience with family conflict over religion impacting treatment.
The individual client of an MFT tells the MFT that he recently took his 94-year-old grandfather, who has been suffering from dementia, on a fishing trip to a nearby lake in a California State Park. He had grown frustrated with the quality of care the grandfather had been receiving at his nursing home, which he said was not adequate to the grandfather’s medical needs. He also wanted to give his grandfather “one last hurrah,” as he was concerned the grandfather’s death was imminent. He was angry that the nursing home staff had berated him upon their return for not notifying them he was taking the grandfather for the weekend. The MFT should:
Ask the client to clarify how the nursing home’s care is inadequate.
An MFT is working with an individual client who was recently fired in a way the client experienced as humiliating. The client tells the therapist that he intends to go this weekend to the office building where he had worked, ensure no people are present in the building, and as long as no people would be endangered, burn the building down. “I know their insurance would cover the losses,” the client says, “I just want to make a point.” Legally, the MFT must:
No specific action is required.
A military family in treatment with an MFT for four months comes into session appearing dazed, as the mother has learned she will be deployed to Germany in a matter of weeks. The family will be moving with her and will need to discontinue treatment immediately, they say, even though the treatment is incomplete. The MFT should:
Discuss the transition, consider increasing the frequency of sessions in the remaining weeks, and encourage the family to continue therapy with a local provider during the deployment.
An MFT worked with a woman in individual therapy for six months, focusing on treatment of depression symptoms following the client’s messy divorce. The client improved significantly in therapy and terminated successfully. One year later, the MFT has been dating a man for two months when the MFT realizes the man is the ex-husband of the former client. The MFT should:
Discontinue the romantic relationship.
An experienced MFT prefers not to work with clients who are in crisis or other emergency situations. In planning for the new year, the MFT decides he would like to change his fee structure to discourage clients who may have more immediate needs from working with him. He also hopes that having clients with greater needs pay more may help him avoid resenting those clients who seek him out more after hours. The MFT could:
Set a fee schedule that charges higher fees for some diagnostic categories than others.
An MFT shopping for clothing approaches the checkout counter and observes that the only worker at the cash register is a client of hers. The MFT should:
Make her purchases as she normally would, behaving like an ordinary customer unless the client chooses to behave in a more familiar manner.
An MFT covered by HIPAA plans to move her office approximately five miles and has hired a moving company to transport all of her office furniture, supplies, and equipment. How should the therapist address the file cabinets that contain hard copy client files?
Ask the moving company to provide a Business Associate Agreement establishing that they will abide by the rules HIPAA sets forth regarding privacy and security of client data.
A former client calls the MFT who had treated her two years earlier. The former client verbally requests that the MFT forward her file to her new therapist in a different state. The former client confirms her identity using her social security number and is able to identify specific topics of the prior therapy, leaving the MFT confident in the identity of the caller. The MFT should:
Take down the information for the new therapist, and send the former client appropriate paperwork to request in writing that her file be released.
An MFT conducting her fourth home visit with a high-conflict family in poverty sees suitcases in their living room. When the MFT asks about the suitcases, the family’s 15-year-old daughter announces that she is moving out, with plans to live with friends. She is not willing to provide the names of those friends or any other information to her family or to the MFT. The MFT should:
Attempt to gain more information about the daughter’s plans.
A Japanese couple in their 40s comes to an MFT reporting frequent fights about how they handle their finances. One partner reports that he is conservative about money and primarily interested in building their retirement accounts. The other reports being primarily interested in “living in the moment” and enjoying what they earn. They ask the MFT how they can best address this difference. Considering the MFT’s legal obligations, the MFT should:
Refer the couple to a financial planner
An MFT is seeing a family for an intake session. The family includes three foster girls, ages 16, 13, and 10. During individual interviews with each of the children, they all reveal that they are currently in sexual relationships. The 16-year-old received treatment for a sexually transmitted disease a year ago after catching it from her then-17-year-old boyfriend. The 13-year-old says that she is having sex with her 14-year-old boyfriend. And the 10-year-old tells you that she is pregnant, though she will not reveal anything about the age or identity of the father. Which of these relationships must be reported as child abuse?
Only the 13-year-old’s relationship is reportable.
An adult client who has been seeing an MFT in therapy for six months asks the MFT for a copy of her treatment record. Because the MFT has documented that she suspects the client is being dishonest in her denials of recent drug use, the MFT worries that sharing the file would harm the therapeutic relationship. The most appropriate course of action for the MFT would be to:
Refuse to turn over the records, offer a treatment summary instead, and inform the client that if she wishes, she can select a neutral therapist to review the file.
An MFT advertises her solo private practice on a professionally-designed web site. The site uses stock photography of a modern, spacious office building, and a group of seasoned professionals holding clipboards. The MFT hopes the design of the web site and the photography it includes will bring an air of professionalism and sophistication to her practice, which she attempts to carry forward in her professional demeanor. Her web site:
Is likely to mislead prospective clients into believing she is part of a successful group practice.
An MFT is working with an individual client who is employed in the movie industry. The client is emotionally unstable following a breakup. The client informs the MFT that the client will be travelling out of state for the next three weeks to work on a film, and asks whether the MFT can continue to work with the client by phone during that time. The MFT should first:
Determine whether they have the requisite qualifications to practice in the state to which the client is travelling.
An MFT who serves on an insurance panel is frustrated that the insurer has not paid the MFT for three months for the MFT’s weekly sessions with a high-conflict family. After inquiring with the company, the MFT receives a letter that the sessions will not be covered, as the family does not have any diagnosed mental disorders, and therefore does not meet the insurer’s requirements for medical necessity. The MFT should:
Inform the family of the insurer’s decision and discuss options for challenging the decision and for further treatment.
An MFT is meeting for the first time with a family seeking treatment for their 16-year-old son. The parents report that the son was recently suspended from school for smoking marijuana, and admitted that he had been regularly using marijuana for several months. The MFT asks to speak with the boy individually. When the parents leave the room, the 16-year-old says, “You seem nice, but this is a waste of time. You and I both know I’m only here because my parents are making me come. I have no intention of stopping smoking. I’ll just get better at hiding it from them.” The MFT should:
Further assess the 16-year-old and his family
A family from Cambodia is seeing an MFT for family therapy. During a family session, the father tells the therapist that he
sometimes disciplines his 15-year-old son the same way the father had been disciplined in Cambodia when he was young: With
lashes across his back, using a stick. The mother voices her objection to this form of discipline, and notes that on multiple occasions
the son was left bleeding and crying. The most appropriate action for the MFT would be to:
Report suspected physical abuse to the local child protective
service agency.
An individual client acknowledges to her therapist (an MFT) that she lied on the MFT’s intake form and actually does have several
past suicide attempts in her history. She says she is not feeling suicidal now, though she has recently experienced the ending of a
romantic relationship and the death of a distant relative. Legally, the MFT should:
Assess further and break confidentiality if required to resolve
any threat of suicide.
A group therapy client informs other group members that she has opened a bakery, and is willing to provide the other group
members with a discount on purchases there. The client extends this offer to the MFT who facilitates the group, and clarifies that
this is simply a way of saying “thank you” for running the group; the client does not expect any special treatment in return. The MFT
must:
Consider the clinical and cultural implications of accepting or
rejecting the offer.
An MFT receives a subpoena from the attorney for an Italian restaurant where a client of the MFT formerly worked. The subpoena
requests the client’s complete clinical record, and notes that the client is suing the restaurant over the client’s firing. The client
claims that the firing was discriminatory and caused damage to her mental health. How should the MFT respond to the subpoena?
Contact the client, determine her wishes, and assert privilege
if she desires.
An MFT with a full-time caseload finds herself on the edge of burnout. She notices she is becoming less empathetic and more
combative with clients, and frequently arrives at the office in the morning still tired from the day before. A colleague she respects
greatly refers her a complex family case. The MFT should:
Decline the referral, and consider reducing her overall
caseload.
An adult client tells an MFT that the client’s 89-year-old mother is in hospice care. The client goes on to say that the hospice staff
have been screening the mother’s mail and phone calls, as they are concerned that she would fall prey to financial scammers who
target the elderly. The client tells the MFT that the mother has severe dementia and that the client believes the screening of mail
and phone calls is appropriate. The client also says the staff has never refused him access to his mother. The MFT should:
Maintain the client’s confidentiality.
An MFT working in a middle school setting is confronted by a parent who is upset that the MFT has not filed a child abuse report
over the bullying her daughter has faced. The daughter is regularly taunted by other girls at the school and has been injured in
some shoving matches. Though the daughter has sought to avoid these fights and does not fight back, the MFT defends herself by
noting that in each case the girl has been fighting with other girls around the same age and size. The daughter is a regular client of
the MFT, and the mother has attended some sessions. The MFT should:
Contact her local child protective service agency to report
physical abuse of the daughter.
An LMFT in a prison mental health setting learns that a client, who had been convicted of intimate partner violence, was reluctant to
attend therapy because a prior therapist had offered the client sex if the client was willing to break up with his wife. The client had
refused to do so, and the therapist had then explained that she did not think the client’s relationship was healthy. The client now
tells the LMFT that the prior therapist was right, but he still felt unsure about therapists as a result of the prior experience. What
should the LMFT do next?
Provide the client with the brochure Therapy Never Includes
Sexual Behavior
An MFT is working with a family consisting of a 15-year-old girl, a 17-year-old boy, their mother, and their stepfather. The family was
referred to therapy by the 15-year-old’s school. The school requests a summary of the 15-year-old’s progress in treatment. The
MFT should:
Seek permission from all family members prior to releasing a
treatment summary.
An MFT in private practice is concluding her last session of the day. After the session ends, the client pays her fee by credit card
and schedules their next meeting, and both MFT and client walk out of the building where the practice is located. There, the MFT
realizes she has had forgotten her wallet and does not have the cash to cover her usual bus fare to get home. The client offers cash
to pay the therapist’s bus fare. When the MFT initially refuses the offer, the client suggests that the money simply be credited
toward the next session’s fee. Ethically, the therapist should:
Politely refuse the offer and work to find another way to get
home.
