IMPORTANT - MISC FACTORS TO REMEMBER Flashcards
A 17-year-old client with a diagnosis of Bipolar Disorder comes to a first session with her parents. The mother informs you that their daughter met with a psychiatrist who prescribed medication, but the family’s faith prohibits her from taking it. The parents tell the therapist they have been trying to “rid her of her demons by praying and relying on our faith.” You notice that the girl appears disheveled, is frequently distracted during the session, and seems agitated. What actions should the therapist take in this case?
A. Report the situation to CPS because client is a minor and she is not receiving proper treatment
B. Initiate involuntary hospitalization since the client is exhibiting clear signs of psychosis
C. Begin treatment with the client and maintain confidentiality due to religious exemptions with child abuse reporting
D. Explore the pros and cons of taking psychotropic medications with the parents and their daughter, while acknowledging their religious rights.
ANSWER D: Explore the pros and cons of taking psychotropic medications with the parents and their daughter, while acknowledging their religious rights.
RATIONALE:
R/O Answer B = since we would only initiate a 5150 (involuntary hospitalization) if there were a grave concern for the client’s immediate safety, something that is not indicated based on the information shared.
R/O Answer C =can also be ruled out, since it completely overlooks several of the key concerns specifically noted in the question stem. Namely, the potential risks facing the client and medication compliance.
This leaves us with options A and D.
R/O Answer A = As the law indicates, if a child is receiving treatment by religious means, or not receiving treatment due to religious reasons, this does not necessarily constitute neglect. In this case, the child is receiving care, has been seen by a psychiatrist and is now seeing a therapist—the parents have just decided against psychotropic medication for religious reasons. In addition, failure to take the medication is not a life or death decision. For these reasons, we would not choose A.
COORECT ANSWER = A
This leaves us with answer D, which gives us an opportunity to have an honest conversation with the family regarding medication while still respecting the family’s religious beliefs. This answer addresses all of the concerns mentioned in the question stem.
This scenario is particularly challenging because the law is a bit vague when it comes to child abuse reporting and religious freedom. If religion were not mentioned in this question, we would search for an answer that includes reporting neglect and be justified in doing so. However, religion is mentioned and the parents state medication is expressly prohibited within their religion. This makes choosing the right answer trickier. According to the Child Abuse and Neglect Reporting Act, “a child receiving treatment by spiritual means…or not receiving specified medical treatment for religious reasons, shall not for that reason alone be considered a neglected child (CA Penal Code 11165.2).”
TRUE OR FALSE
LEGALLY, if a child is receiving treatment by religious means, or not receiving treatment due to religious reasons, this does not necessarily constitute neglect.
TRUE – DO NOT REPORT CHILD ABUSE
According to the Child Abuse and Neglect Reporting Act, “a child receiving treatment by spiritual means…or not receiving specified medical treatment for religious reasons, shall not for that reason alone be considered a neglected child (CA Penal Code 11165.2).”
You cannot report Child Abuse/Neglect if treatment or medication is given or not given DUE TO RELIGIOUS BELIEFS.
(Ex: child diagnosed bipolar & is prescribed medication–but parents refuse medication due to religion/beliefs- TH CANNOT REPORT CHILD ABUSE/NEGLECT
This scenario is particularly challenging because the law is a bit vague when it comes to child abuse reporting and religious freedom. If religion were not mentioned in this question, we would search for an answer that includes reporting neglect and be justified in doing so. However, if religion is mentioned and the parents state medication is expressly prohibited within their religion. Then NO REPORT
TX UNIT - FAMILY
How should the therapist clinically manage the ethical responsibilities in this case?
(Family TX- Initial Session - Interventions)…what interventions are ethically the TH responsibility
A. Address clients’ expectations for treatment; Discuss risks and benefits of being in therapy; Set fees prior to the first session.
B. Manage the fee; Determine who the client is and the nature of the therapist’s relationship with the parties involved in treatment; Provide referrals if family decides not to continue therapy
C. Address clients’ expectations for treatment; Inform clients of the limits of confidentiality; Determine who the client is and the nature of the therapist’s relationship with the parties involved in treatment.
D. Address clients’ expectations for treatment; Manage the fee; Obtain a signed release from each of them prior to speaking with Karen’s teacher.
How should the therapist clinically manage the ethical responsibilities in this case?
(family TX = initial stage/assessment –ethical interventions
(Correct Answer = C: Address clients’ expectations for treatment; Inform clients of the limits of confidentiality; Determine who the client is and the nature of the therapist’s relationship with the parties involved in treatment.
TX UNIT - FAMILY
How should the therapist clinically manage the ethical responsibilities in this case?
(Family TX- Inital Session - Interventions)…what interventions are ethically the TH responsibility
A. Address clients’ expectations for treatment; Discuss risks and benefits of being in therapy; Set fees prior to the first session.
B. Manage the fee; Determine who the client is and the nature of the therapist’s relationship with the parties involved in treatment; Provide referrals if family decides not to continue therapy
Correct
C. Address clients’ expectations for treatment; Inform clients of the limits of confidentiality; Determine who the client is and the nature of the therapist’s relationship with the parties involved in treatment.
D. Address clients’ expectations for treatment; Manage the fee; Obtain a signed release from each of them prior to speaking with Karen’s teacher.
How should the therapist clinically manage the ethical responsibilities in this case?
(family TX = initial stage/assessment –ethical interventions
(Correct Answer = C: Address clients’ expectations for treatment; Inform clients of the limits of confidentiality; Determine who the client is and the nature of the therapist’s relationship with the parties involved in treatment.
TH/CT Conflicting Values:
IF TH personal beliefs conflict & bias TH objectivity & strongly believing against CT’s views.
How should the therapist address the conflict presented in this case?
How should the therapist address the conflict of conflicting beliefs between TH and CT?
ANSWER = Seek immediate consultation to discuss the matter and determine if a referral would be appropriate.
What legal obligations does the therapist have if …..
“A minor (15yr) brought by legal guardian (w/custody) for past 3yrs since minor’s mom died. Guardian reports “w/bad crown + skips school + lying about location)
Kayla rolls her eyes and responds “Don’t pretend like you care. I’m not afraid of you anymore.”
ANSWER = D. Obtain signed informed consent to treat a minor; Set fee prior to treatment; Assess for child abuse.
[QUESTION]:
Kayla, age 15, is brought in for therapy by her Aunt Lynda who was given legal custody following the death of Kayla’s mother three years ago. Lynda reports that Kayla is “running with the wrong crowd”, has been skipping school and is lying to her about where she goes at night. Lynda states, “She told me that she was at her friend’s house, but I went over there and nobody was home. I just can’t trust her anymore.” Kayla rolls her eyes and responds “Don’t pretend like you care. I’m not afraid of you anymore.”
What client factors must the therapist consider in planning initial treatment?
B. The couple’s expectations for Bill’s treatment outcome; The severity of Bill’s current alcohol use; Bill’s feelings of shame regarding seeking help.
A lesbian couple seeks therapy for relationships issues. One of the women is African American and the other is Chinese American. The African American woman complains that her partner is ashamed of her and won’t introduce her to her family. The Chinese American shakes her head and states “She just doesn’t get it.”
How should an attachment therapist incorporate human diversity issues in the treatment plan?
B. Explore how their cultural backgrounds influence their relational dynamics.
CT eports a history of eating disorders she feels she “has a handle on right now but who knows.
The therapist has a history of eating disorders. What should the therapist’s first action be?
ANSWER = C. Identify her physical symptoms and recommend a medical evaluation in conjunction with thrapy
! A therapist is running a therapy group for adults with relationship issues. The group has been meeting weekly for two months. During a group therapy session, one of the members shares that he doesn’t feel like he is getting anything from the group and is thinking of quitting.
How should therapist respond?
ANSWER = D: Explore other group members’ reactions.
[Wrong:]
A. Ask the client what the therapist could be doing differently. (my bad)
B. Identify ways the group has helped him.
C. Invite the client to meet following group to discuss his concerns.
A newly engaged couple, Mark, age 40 and Elizabeth, age 36, seek therapy for communication problems.
In the initial session Elizabeth reports that they have huge fights after they visit Mark’s family and that he thinks that is a sign they shouldn’t be together.
What intervention would a strategic family therapist consider?
ANSWER =C
Instruct the couple to schedule arguments after seeing in-laws.
A therapist is leading a group for middle school kids with truancy issues. During the group, one of the members shares that his older step-brother “sells pot to kids in the neighborhood” and when their parents are gone shares it with him.
How should the therapist clinically manage his disclosure?
ANSWER = C. Facilitate a discussion about the disclosure with the group members.
(vs: B.) File a child abuse report immediately
[WRONG]
An elderly woman and her daughter seek therapy. The daughter reports that her mother can’t live on her own any more and wants the therapist to talk some sense into her. The mother reports that she is “doing just fine on her own” and doesn’t want to be put in a home.
How would a Solution-Focused therapist approach the case?
ANSWER =
B. Explore what they each see as an ideal outcome and identify resources.
(vs: C: C. Identify the mother’s strengths to determine if it is appropriate for the mother to continue living alone.
[WRONG]
A family is referred by their child’s therapist for family therapy. The mother reports that she is basically a “single parent” because her husband works so much. The two young children sit with the mom on the couch and the husband sits by himself in the corner chair.
How would a Structural family therapist proceed in this case?
ANSWER = B
B. Align with the father.
Answer C.) Explore the parent’s beliefs about parenting roles.
[WRONG]
New 2021 EXAM CHANGES?
Focus more on “ASSESSMENT & TREATMENT”
(TDC added 2 new topics to the “top 50”)
Fewer questions RE: Law & Ethics
