Highpass exam 2 Flashcards
An 88-year-old woman experiencing cognitive decline and living in an assisted living facility is visited by an LMFT weekly to address symptoms of depression. The woman has reported several instances of mistreatment by her family members, which the LMFT knows to be untrue based on the reported timelines. For example, the woman has told stories about being present at events elsewhere in the world that she has simply seen on television news, when the LMFT is aware that the woman has not left the assisted living facility for anything other than doctor appointments in more than five years. The woman requests a complete copy of her treatment record. The LMFT is concerned that the woman would be upset to learn that the LMFT does not believe her stories. The LMFT fears that if the woman were to read the file, her depression would significantly worsen. How should the LMFT proceed?
Refuse to release the records, documenting the request and the rationale for refusal
An MFT becomes nervous when her male client, who has been struggling with symptoms of psychosis, threatens to drive his car into oncoming traffic on the way home. If the therapist believes that the client poses a threat as the client leaves the office, the MFT should:
Contact law enforcement to initiate the process of assessment for involuntary hospitalization
An MFT who is strongly opposed to abortion has been working with a client for six months on issues of depression. The client mentions that 20 years ago, when the client was a teenager, she had an abortion, and that her parents and her boyfriend at the time never knew. The client asks the MFT directly whether the MFT believes it is OK that the client has kept this secret for so long. How should the MFT respond?
Ask the client about her own perspective, while monitoring herself for outward indicators of judgment or non-acceptance
During family therapy, a 14-year-old client is sharing her recent experience at summer camp. One of her stories involves a friend who got into trouble at the camp for putting a frog in the bed of one of the camp counselors. The client reports that the counselor got so angry, she hit the friend with a broom, leaving scratches and a welt on the friend’s face. Considering their legal responsibilities, the therapist should:
Gather information for a mandated report of suspected child abuse
A client’s insurance company has repeatedly denied coverage for what the MFT believes is medically necessary outpatient therapy for bipolar disorder. In session, the client tells the MFT that unless the insurance company pays at least a portion of the cost of therapy, the client will not be able to afford continuing. Which of these is an appropriate first step for the MFT to take in resolving the issue?
With the client’s consent, attempt to advocate for them directly with the insurance company.
A client family has been struggling with financial needs since the father was furloughed from her job at a car wash. The family is in therapy to address areas of acculturation and family conflict. There are four boys in the family, ranging in ages from 3 to 13. While all of the family members sometimes come to therapy in dirty, torn clothes, the 8-year-old boy seems particularly withdrawn. He appears underweight, and says that the family sometimes waits for him to go to sleep before they eat dinner. “That’s not right,” the mother protests. “We send you to bed without dinner when you disobey.” The mother expresses her frustration that the 8-year-old is frequently sick and needs to stay home from school. To resolve the MFT’s legal obligations, the MFT should:
Report suspected child neglect
A former client files a civil lawsuit against an MFT, seeking monetary damages for several alleged violations. According to the suit, the former client claims that the MFT billed for sessions that were not provided, failed to recognize symptoms of depression, and did not obtain the client’s consent for telehealth services. The MFT does not agree with these charges and is preparing to defend themselves at trial, but is concerned because the former client was adamant that they would not provide permission for any of their treatment records to be shared under any circumstances – including in court. The MFT should:
Expect that they will be able to use their records from the client’s care to defend themselves
A walk-in client at a local counseling center presents with moderate suicidal ideation and racing thoughts. The front desk worker at the clinic tells an available MFT that the client should be seen immediately, and that the clinic manager has approved skipping the usual intake paperwork to get the client in to see the MFT as quickly as possible, as the client has verbally agreed to be seen. Legally, the MFT should:
Inform the client of the fee for services, and the basis on which the fee is computed, prior to beginning treatment.
In a school setting, an MFT is working individually with a number of children who have been identified as “at-risk” for various reasons. In one session, a 12-year-old girl tells the therapist that the girl has been in 10 fights so far this school year, and shows off several scars she says are from the fights. The girl takes pride in her scars, saying, “This is how you prove you’re tough.” The MFT knows from school administration that physical confrontations among students are common at the school. The MFT should:
Maintain confidentiality
An MFT is distressed to learn that a former client has posted a negative review of the therapist on a popular web site where consumers rate the service they received from health care professionals. While some of the review simply takes issue with the therapist’s style and lack of success in the case, the MFT determines that a few of the client’s statements are factually false, including an accusation that the client had been charged for sessions that she did not actually take place. The MFT should:
Maintain the client’s confidentiality.
An MFT is employed as a professor at a university. As part of her academic role, she routinely conducts research on the therapy process. For one study, she is interested in learning more about the impact of client and therapist race on the therapy process. She is set to begin recruiting therapists and clients to participate in the study. However, she is concerned that informing participants of her specific research question in advance would lead both clients and therapists to attend to issues of race more than they typically would. Considering her responsibilities, the MFT should:
Inform clients and therapists about the purpose of the research, and address concerns about them over-attending to issues of race in her manuscript as a cautionary note
An MFT who routinely transmits client data to insurance companies to obtain reimbursement decides to transfer records to an electronic record system and get rid of their old paper files. Prior to contracting with a shredding company to destroy the old paper files, what should the MFT do to fulfill their legal responsibilities?
Obtain a Business Associate Agreement from the shredding company
An LMFT has been working with a 20-year-old college student who has been experiencing symptoms of anxiety since leaving home a year earlier. The client has provided the LMFT a release of information allowing the LMFT to share information with the client’s parents. The LMFT receives an email, which notes it is from the client’s mother and is requesting an update on the client’s therapy. However, the email comes from a different address than the one the LMFT had been provided by the client. How should the LMFT proceed?
Attempt to contact the client to determine their wishes
An Italian family seeks therapy from an MFT. The family consists of a mother, father, grandfather, and three teenagers, all of whom share a home. They describe themselves as “tight-knit, loud, and boisterous,” and the initial session reflects this – they often talk over one another and occasionally shout, even when talking about topics they agree on. They tell the MFT they came to therapy because they are concerned about the middle teenager, age 16, who has been fighting with her siblings and parents. They say the 16-year-old recently disavowed her Catholic religion as well. When considering the MFT’s ethical obligations, how should the MFT approach treatment?
Become louder in session to emulate the family’s style of communicating; observe family interaction patterns to determine impacts and needs
An MFT working in a county mental health clinic seeks to terminate with a client who has not made meaningful progress in 3 months. The MFT does not expect that continued treatment would be helpful to the client. The MFT’s supervisor says that as long as the client is interested in continuing treatment, the MFT cannot terminate, as agency policy requires that they treat every client who is willing to engage in therapy. How should the MFT address their ethical responsibilities?
Inform the supervisor that continued treatment would violate the MFT’s ethical responsibilities
A counseling agency partners with a school district to provide therapy services for at-risk youth who get involved in the school’s disciplinary process. Over time, an MFT associate working for the agency becomes uncomfortable with the agency’s policy to provide at least the number of sessions ordered by the school, and to offer further sessions at a higher rate if the client continues to have mental health needs. The associate believes that the policy leads to clients who do not need treatment continuing to be seen to meet the school’s directives, and some with significant needs dropping out of treatment in the face of significant fee increases. Considering her ethical responsibilities, the associate should:
Inform the agency that their policy is in conflict with the associate’s ethical responsibilities
A 17-year-old who has been participating in family therapy under her parents’ consent asks the MFT for a copy of treatment records that apply specifically to her. She explains that her school, from which she was recently suspended, is requesting proof that she is receiving mental health care. She says a treatment summary indicating her participation should suffice if the MFT does not want to provide more detailed records. Considering the MFT’s ethical responsibilities, how should the MFT respond to this request?
Contact the parents and any other family members involved in treatment to determine whether they will authorize the release of records, and whether they would prefer a treatment summary be provided
In session, a client comments on how the therapist’s office is unusually cold. The therapist apologizes, and says that the office needs repair to the heating system that will cost several thousand dollars. The therapist tells the client it will take about a month for the therapist to put together the money needed for the repair. The client notes that they are a long-term client planning to remain in therapy for at least another year, and offers to prepay for the next 10 sessions so that the therapist can make the repair and the office can be more comfortable for everyone. The client asks for a slight decrease in their session fee in exchange. The therapist should:
Decline the client’s offer
An MFT who has been in private practice for five years decides to raise her fees. Which of the following is true?
The MFT may raise fees for both new and ongoing clients, if she provides adequate notice to existing clients.
An MFT is treating a client for trauma, using exposure-based techniques. During a particularly intense session, the client becomes overwhelmed, and tells the therapist she is ending treatment. She reports that she has become distracted and irritable with her family and at work, and that the treatment is not helping her in the way she hoped. The therapist should:
Empathize with the client, and remind her of her rights
The father of an MFT’s adult client calls the therapist to say that the client is planning to kill the client’s stepmother. The MFT does not have a Release of Information to speak to the father about the client. The father says that he fears the client is on his way now to the stepmother’s home with a weapon. The father provides the stepmother’s address and phone number. The MFT should:
Not provide any information to the father, and contact police.
An LMFT working in an agency setting learns that a child she sees for therapy has been physically abused by the child’s parents. The parents are treated by another therapist at the same agency, and it was that therapist who shared the information about the abuse and is preparing a written report to the local child protective service agency. The LMFT believes she has information from her last meeting with the child that would be relevant to the abuse report. How should the LMFT proceed?
Provide the relevant information to the colleague, and collaborate on the report
An MFT has been working with a couple for four months when the couple decides to separate. They ask the MFT whether they can continue as individual clients in order to address the impacts of the separation on each of them individually and on their family (the couple shares a two-year-old daughter). They report that they have not finalized a decision of whether to divorce, but have no interest in working on their relationship at this time. Which of the following is the best course of action, considering the MFT’s ethical responsibilities?
Given the potential for conflicts emerging from individual care, refer each partner to other providers for individual work, and let them know that the MFT would be happy to work with them together in the future on relationship or co-parenting issues
A family is in therapy seeking help with parenting conflict. They report that the teenage daughter is frequently defiant at home, and the parents cannot agree on a strategy for controlling her behavior. The parents ask the MFT to provide a superbill that they can submit to their insurance carrier for possible reimbursement. The MFT provides the superbill, but the insurance provider refuses payment, because the superbill was submitted without a diagnosis code. The MFT should:
Remind the clients about the limitations of coverage
An Hispanic family approaches an MFT for family-based treatment. The MFT soon learns that several family members have their own individual therapists, and the parents in the family have a couple therapist who is working with them on their relationship. The family insists that these efforts are all in support of one another, and the family therapy would be to address family conflict and rule-setting. The family offers to pay the MFT the full fee, and insists they would attend every scheduled session. The MFT should:
Ask the family to sign releases allowing for consultation and coordination with the other therapists, and proceed with family therapy
A family of six is seeing an MFT to address issues of discipline and conflict within the family: A 64-year-old grandfather, his 38-year old son, the son’s 29-year-old wife, and their three children, ages 11, 8, and 5. The grandfather is skeptical of therapy and concerned about privacy, and asks the MFT for more information about how records are stored and maintained. Which of the following is a useful and accurate response?
Inform the grandfather that records of treatment will be maintained for at least 20 years
In individual therapy, a 16-year-old client who consented for therapy on her own reports that she and her 21-year-old girlfriend recently engaged in oral sex for the first time. The client says that the sex was consensual, and was a positive experience. Still, she asks the MFT to keep this information private, as she says her parents are unaware of her sexual orientation. The MFT:
Must maintain confidentiality
An MFT learns that Jane, another MFT working in the same clinic, developed a sexual relationship with one of Jane’s clients. Jane says that she terminated the therapy and referred the client to another clinician. Ethically, the MFT should:
Discuss with the colleague that the MFT is concerned about the colleague’s professional boundaries
The parents of a 14-year-old Latino boy who independently consented for mental health treatment contact the MFT who is providing therapy to the teenager, and ask for an update on his care. They say they have been worried about the 14-year-old’s increasingly distant behavior. The MFT has been providing treatment for the teenager for two months, and does not have a Release of Information allowing for discussion with the parents. How should the MFT proceed?
Do not provide any information on the client’s care, even whether the child is a client.
An 18-year-old female client of an MFT posts several comments on the MFT’s social media account and on a popular reviews web site, praising the MFT for the high-quality care the MFT provided. The client encourages others to seek mental health care generally, and the services of the MFT specifically, if “you want to get your life on the right track.” How should the MFT respond, considering the MFT’s ethical responsibilities?
At the next scheduled session, discuss with the client the potential risks involved in having such posts and comments publicly available
