Highpass exam 3 (book)

Question 1

An LMFT who specializes in couple therapy is approached by a man seeking treatment for his marriage. The man explains that his marriage is a polyamorous “arrangement” with four other individuals, who all share a home and financial resources. The LMFT has not worked with polyamory before, and is not sure how traditional couple therapy models may be applied with polyamorous relationships. But the LMFT does not feel judgment or bias toward the man or the others in the arrangement. How should the LMFT proceed?

Answer 1

Seek consultation or supervision related to the treatment of polyamorous relationships

Question 2

An LMFT is moving from agency work to her own private practice. She has leased an office and launched a web site, and has begun receiving referrals of prospective clients. Some of the prospective clients reaching out to her are individuals who the LMFT had previously treated in her prior agency role. How should the LMFT address her ethical responsibilities related to the transition in workplace?

Answer 2

Develop a professional will

Question 3

The adult client of an LMFT is suffering from a severe cold and cancels their scheduled therapy session 30 minutes before the session was set to begin. The LMFT charges the clients credit card for the full session rate. A few days later, the client calls the LMFT and expresses their anger that they were charged when they could not control being sick, and when the LMFT does not have provisions for telehealth sessions in such instances. The client also notes that no late cancellation fee had been disclosed to the client at the beginning of therapy. The LMFT informs the client that the fee is charged based on the appointment, and the fact that the LMFT would not have been able to fill that newly-empty time slot at the last minute. How should the LMFT proceed with this client?

Answer 3

Refund the charge.

Question 4

An LMFT is contacted by a close friend and colleague (also an LMFT), who recently was notified that a former client had filed a civil lawsuit against the colleague, alleging malpractice. The colleague appears to be in distress, and reports feeling taken by surprise by the suit. The colleague asks the LMFT for guidance on how to respond to the lawsuit, including whether to hire an attorney or seek to quickly settle out of court. How should the LMFT respond?

Answer 4

Encourage the colleague to discuss their concerns with an attorney

Question 5

An adolescent male client tells an LMFT that he is drawn to violent movies and video games, and spends a great deal of time fantasizing about what he would do if confronted with a situation where he would need to become violent to survive. Though he has no history of violence or substance use, the client is struggling in school and the family has guns in the home. The LMFT should:

Answer 5

Engage in discussion of what makes the games, movies, and fantasies so appealing. No specific ethical or legal responsibilities are triggered by the information in the question.

Question 6

While browsing a popular mobile phone app people can share short videos, an LMFT is shocked to see a former client from 10 years ago holding up the LMFT’s picture and repeatedly saying “This psychologist saved my life.” The former client explains how they had struggled with depression and suicidality, and came through it thanks to the therapy process. The video ends with the client saying, “If you’re a client now, you’re lucky. Next time you go to session… say thanks for me, ok?” The LMFT no longer has records from the client’s treatment, but sees that they can contact the former client through the app. Ethically, how should the LMFT proceed?

Answer 6

Contact the former client to request that they change the word “psychologist” since the LMFT is not one

Question 7

A client receiving individual treatment from an LMFT for an anxiety disorder was fired from her job at a technology company. The client asks the LMFT for a letter in support of the client’s lawsuit against the company. The client asks the LMFT to mention in the letter that the client’s bosses had created a hostile work environment. Considering the LMFT’s ethical responsibilities, the LMFT should:

Answer 7

Offer to write a letter attesting to the client’s treatment, without mention of the workplace

Question 8

A LMFT is in the process of leaving the agency where they have worked for the past five years. The agency has honored some client requests to be reassigned to other therapists in the agency, but some clients have been referred to outside providers if the client had a preference to be referred out or if their specific needs suggested that an external referral would be preferable. The LMFT’s last day at the agency is one week away. How can the LMFT best assure continuity of care to clients who are being transferred?

Answer 8

For clients who authorize it, speak directly with each client’s new provider, and provide copies of records to external providers

Question 9

An LMFT attends a weeklong workshop focused on understanding human behavior in its social and cultural context. The LMFT return an home behavior in is social and cultural conte MET VieT ra tums to working na chans the an aly: Though sine stand by he as my con a
changed dramatically. Though she stands be her assessment of spectic cient symptoms and her observations of ilent behaviors, she no longer believes that most of the diagnoses she hidgiven should be included in the clients records, as she has come to see diagnosis as a fundamentally oppressive act. Clients express confusion at the change, and become frustrated when their insurance will no longer cover therapy. How should the LMFT proceed?

Answer 9

Evaluate herself for impairment, and consider whether diagnosis can be given in a manner that facilitates treatment without being oppressive

Question 10

An LMFT is beginning family therapy with a mother, stepfather, and 15-year-old daughter. According to the family, the daughter had been sexually abused by her father when she was 7. She talked to her teacher about the abuse soon after it happened, and the teacher reported it to authorities. The father was arrested and convicted, and died in jail when the daughter was

Answer 10

Report suspected child abuse

Question 11

A client requests and receives a copy of her clinical record from the LMFT who has been providing her with therapy. The client reviews the record and becomes visibly angry, demanding that the LMFT change the diagnosis in her file. The LMFT should:

Answer 11

Remind the client that she may submit a written statement disputing the diagnosis and have that statement included in the file. This is a legal right of any client who disagrees with something in their record.
Incorrect. Remind the client that the diagnosis is used simply to facilitate payment for services. Diagnosis

Question 12

As a client leaves an LMFT’s office, the LMFT believes the client poses a serious danger to the client’s spouse. (The client had been making threats in session about what he would do to her.) The LMFT, knowing the couple ives roughly 30 minutes from the LMFT’s office, call the dient immediately, and is able to resolve the danger. The client disavows any continued plan to harm his spouse, and apologizes to the LMFT for “getting so out of hand.” What does the LMFT need to do to resolve the LMFT’s legal responsibility?

Answer 12

Notify law enforcement within 24 hours

Question 13

A couple in their 40s presents to an LMFT asking for both couple and individual therapy. They describe themselves as open books, and ask the LMFT them both individually and together so that the treatment can remain focused on helping them both to improve as partners, even through individual efforts. One partner has a history of alcohol abuse, but reports having been sober for six years. They ask for a mix of individual and couple sessions. How should the LMFT proceed, in accordance with their ethical responsibilities?

Answer 13

CORRECT. Consider the potential conflicts that may emerge between couple work and either or both individuals, and clarify the LMFT’s role.

There is nothing in the CAMFT code of ethics that prohibits the kind of concurrent treatment the couple is requesting. But the code does direct MFTs to carefully consider the potential conflicts that can result. In this case, because the couple is aligned around a singular treatment plan, it may be appropriate for the LMFT to work with them as they have requested. As for the incorrect responses, there is no ethical mandate for each treatment unit to be treated separately, just a requirement for careful consideration. The couple cannot absolve the LMFT of the therapist’s ethical responsibilities.
And the alcohol abuse treatment, if necessary, does not need to be sectioned off; indeed, there is research supporting the important role of the partner in an individual’s effort to maintain sobriety. Though again, the LMFT would need to carefully consider how such treatment would fit into the overall treatment plan.

Question 14

A client who has expressed great concern about anyone knowing she is in therapy passes out in the middle of a session. The LMT the client was seeing is able to wake her long enough to learn that she has recently been struggling with illness and has pain from a neck injury, and the LMFT knows from the client’s intake paperwork that she has a blood disorder. The LMFT
should:

Answer 14

Call 911, summon paramedics, and inform them of the client’s medical issues. LMFTs are allowed to share medical information in an emergency situation, and the LMFT in this instance can do so without revealing any information about the client’s therapy.

Question 15

A client has canceled three of the other four scheduled sessions with an LMFT, and been a no-show for the other four. Each time the client has promised to pay any balance charged, and to come in for a session the following week. The LMFT finds herself irritated with client’s behavior, going so far as to warn the client two weeks ago that she would simply close the dient’s case and refer out if the client didn’t come in. The client was a no-show for the next two scheduled sessions. Even before this long series of missed appointments, the LMFT found herself personally disliking the client. How should the LMFT manage her ethical responsibilities in this case?

Answer 15

CORRECT. Close the case, providing the client with appropriate referrals to other providers

LMFTs can terminate therapy for almost any reason, so long as that reason is not discriminatory in nature, any evident crisis issues are addressed, and the client is provided with appropriate referrals. In this case, the client has a pattern of non-attendance and was warned that this would lead to termination. There is no legal or ethical responsibility to provide redundant warnings (C). While assessing for crisis is generally a good idea (A), even if crisis issues were present, this would not necessarily obligate the therapist to remain the client’s treatment provider. If anything, evidence of crisis combined with non-attendance in therapy might suggest a need for coordinated transfer to a higher level of care. While the LMFT’s response to the client may indeed indicate countertransference (D), therapists are not legally or ethically required to continue working with clients they don’t like.
Termination is appropriate here.

Question 16

An LMFT is running an open support group for women whose children are preparing to leave home. The group has been running for several years, and many of the participants have developed close personal relationships. A trans woman, whose son will be leaving for college in a few months, contacts the LMFT to inquire about joining the group. The LMFT is concerned that some group members may be uncomfortable with this woman joining the group, and does not want the woman to have a negative experience. How should the LMFT proceed?

Answer 16

CORRECT. Invite the woman to join the group, and monitor the group closely
Gender identity and expression are not central to the group. Referring out, or even asking the woman to wait a few weeks before joining, are not steps that the LMFT would take with a cisgender woman. As such, this kind of delay or referral is discriminatory. The only non-discriminatory response would be to invite the woman to join just as the LMFT would with any other person who fits the group’s purpose. The LMFT should then monitor the group to ensure that group members are not behaving in hostile or discriminatory ways. (“Clarifying the rules” does not resolve the issue, and may still result in discrimination. There is no reason in the vignette that the woman should not be allowed to join the group.)

Question 17

A 35-year-old woman regularly attends individual therapy with an LMFT to treat symptoms of depression. The woman is married with two young children, and has been with her husband for 12 years. She reports that her husband is physically violent with her once or twice a year, and that this violence has never occurred in front of the children. She says she regrets marrying him, but that he provides reliable financial support for their family. and so she has no desire to leave the marriage. How should the LMFT proceed?

Answer 17

CORRECT. Develop a safety plan

The LMFT may not agree with the client’s decision-making, but the client has a right to make her own decisions for her life, and the LMFT has an ethical responsibility to respect those decisions. There is nothing reportable here, and encouraging the client to leave her marriage would be imposing the LMFT’s preferences on her. The best option is to develop a safety plan, respecting the client’s decision to remain in the marriage while aiming to reduce physical risks going forward.

Question 18

In a college town with a population of about 30,000, the LGBT community is primarily served by two experienced LMFTs. Each has their own private practice. A newly-licensed LFT opens a local private practice, advertising that they also specialize in serving the LGBT community. The two existing therapists for the community each are concerned that the newly-licensed LMFT may not provide competent care, and may impact their ability to keep their own practices open. How can the two experienced LMFTs address their concerns?

Answer 18

CORRECT. Review the newly-licensed LMFT’s marketing to evaluate the newly-licensed LMFT’s fees, if published, and their qualifications for calling themselves a specialist

All of the first three options here involve some form of anti-competitive practice. Independent therapy practices cannot work together in ways that will discourage competition or inflate prices for consumers. It is, however, acceptable to see what others are charging, and to use that as part of the basis for setting your own fees, so long as your decision-making is truly independent. It is also acceptable to review others’ marketing in order to compete more effectively.

Question 19

An LMFT in private practice hires an assistant to address tasks such as marketing, scheduling, and billing. The LMFT gives the assistant training in HIPAA and related privacy requirements. As the LMFT is approaching a vacation, the assistant prepares a mass end how the current clients informing them of the LMFT’s upcoming absence and how they can receive crisis of emergency care if necessary during the vacation. The assistant accidentally includes all client email addresses in the “To.” field of the email, such that each recipient can see the addresses of all other recipients. The assistant informs the LMFT immediately. How should the LMFT proceed?

Answer 19

CORRECT. Contact impacted clients individually to inform them about the issue and the steps the LMFT is taking to ensure it does not happen again, and provide additional training to the assistant

While the information improperly disclosed here is relatively low-risk, it is important that the LMFT use the opportunity to improve their protections for client information going forward. Only option B here attempts to address the immediate issue and also improve processes for the future. An apology (A) is good, but doesn’t actually improve data protections. Similarly, reissuing the newsletter (C) doesn’t resolve or even acknowledge the breach. And there is no “level” system of classifying breaches in the CAMFT code of ethics, state law, or HIPAA (D).

Question 20

At the end of their supervision relationship, an associate MFT is surprised to see that their supervisor completed Verification of Experience forms that include 100 more clinical hours than the associate had obtained under that supervisor. The associate asks the supervisor about the discrepancy, and the supervisor explains that the additional hours are bonus credit given in appreciation of the supervisee’s work. The form is already signed. In keeping with their ethical responsibilities, the associate should:

Answer 20

a. CORRECT. Return the form and request that the supervisor complete and sign one without bonus hours
Incorrect. Respect the supervisor’s decision and retain the form to submit to the BBS upon completion of hours

For the supervisee to submit this form would be fraudulent, as the form does not reflect actual hours of experience obtained. The supervisee does not need to consult to determine whether the bonus is appropriate, as it is plainly not. The CAMFT Code of Ethics makes legal compliance in the supervision relationship a responsibility of both the supervisor and the supervisee. The associate should return the form and request an accurate one.

Question 21

A few days after a particularly difficult session, a client asks her therapist (an LMFT) to show her the information the LMFT wrote in the clients file about that session. The client had discussed childhood trauma and tells the LMFT she wants any information about that trauma removed immediately from the file. The LMFT empathizes with the client, but had included information about the trauma in progress notes and believes it is important to the client’s treatment. Legally, the LMFT should:

Answer 21

CORRECT. Inform the client that the client is free to review the file but that the LMFT cannot comply with the client’s request to change the note. It is the therapist, not the client, who determines the content of the file and must ensure it meets the standard of care. If the information about trauma is important to the treatment, it belongs in the file.

Question 22

At a busy group practice an lmft observes that a colleague has been Increasingly letting sessions go past their scheduled end time, and that the colleague’s office has become disorganized. The colleague explains that they have been going through a divorce, and fighting for custody of their children. The colleague has been using cocaine to keep their energy up for client care, but feels “out of gas” to maintain c

Answer 22

CORRECT. Offer to connect the colleague with legal, substance use treatment, or other resources
The CAMFT Code of Ethics encourages LMFTs to offer support to colleagues who are experiencing impairment due to substance abuse or mental health issues.

Question 23

During the assessment process in outpatient therapy, a 38-year-old woman describes to an LMFT the woman’s long history of troubled romantic relationships. The woman carries a diagnosis of Borderline Personality Disorder. She reports that she was sexually abused as a child, had several difficult dating experiences, once had a threesome with the therapist she and her husband were seeing for couple therapy, later divorced that husband, and has had a series of brief romantic relationships with married people. She has been through a great deal of therapy, she says, but she asks the LMFT not to request prior treatment records. Considering the LMFT’s legal responsibilities, the LMFT should:

Answer 23

CORRECT. Provide the client with a copy of the brochure Therapy Never Includes Sexual Behavior
The only specific legal obligation triggered by the information in the question is the obligation to provide the brochure Therapy Never Includes Sexual Behavior. Whether the therapist believes the client is telling the truth does not matter; a client is reporting a sexual relationship with a previous therapist, and that is enough to trigger the obligation.

Question 24

A 14-year-old client consented to her own treatment at a nonprofit agency, which agreed to treat her for $5/session. The client tells the therapist (an LMFT) that the client has been abusing a friend’s prescription painkillers. Legally, the LMFT should:

Answer 24

CORRECT. Document the discussion and refer the client to a physician

Question 25

An LMFT is working with a client in a alterent part of the state, one the LMFT is not familiar with, via telemedicine. During a session taking place via videoconference, the client informs the therapist that he recently lost his job and is struggling to navigate the complex web of social services in his area.
He fears losing his home in a matter of weeks. Ethically, the LMFT should:

Answer 25

CORRECT. Reconsider whether telemedicine services are appropriate for this client. This best summarizes the LMFT’s specific ethical responsibility in this case. We are required to evaluate whether telemedicine services are appropriate to the client’s needs.

Question 26

An LMFT is brought in as an expert witness in a criminal case where a woman was accused of violently beating her 8-year-old daughter. The LMFT is asked by the court to speak on the long-term effects of child abuse, as well as on factors that can lead mothers to become abusive. The LMFT has expertise in these areas. The LMFT also finds the behavior that the woman is accused of repugnant. The LMFT should:

Answer 26

CORRECT. Speak solely from her knowledge and expertise in the field, and avoid saying anything about the specific case being tried.
This is the appropriate role of an expert witness in a court proceeding.

Question 27

An LMFT turns away a prospective client after the client suggests the lmft overbill the client’s employer, who is paying for treatment through an Employee Assistance Program. The client was hoping to split the money with the therapist. Months later, the former prospective client is on trial for fraud, accused of engaging in a similar scheme with a different therapist. The LMFT is called to testify against the client. The LMFT should:

Answer 27

CORRECT. Consult an attorney and prepare to testify
There is a specific exception to privilege that applies when the therapist was sought out for the purposes of committing a crime (as was the case here) or avoiding detection after the fact. While it is ultimately up to the judge to determine whether the exception applies, the LMFT should consult an attorney and prepare to testify.

Question 28

An online business aims to make therapy more affordable for telehealth clients by using what they call a “reverse auction” process. When a prospective client signs up with the business, the business creates a de-identified summary of client information (such as location, demographics, and presenting problem), and then allows participating therapists to “bid” on the client by posting what they would agree to charge that client per 50-minute therapy session. The therapist who has offered the lowest “bid” when the auction closes pays the business a nominal fee, and then receives the client’s full information, including their name, phone number, and email address. The client is told which therapist won the auction, what fee the therapist committed to, and the therapist’s contact information. How should LMFTs interact with this service?

Answer 28

CORRECT. LMFTs should not participate in this service
The key phrase in the question is “pays the business a nominal fee.” At that point the rest of the question becomes irrelevant. LMFTs cannot charge a fee or pay a fee for referrals, and this business structure would require LMFTs to pay for each specific referral the business would generate for them. It is thus against the law for LMFTs to participate.
Preparing

Question 29

In the client’s second session, the individual client of an LMFT requests a letter that would allow the client to have an emotional support dog in their apartment. The client reports that their apartment building does not typically allow dogs, but their pet dog who is currently fier care of a family member helps the client to manage their panic attacks. Prior to issuing the requested letter, the LMFT is legally required to:

Answer 29

CORRECT. Establish at least a 30-day clinical relationship with the client, including a full clinical assessment
Under state law, LMFTs and other therapists issuing letters for emotional support dogs must first establish a 30-day therapeutic relationship, and conduct a formal assessment, among other requirements. The therapist is not required to seek prior records, to evaluate the animal directly, or to attest to the animal’s safety.

Question 30

Against the wishes of a client family, an LMFT makes a report of suspected child abuse. The 11-year-old daughter in the family had told the LMFT that she had been sexually abused by a popular and respected teacher at their school. The family fears that the report will lead to them becoming outcasts in their school and community. The mother expresses anger that the LMFT made the report, asks the LMFT to withdraw the report, and threatens to pull the family out of therapy. How should the LMFTproceed?

Answer 30

CORRECT. Inform the family of how child abuse reports are investigated, and what the likely next steps are
The LMFT’s child abuse report was legally mandated, and there is nothing in this question that challenges the reasonable suspicion of abuse that formed the basis of the report. The LMFT should not attempt to withdraw it (A). At the same time, the LMFT cannot guarantee that the report will have no consequences (B). While reports legally should remain confidential, the teacher may be suspended or even jailed, and the family may suffer in their community if others suspect they were the reason a popular teacher was arrested. The best path forward is for the LMFT to attempt to minimize any harm that may result from the report, by explaining the likely next steps in the investigation process. The mother has not decided to remove the family (D), only threatened to do so, and such a removal may do more harm than good if the daughter or the rest of the family is in need of continued care.