MOCK 1 EXAM - PRACTICE QUESTIONS (100)

Question 1

#1: Karen, a slightly overweight 13-year-old girl, is referred for therapy by her teacher. Parents, Brad and Nina, attend the first session with Karen. Nina shares that her daughter has complained about going to school since they moved to town a month ago. Brad adds that she used to be excited to hang out with the family and now she just wants to be alone in her room. He adds, “You can fix her, right?” Karen glares at her father and says, “Fix me? You’re the ones who needs help”.  
How should the therapist clinically manage the ethical responsibilities in this case?

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.

Answer 1

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.

Question 2

#2: During an initial assessment interview, a therapist observes that her new client is suspicious of the agency and the therapist.  The therapist provides informed consent, including the limits of confidentiality.  After receiving informed consent, the client tells the therapist that he wants to share certain information but is concerned it could get his friends in trouble.  
What is the most appropriate response to address the client’s concern in this case?

A. Recognize the client is not ready to talk about the situation and shift the focus to a less threatening subject.

B. Acknowledge it could be hard to feel safe in this situation and encourage him to only share information when he feels he is ready.

C. Confirm the client understands when a therapist must break confidentiality and show him where the files are locked to ensure his privacy.

D. Encourage the client to talk about these things and reassure him that the therapist is not required to report on the behaviors of his friend.

Answer 2

CORRECT =
B. Acknowledge it could be hard to feel safe in this situation and encourage him to only share information when he feels he is ready.

Question 3

#3: A 17-year-old is referred by her doctor to a mental health agency for counseling.  The client learned several weeks ago that she’s pregnant.  She reports she is in a relationship with the person who got her pregnant, but they are not getting along, she does not want him to know, and does not think she wants to have the baby.  She is conflicted about what to do and tells the therapist she would like support as she decides what to do.  The therapist has personal beliefs against abortion and feels strongly the client should not have an abortion.  
How should the therapist address the conflict presented in this case?

A. Seek immediate consultation to discuss the matter and determine if a referral would be appropriate.

B. Seek consultation and refer the client to prenatal services.

C. Encourage the client to include her boyfriend in making a decision.

D. Share the therapist’s personal beliefs and process how it effects the client and therapist’s relationship.

Answer 3

CORRECT =

A. Seek immediate consultation to discuss the matter and determine if a referral would be appropriate.

Question 4

#4: 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 legal obligations does the therapist have in the case described in this vignette?

A. File a child abuse report; Request documentation to verify custody; Obtain a release to speak to school counselor.

B. Set fee before the onset of therapy; Explore expectations of therapy; Assess for child abuse.

C. Obtain signed informed consent to treat a minor; File a child abuse report; Set fee prior to the onset of therapy.

D. Obtain signed informed consent to treat a minor; Set fee prior to treatment;Assess for child abuse.

Answer 4

CORRECT =

D. Obtain signed informed consent to treat a minor; Set fee prior to treatment;Assess for child abuse.

Question 5

#5: A lesbian couple, Michelle, a 44-year-old African American and Kara, a 38-year-old Caucasian, are referred by a friend. The couple reports that they fight all of the time and can’t agree how to parent. They have two adopted children, Josh, 6 and Logan, 4. They report that Josh has been disruptive in class, won’t stay seated and is aggressive with other children.  Kara starts crying when she says, “I don’t know what to do to help him. I am so worried about him. I can’t sleep without taking something”. Michelle complains angrily, “Well, she pops pills whenever she’s stressed and she worries about everything. If she actually disciplined him, we wouldn’t have this problem. He listens to me. Now, he’s completely out of control like you with that sleep drug”. Kara whimpers back, “He listens to you because he’s afraid of what you’ll do. ”
What interventions would a Bowenian therapist use in the beginning phase of treatment with Michelle and Kara?

A. Analyze the triangulation of substance abuse in Kara & Michelle’s relationship and develop a family history to identify Michelle and Kara’s learned parenting styles.

B. Identify the role of substance abuse as intrusive in their partnership and assist the couple in understanding the role of parenting in their families of origin.

C. Reduce the emotional reactivity of Michelle and Kara’s opposing responses to parenting and Interpret the multigenerational parenting styles of Michelle and Kara’s families of origin.

D. Develop a family history to identify Michelle and Kara’s learned parenting styles and analyze substance abuse as Kara’s avoidance of relationship responsibility.

Answer 5

CORRECT =
B. Identify the role of substance abuse as intrusive in their partnership and assist the couple in understanding the role of parenting in their families of origin.

Question 6

#6: Helen, a 61-year-old woman referred by her medical doctor, is having difficulties adjusting to a below-the-knee amputation due to complications from diabetes. A note from her doctor indicates that Helen has elevated blood sugars and inconsistently follows her eating plan and medication regimen. Initially, Helen is very animated, speaking rapidly and using expansive gestures. She becomes irritable when asked how she is feeling but admits that she has no appetite and isn’t sleeping well at night. Upon further discussion of her medical condition, Helen becomes tearful and states, “I can’t keep track of this disease. It’s just too much! I’m afraid I am going to get depressed again.” 
What clinical issues require further assessment in the case provided in the vignette?

A. Helen’s social isolation; Suicide potential for Helen; Helen’s preoccupation with physical challenges and limitations.

B. Helen’s understanding of her medical issues; Socioeconomic stressors affecting Helen; Helen’s mental status.

C. Helen’s psychiatric history; Suicide potential for Helen; Helen’s mental status.

D. Helen’s substance use; Socioeconomic stressors affecting Helen; Helen’s mental status.

Answer 6

CORRECT =

C. Helen’s psychiatric history; Suicide potential for Helen; Helen’s mental status.

Question 7

#7: A therapist has been meeting with a 36-year-old client for several months.  In one of the sessions, the client discloses that when she was much younger, she had sexual relations with one of her therapists.  The therapist provides the client with the brochure “Professional Therapy Never Includes Sex.”
 In addition to providing the brochure, what additional steps should the therapist consider?

A. Process the relationship with the client and encourage the client to file a report with the BBS.

B. Process the relationship and file a report with the BBS.

C. Inform the client that her previous therapist’s behavior was illegal and encourage her to talk to a lawyer.

D. Determine how old the client was when she had a sexual relationship and file a child abuse report, if necessary.

Answer 7

CORRECT =

A. Process the relationship with the client and encourage the client to file a report with the BBS.

Question 8

#8: An 8-year-old client is brought to therapy by her mother, who states that the client has been moody and defiant at home and has been acting aggressively with other children at school since they moved a few months ago. The mother states that “she’s at the end of her rope and has no idea how to deal with her daughter.” She further states tearfully that the client’s father is in rehab for heroin addiction. 
Which of the following goals should be included in the treatment plan for this case?

A. Decrease aggression at school and defiance at home; Re-establish appropriate relationships between family members; Refer the mother for financial assistance.

B. Decrease aggression at school and defiance at home; Improve mother’s parenting skills; Refer the mother to Al Anon.

C. Enhance impulse-control and attention span; Explore the marital relationship; Refer the mother to Al Anon.

D. Enhance impulse-control and attention span; Explore the marital relationship; Refer the mother for anger management.

Answer 8

CORRECT =

B. Decrease aggression at school and defiance at home; Improve mother’s parenting skills; Refer the mother to Al Anon.

Question 9

#9: A therapist in private practice has been treating a 54-year-old male client for four months. Over the past two months, the client regularly arrives late to appointments and has also missed several of them.  Although the cancellation policy was clearly explained at the onset of therapy, the client continuously fails to call in advance to cancel.  When confronted, the client minimizes the problem and accuses the therapist of having unreasonable expectations.  
How should the therapist initially respond to the client?

A. Remind client of his cancellation policies, have him sign an attendance contract and require he pay for missed appointments.

B. Confront the client about his perception of the problem and discuss how to move forward.

C. Reframe client’s behavior as having difficulty with therapeutic work and collaborate with client to reformulate goals.

D. Review cancellation policy and discuss possible termination with client.

Answer 9

CORRECT =

B. Confront the client about his perception of the problem and discuss how to move forward.

Question 10

#10: 39-year-old Emilio and 36-year-old Helena are referred by their middle child’s teacher. They have 2 sons, ages 11 and 7, and a 9-year-old daughter, Raquel. Both parents disclose being very busy and stressed at work, which means that neither of them is able to be home much. They are both concerned about their daughter Raquel, who appears more and more withdrawn and shut down lately. “I can’t get her to do anything”, Helena complains. “Plus she used to love going over to her aunt’s and uncle’s place, but, ever since a couple of months ago, she refuses to set foot in that house. I wonder if it has anything to do with that incident?” 
How would a therapist assess and clinically manage potential child abuse in this case?

A. Ask Helena what she means by “that incident”; inquire about any other recent changes in Raquel’s behavior; process the parents’ reactions to a possible child abuse report.

B. Review parenting skills modeled by the couple’s own parents; file a child abuse report based on the information provided; process the parents’ reactions to filing a child abuse report.

C. Evaluate current child care arrangements; obtain a release to speak with Raquel’s teacher; file a child abuse report based on Helena’s concerns.

D. Obtain a release to speak with Raquel’s teacher; ask Helena what she means by “that incident”; explain the therapist’s obligation to report child neglect.

Answer 10

CORRECT =

A. Ask Helena what she means by “that incident”; inquire about any other recent changes in Raquel’s behavior; process the parents’ reactions to a possible child abuse report.

Question 11

#11: A therapist at a community mental health agency meets with the parents of an 8-year-old boy who has a life threatening illness.  The parents are declining appropriate medical treatment for their son because it goes against their religious beliefs.  The child is receiving some care within the guidelines of their church’s ministry but the child’s condition is progressively worsening.  
How should the therapist respond to this dilemma?

A. Consult with a colleague who has familiarity with the religion and determine if their behavior is in line with the religious doctrines.

B. Not report the situation because the family’s religious values and right to self-determination restrict the therapist’s actions.

C. Report the situation to child protective services and process the report with the family.

D. Explore the parent’s willingness to take actions in the best interest of the child and determine if a report to child protective services is necessary.

Answer 11

CORRECT =

C. Report the situation to child protective services and process the report with the family.

Question 12

#12: A mother brings her 15-year-old daughter to therapy after learning that her daughter is pregnant.  The mother informs the therapist that an abortion is out of the question because of their religious beliefs, but she does not think the daughter should keep the baby.  The mother tells the therapist she wants to place the baby for adoption because she is in ill health and cannot help her daughter raise the baby.  
How should the therapist initially address the daughter’s pregnancy?

A. Meet with mom and daughter separately to explore how they each feel about adoption.

B. Educate clients about the process of adoption and provide a referral to a family planning agency.

C. Meet with the daughter separately to explore her feelings about the pregnancy and provide clients with appropriate referrals.

D. Ask the daughter how she feels about adoption and provide clients with appropriate referrals.

Answer 12

CORRECT =

C. Meet with the daughter separately to explore her feelings about the pregnancy and provide clients with appropriate referrals.

Question 13

#13: Brian, age 34, and Kim, age 30, are referred by Kim’s co-worker for therapy. Kim shares that she recently caught Brian cheating on her and even though he says it’s over, she doesn’t know whether she trusts him. Brian says “I know I messed up. It won’t happen again. I don’t know why we have to keep dwelling on this.” 
How should the therapist proceed with the initial assessment in this case?

A. Explore what conditions would allow Kim to trust Brian again.

B. Invite the couple to discuss how they met and what keeps them together.

C. Determine what prompted Brian to have an affair.

D. Normalize Kim’s feelings that she won’t be able to trust Brian again.

Answer 13

CORRECT =

B. Invite the couple to discuss how they met and what keeps them together.

Question 14

14: Dan, age 46, his girlfriend Nicole, age 34, and her daughter Allison, age 16, are referred to therapy by Allison’s school. She has been isolating herself and crying a lot since a cross-country move last month. Dan angrily says, “I’m out of a job and we might lose our house. Allison needs to toughen up and stop complaining about changing schools and missing her friends.” Nicole, who has a split lip, timidly explains that she thinks Allison is upset because she and Dan aren’t getting along. Allison does not make eye contact and begins to cry softly and says, “Dan drinks too much. I am tired of hearing them fighting. I can’t take it anymore.” What interventions would a Solution Focused therapist use to treat Allison in the middle phase of treatment?

A. Validate what Allison is doing well to cope with her problems and identify on a scale of 1-10 how Allison feels she has been coping with her situation.

B. Encourage Allison to do more of what has been working for her and teach communication skills so she can make new friends at school.

C. Find out what would be different if things in Allison’s life were better and encourage Allison to do more of what has been working for her.

D. Identify on a scale of 1-10 how bad Allison feels her problems are and validate what Allison is doing well to cope with her problems.

Answer 14

CORRECT =

A. Validate what Allison is doing well to cope with her problems and identify on a scale of 1-10 how Allison feels she has been coping with her situation.

Question 15

#15: A therapist in private practice meets with a new client who shares that she is also a therapist.  The client discloses that she has been practicing for over twenty years and is considering closing her practice.  She shares that over the past year she developed feelings for a client and had a brief affair, but ended it because she knew it was wrong.  She indicates feelings of guilt and remorse and feels she should no longer practice because of her actions. 
How should the therapist manage the ethical responsibilities presented in this case?

A. Explore the client’s feelings of guilt and remorse, as well as her thoughts about ending her practice.

B. Validate her feelings of guilt and remorse and provide her with the brochure “Professional Therapy Never Includes Sex.”

C. Encourage the client to obtain legal counsel.

D. Encourage the client to address the ethical violation directly with her client and provide him with the brochure, “Professional Therapy Never Includes Sex.”

Answer 15

CORRECT = A

A. Explore the client’s feelings of guilt and remorse, as well as her thoughts about ending her practice.

Question 16

16: A pediatrician refers the parents of a 10-year-old boy to therapy shortly after the boy was diagnosed with diabetes. The parents report the family is facing financial problems, and numerous other challenges that are causing them significant stress. The mother begins crying, sharing she is so overwhelmed by the challenges they are facing and feels guilty about her son’s diagnosis. Considering the various problems the family is confronting, the therapist should consider which of the following actions?

A. Offer to work individually with the son to address his emotional response to the diagnosis.

B. Offer to work with the mother and son to address feelings of guilt and stress related to the recent diagnosis and other stressors.

C. Validate the parents’ emotional responses to their different stressors and help them prioritize treatment goals.

D. Schedule a session to meet with the entire family to determine if family or individual therapy is necessary.

Answer 16

CORRECT = C

C. Validate the parents’ emotional responses to their different stressors and help them prioritize treatment goals.

Question 17

#17: A family of three presents for treatment after being referred by a family friend. Lucas, 42, states that he has recently announced to the family that he is transgender and would like to begin his transition in the near future. His wife, Amelia, 35, tells the therapist that she has been completely numb since receiving her husband’s news, unable to imagine what her life is going to be like. Their son Ethan, 14, reveals his latest involvement with oxycodone. “Once kids at school learned about my dad, the ridicule has not stopped. And my parents are so preoccupied with their own problems that nobody even notices that I am high most of the time.” 
What initial interventions should the therapist consider in the case presented in the vignette?

A. Encourage couple to practice active listening; encourage Ethan to seek substance abuse treatment; explore Amelia’s reaction towards Lucas’ transition.

B. Arrange to interview each member separately; encourage Ethan to seek substance abuse treatment; assess Amelia for symptoms of depression.

C. Assess Ethan for suicidal ideation and intervene accordingly; provide Lucas with appropriate referrals to support his transition; assess Amelia for symptoms of depression.

D. Assess Ethan for suicidal ideation and intervene accordingly; provide Amelia with a referral to a support group for people whose spouses are transitioning; set Lucas up with individual therapy.

Answer 17

CORRECT = C

C. Assess Ethan for suicidal ideation and intervene accordingly; provide Lucas with appropriate referrals to support his transition; assess Amelia for symptoms of depression.

Question 18

#14: Jeremy, a 14-year-old Asian-American boy, is referred for therapy by his school counselor.  His mother, Sue, attends the initial session with him. She shares that her son has been having hard time adjusting to his new school.  He attended a small private school for many years, but since his father lost his job they weren’t able to afford it so he had to switch to a large public school. Jeremy states that he “hates going to school because he doesn’t have any friends. “ His mom replies that “school is about learning, not about friends.”  The therapist asks to meet with Jeremy alone and completes a risk assessment. 
 How should the therapist handle the legal requirements if Jeremy reports having thoughts of suicide?

A. Ask Jeremy to sign a no harm contract; Inform mother of Jeremy’s suicidal thoughts.

B. Obtain family history of depression; Initiate a 5150 if Jeremy has a plan to harm himself.

C. Ask Jeremy about prior self-harm history; Refer Jeremy to a teen depression group.

D. Determine if Jeremy has a plan; If Jeremy has a plan, determine whether he has the means.

Answer 18

CORRET = D

D. Determine if Jeremy has a plan; If Jeremy has a plan, determine whether he has the means.

Question 19

#19: Dan, age 38, and his wife Mary, age 35, are referred by Dan’s oncologist. Dan shares that he was recently diagnosed with a brain tumor that is inoperable and the doctors say he has three months to live. They share that they haven’t told their two teenage daughters and are seeking therapy to help them all cope. Mary begins to cry and says, “I know my older daughter is going to be devastated.  You can help her right?” 
What legal obligations does the therapist have initially in the case provided in the vignette?

A. Explore their expectations for treatment; Determine whether Dan has an Advanced Directive; Work within scope of practice.

B. Obtain informed consent for treatment; Maintain separate files if family members are seen individually; Obtain a signed release before consulting with Dan’s doctor.

C. Encourage the family to create an advanced directive for Dan; Work within scope of practice; Obtain a release before consulting with Dan’s doctor.

D. Obtain informed consent for treatment; Obtain a release before consulting with Mary’s doctor; Set fee before onset of therapy.

Answer 19

CORRECT = B

B. Obtain informed consent for treatment; Maintain separate files if family members are seen individually; Obtain a signed release before consulting with Dan’s doctor.

Question 20

#20: A recently married couple, Marcus, an Asian American age 31, and John, a Caucasian age 28, are referred by Marcus’s health insurance panel. John tearfully tells of Marcus’s lack of affection over the past few months and adds that Marcus has been spending a lot of “extra time” at work with a new co-worker.  Marcus shakes his head and says, “I’m tired of dealing with his paranoia. He’s depressed! I am tired of him calling me at work and telling me he wants to die.  I can’t take it anymore.” 
What ethical responsibilities does the therapist have based on the case provided in the vignette?

A. Manage the fee; Assess for John’s suicide ideation; Review the limits of confidentiality.

B. Manage confidentiality with insurance carrier; Inform couple that the therapist does not keep “secrets”; Identify expectations of treatment for both Marcus and John.

C. Manage the fee; Assess for John’s suicide ideation; Obtain consent to treat from the insurance provider.

D. Inform the couple of the “no secrets” policy; Assess for John’s suicide ideation; Identify expectations of treatment for both Marcus and John.

Answer 20

CORRECT = D

D. Inform the couple of the “no secrets” policy; Assess for John’s suicide ideation; Identify expectations of treatment for both Marcus and John.

Question 21

#21: A therapist has been seeing a client intermittently for two years, and they have a strong relationship.  The client is often fearful and suspicious of new situations.  The focus of interventions has been to promote client’s independence and personal decision-making.  The client recently learned of an opportunity to move into a group home that offers better social support than the current living arrangement.  The client is reluctant to discuss the new housing option and reports being worried about making a change.  The therapist asks the client to tour the home and see what it is like before rejecting it.  Because he trusts the therapist, the client agrees.  
What are the ethical implications of the therapist’s actions in this case?

A. The therapist is acting unethically by imposing the therapist’s values onto the client.

B. The therapist is acting ethically by assisting the client to compartmentalize his concerns, making them more manageable.

C. The therapist is acting ethically by empowering the client through the process of self-determination.

D. The therapist is acting ethically by using the therapist/client relationship as an intervention tool.

Answer 21

CORRECT = D

D. The therapist is acting ethically by using the therapist/client relationship as an intervention tool.

Question 22

#22: A 54-year-old married client with depression and anxiety has been meeting with a therapist for over a year.  Early on in therapy, he brought his wife in for a collateral session.  Since they’ve already met, he asks the therapist to contact his wife to invite her back for an additional collateral session and to discuss his need for additional support from her.  The client explains that he feels his wife would listen to the therapist better than she would listen to him. 
How should the therapist respond to this request?

A. Offer to invite the wife for a collateral session so the client can directly discuss his need for additional support.

B. Encourage the client to invite his wife for a collateral session.

C. Call the wife and present the client’s request for a collateral session and need for additional support.

D. Explore client’s difficulty communicating his needs and help identify strategies he can use to engage her.

Answer 22

CORRECT = D

D. Explore client’s difficulty communicating his needs and help identify strategies he can use to engage her.

Question 23

#23: A 25-year-old man has been meeting with a therapist for several months. He has tears in his eyes as he reports to the therapist that his girlfriend of three years broke up with him over the weekend.  He tells the therapist that he is beside himself and doesn’t think he will ever have a healthy relationship.  He explains that he tried to make the relationship work, but his girlfriend was always disappointed in him.  He states, “I am such a loser and will be alone the rest of my life.  I can’t handle this anymore.” 
How would a Cognitive Behavioral therapist intervene in the middle stage of treatment?

A. Identify the types of cognitive distortions the client is using and challenge the client’s negative thoughts.

B. Teach the client to track his thoughts and develop healthier, alternative thoughts.

C. Have the client examine the evidence that supports his negative beliefs as well as the evidence that contradicts these thoughts.

D. Have the client identify times in his life when he had healthy relationships and did not feel like a “loser.”

Answer 23

CORRECT = C

C. Have the client examine the evidence that supports his negative beliefs as well as the evidence that contradicts these thoughts.

Question 24

#24: A Caucasian therapist is working in a community agency providing individual therapy to teens struggling with substance abuse.  The majority of clients at the clinic are Latino and African American. Over the course of therapy with an African American client, the therapist becomes aware that the client has strong negative beliefs toward Latinos and begins to feel uncomfortable in sessions with him. 
The therapist should:

A. Explore origin of client’s beliefs; determine whether the client has been a victim of racism; and seek consultation.

B. Educate the client about the negative effects of racism and seek consultation.

C. Confront the client about his beliefs and explore the origins of his beliefs.

D. Respect the client’s beliefs; focus on the presenting problem; and seek consultation.

Answer 24

CORRECT = D

D. Respect the client’s beliefs; focus on the presenting problem; and seek consultation.

Question 25

25: Juan, a 24-year-old Hispanic male, is court-mandated to therapy as part of his conditions of parole. He was recently released after spending three years in prison for a felony assault charge. Juan reports a history of alcohol, crack, and crystal meth use. He shares that he has heard voices in the past and that is why he attacked a lady at the mall. He is currently in a halfway house and taking psychotropic medications. He states “I can’t find a job, no one wants to hire a high school dropout. It was easier when I was locked up. All my friends are still in there. I don’t want to get out of bed in the morning, there’s no point. If my parole officer keeps riding me, I don’t know what I’ll do.” Angrily he adds, “I don’t see how therapy is going to help.”

What adjunctive resources should the therapist consider utilizing initially with Juan in this case?

A. GED program; MD; Substance abuse treatment center.

B. Vocational skills center; Depression support group; Psychiatrist.

C. MD; Narcotics Anonymous; Depression support group.

D. Narcotics Anonymous; Vocational skills center; Psychiatrist.

Answer 25

CORRECT = D

D. Narcotics Anonymous; Vocational skills center; Psychiatrist.

Question 26

#26: A therapist is meeting with a 68-year-old man following the death of his spouse. The man has a history of severe depression and is currently being closely monitored by the therapist for risk of suicide.  His son has been living with him since the death of his wife and has taken charge of the finances. The client tells the therapist that this will be his last session since the son decides how the money should be spent and no longer feels the man should receive therapy.   The man tells the therapist he feels powerless and scared, and expresses a continued need for therapy.  
The therapist should:

A. Validate client’s feelings about termination and explore alternative no-fee therapy options.

B. Call APS immediately and file a written report of elder abuse within 24 hrs.

C. Offer to meet with the client and son together to discuss the need for ongoing therapy.

D. Call APS immediately and file a written report of elder abuse within 2 days

Answer 26

CORRECT = D

D. Call APS immediately and file a written report of elder abuse within 2 days

Question 27

#27: A single mother informs the therapist that she was offered a promotion within her company, but the new position would require she move to another state where she doesn’t have any friends or family. She asks the therapist to assist her in finding childcare for her 3-year old. She adds that, although she is leaning toward accepting the new position, she thinks it could be easier to remain in her present living arrangement with her parents until the child is older. The therapist feels strongly that the client should stay.
 Given the client’s desire to move, how should the therapist respond?

A. Respect the client’s decision and help her identify child-care options.

B. Suggest a family session with client’s parents to explore the pros and cons of her options.

C. Respect the client’s right to self-determination, and explore the pros and cons of her options.

D. Share therapist’s concerns, explore the pros and cons of her options.

Answer 27

CORRECT = C

C. Respect the client’s right to self-determination, and explore the pros and cons of her options.

Question 28

#28: 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?

A. Bipolar II Disorder

B. Amphetamine Use Disorder

C. Schizotypal Personality Disorder

D. Cannabis Use Disorder

Answer 28

CORRECT = B

B. Amphetamine Use Disorder

Question 29

#29: A private practice group is hiring an intern. An unlicensed MFT applies. Her current  therapist would be one of her supervisors. The therapist informs the client that it would create an inappropriate dual relationship. The client claims the dual relationship wouldn’t bother her and she really wants to work there.  
How should the therapist proceed?

A. Discuss termination with client and provide referrals to therapists outside of the practice.

B. Discuss possible risks of the dual relationship.

C. Inform client that it would be an ethical violation to hire her and process the rejection.

D. Consult with a colleague about the dilemma.

Answer 29

CORRECT = C

C. Inform client that it would be an ethical violation to hire her and process the rejection.

Question 30

#30: A 32-year-old client seeks therapy to address relationship issues. She has two young children and recently left an abusive relationship. She was married for 7 years and states that the last 5 years included verbal and emotional abuse.  She reports depressive symptoms, trouble in dealing with separation, low self-esteem and difficulty parenting her children. 
What interventions would a Structural Family therapist utilize in the middle phase of treatment to strengthen the parental hierarchy between the client and her children?

A. Initiate enactments to help client identify specific ways to enact clear boundaries.

B. Have client arrange chairs to represent current hierarchy and rearrange chairs to represent her status as a parent.

C. Track and match client’s interactional style.

D. Identify the influence and control her spouse has had on her in the past.

Answer 30

CORRECT = B

B. Have client arrange chairs to represent current hierarchy and rearrange chairs to represent her status as a parent.

Question 31

#31: A therapist specializes in adolescent substance abuse treatment. She creates a website about her practice and solicits testimonials from former clients to include in the brochure.  She has the clients sign a release to share their testimonial.  
The therapist’s actions are:

A. Acceptable because she obtained a release.

B. Acceptable if she changes the identity of the clients.

C. Unethical because the clients are minors.

D. Unethical because she solicited testimonials.

Answer 31

CORRECT = D

D. Unethical because she solicited testimonials.

Question 32

A 19-year-old client seeks treatment for relationship issues. The client shares that he is attracted to both women and men and he doesn’t know how to explain it to his parents. Three months into treatment the client is unexpectedly laid off from his job and leaves a message that he can’t afford therapy. He declines to attend termination sessions because of concerns about spending money while unemployed.
How should the therapist clinically manage the ethical issues in this case?

A. Call the client and explain why the client needs to meet for a final session to gain a sense of closure and provide referral to LGBT services.

B. Offer a termination session at a reduced fee to enable the client to process the termination and provide referrals to low fee services.

C. Encourage the client to continue therapy in order to determine his sexual identity.

D. Send a letter to the client affirming that he terminated against professional advice and is welcome to return.

Answer 32

CORRECT = B

B. Offer a termination session at a reduced fee to enable the client to process the termination and provide referrals to low fee services.

Question 33

#33: A male therapist has been meeting with a recently divorced female client for several months.  During a session, the client shares that she is attracted to the therapist.  The therapist recently sought consultation because he found himself attracted to the client.  
How should a psychodynamic therapist respond?

A. Discuss the need to refer the client to a different therapist.

B. Identify the client’s feelings as a transference from her ex-husband.

C. Explore the client’s feelings and discuss the limits of therapeutic boundaries.

D. Continue to seek consultation from a colleague and refer client out.

Answer 33

CORRECT = C

C. Explore the client’s feelings and discuss the limits of therapeutic boundaries.

Question 34

#34: Alice, age 14, is brought to therapy by her mother, Joan, after she reported having thoughts of killing herself.  Joan is a single mother to Alice and Jill, age 16.  Alice refuses to go to school, is often irritable and frequently argues with her mom and sister. Joan reports that Alice has cut herself in the past. Joan also shares that she herself is on medication for bipolar disorder. 
How would a Bowen Family Therapist assess the intergenerational issues related to the crisis issues in this case?

A. Maintain a nonanxious presence; Role model a clear sense of differentiation; Identify triangles with present and/or extended family members

B. Construct a genogram related to suicide, defiant behavior and mental health issues; Determine whether family members can distinguish thoughts from feelings; Identify triangles with present and/or extended family members

C. Maintain a nonanxious presence; Teach family members how to use “I” statements; Identify each member’s sibling position

D. Construct a genogram related to suicide, defiant behavior and mental health issues; Explore emotional cutoffs between present and extended family members; Identify multigenerational patterns of parenting and rebellion

Answer 34

CORRECT = D

D. Construct a genogram related to suicide, defiant behavior and mental health issues; Explore emotional cutoffs between present and extended family members; Identify multigenerational patterns of parenting and rebellion

Question 35

#35: Jim, age 31, and Tina, age 32, seek therapy for intimacy issues. Tina tearfully tells of Jim’s lack of affection over the past year. He can’t control the amount of time he spends on the Internet at work or at home. Tina says angrily, “I can’t keep living like this! He is spending all our money on porn sites. You can fix him right? What will our friends and family think if they knew that we have to come to therapy?” Tim looks out the window as she speaks. 
What clinical issues should the therapist address with the couple in this initial session?

A. The costs and benefits of internet pornography and when the issue started.

B. Their expectations of therapy and their feelings about seeking help.

C. Their reasons for seeking help at this time and the limits of confidentiality.

D. Their values and beliefs about intimacy in their relationship and how they’ve coped with this conflict in the past.

Answer 35

CORRECT = B

B. Their expectations of therapy and their feelings about seeking help.

Question 36

#36: A 42-year-old female client seeks therapy at the urging of her partner. The client is late to the first session and appears disheveled. The client begins crying and reports that she is distraught about the recent loss of her 82-year-old mother. 
 How would a Client Centered therapist proceed in this case:

A. Express sympathy for the client’s loss and assess for danger to self.

B. Use body language to communicate empathy and provide psychoeducation about grief reactions.

C. Use reflective listening to explore her reaction to her mother’s death.

D. Relate a personal experience of loss if it is similar to the client’s experience.

Answer 36

CORRECT = C

C. Use reflective listening to explore her reaction to her mother’s death.

Question 37

#37: A 83-year-old man has been in therapy for six months following the death of his wife. One session he informs the therapist that he recently changed his will, making the therapist the beneficiary of his estate. He states, “You have been so kind to me, you know me better than anyone.”  
How should the therapist clinically manage the ethical issue presented in this vignette?

A. Inform the client that this is a boundary violation.

B. Tell the client it is flattering but it is inappropriate due to the nature therapeutic relationship.

C. Explain this would be a dual relationship.

D. Assist him in finding a charity that could become the beneficiary.

Answer 37

CORRECT = B

B. Tell the client it is flattering but it is inappropriate due to the nature therapeutic relationship.

Question 38

38: Melissa is a 44 year-old single mother of three children, Kristin age 17, Julie age 14, and Brad age 12. Melissa reports that Kristin is highly disruptive at home and at school and she suspects that she is using drugs and alcohol. She notes that Julie and Brad have become more withdrawn in response to Kristin’s behavior and they spend most of their time at home in their rooms. How would a Strategic Family therapist intervene in the middle phase of treatment?

A. Request that the children sit together in the session and ask Melissa and Kristin to take turns starting their fights.

B. Identify times when Kristin wasn’t disruptive and encourage the family not to change.

C. Ask Kristin to be extra disruptive every other night and ask Melissa and Kristin to take turns starting their fights.

D. Ask each family member to describe what they want from therapy and encourage the family not to change.

Answer 38

CORRECT = C

C. Ask Kristin to be extra disruptive every other night and ask Melissa and Kristin to take turns starting their fights.

Question 39

39: Sue, age 70, and Larry, age 69, are referred by their gerontologist. Larry was recently diagnosed with Major Neurocognitive Disorder. Sue shares that Larry has become very irritable since starting a new medication, and that he actually pushed her down on the floor when he became upset. She shows a bruise on her elbow and knee. She states, “I don’t think I can handle taking care of him anymore, but I don’t want to leave our home.”

What resources should the therapist utilize initially in this case?

A. Neurologist; Domestic Violence Resources; Psychiatrist

B. Gerontologist; Adult Protective Services; Home Care Assistance

C. Neurologist; Nursing Home; Care Giver Support Group

D. Caregiver Support Group; Adult Protective Services; Home Care Assistance

Answer 39

CORRECT = B

B. Gerontologist; Adult Protective Services; Home Care Assistance

Question 40

#40: Michael, a 25 year-old African-American man, is court-ordered to therapy after being released from prison, where he spent time for selling drugs. Michael states that he is only there because he is required to come. Under his breath he says, “The whole system is rigged against the black man.” 
How should the therapist respond to the client in this case?

A. “Tell me what you mean by ‘This whole system is rigged against the black man.’”

B. “How have you been adjusting to life outside of prison?”

C. “I imagine you’ve experienced a lot of racism.”

D. “It is up to you how much you get out of therapy.”

Answer 40

CORRECT = C

C. “I imagine you’ve experienced a lot of racism.”

Question 41

#41: A Chinese-speaking therapist moves to a new city with a relatively large Chinese American population.  The therapist would like to market her mental health services to the Chinese population.  
What factor tends to be the largest barrier to Asian-Americans utilizing mental health services?

A. Lack of insurance

B. Language issues

C. Shame and stigma

D. Reliance on traditional medicine

Answer 41

CORRECT = C

C. Shame and stigma

Question 42

#42: A 6-year-old, Nate, is referred to therapy by his teacher because he is very disruptive in class, uses obscene language, fights with other students and consistently speaks out of turn.  The parents, Steve and Nancy, corroborate that he shows similar behavior at home and does not respond to punishment.  The parents add that their son seems unresolved in his grief over his baby sister’s recent death.  
In the initial phase of treatment, how would a Narrative therapist intervene compared to a Solution Focused therapist?

A. Narrative would identify times when Nate’s behavior wasn’t a problem at school and/or at home and provide psychoeducation on grief in children; Solution Focused would normalize Nate’s behavior and identify family strengths.

B. Narrative would separate Nate from his bad behavior and explore the effects of the bad behavior at school and home; Solution Focused would ask about times when Nate had behaved well and how the family would know the problem was gone.

C. Narrative would provide psychoeducation on grief and explore how the family has attempted to punish Nate in the past; Solution Focused would identify family strengths and unique outcomes when the problem wasn’t present.

D. Narrative would explore the effects of society’s dominant discourse on Nate’s problem; Solution Focused would determine the effect the problem was having on the family and provide psychoeducation on grief in children.

Answer 42

CORRECT = B

B. Narrative would separate Nate from his bad behavior and explore the effects of the bad behavior at school and home; Solution Focused would ask about times when Nate had behaved well and how the family would know the problem was gone.

Question 43

#43: A 45-year-old woman comes to therapy feeling a lack of meaning in her life.  She explains that she is tired of her mundane existence and is feeling depressed.  She states, “the only thing I really feel excited about is a martial arts class that I attend two times per week”.  
How would a Depth-oriented therapist proceed?

A. Consider the image and metaphor of martial arts in her life; Metaphorically explore how fighting for/against something could apply to her current situation; Ask the client to say more about her connection to martial arts.

B. Explore the soul of the fighter in her that wants to emerge; Ask her to perform some martial arts in the room so that she can experience the feeling it brings her; Ask her about her dreams.

C. Consider the metaphor and image of martial arts in her life; Ask her to imagine not being depressed as a way to reduce depression; Explore how she feels when she is doing martial arts.

D. Explain to her that the martial arts is compensating for her depressed mood; Ask her about her dreams; Discuss the importance of balance in her relationships.

Answer 43

CORRECT = A

A. Consider the image and metaphor of martial arts in her life; Metaphorically explore how fighting for/against something could apply to her current situation; Ask the client to say more about her connection to martial arts.

Question 44

#44: A 16-year-old client is sent to therapy by his mother who is concerned he is “doing drugs and running with the wrong crowd.” The client denies drug use and complains that his mother is overbearing. Four months into therapy, the client confesses to the therapist that he recently broke into one of a neighbor’s house with a friend.  
How should the therapist clinically manage the legal issues in this case?

A. Inform the client that his behavior is illegal and share concerns with his mother.

B. Maintain client confidentiality about the incident and document it in the record.

C. Obtain a written contract that the client will not commit another break in and document it in his file.

D. Inform the client that the police need to be notified of the crime.

Answer 44

CORRECT = B

B. Maintain client confidentiality about the incident and document it in the record.

Question 45

#45: A 38-year-old woman seeks therapy for stress related to parenting and family conflict. In the sixth session the patient complains that she and her husband are upset because the patient’s mother-in-law recently disciplined her 2-year child with spankings that left red marks.  The patient is very upset and doesn’t know how to approach her mother-in-law about the incident.  
How should a Cognitive Behavioral therapist clinically manage the legal issues in this case?

A. Explore the client’s underlying beliefs related to her reluctance to approach her mother-in-law.

B. Inform the client that a child abuse report must be filed and explain to her what will happen.

C. Assess how client has handled conflicts about discipline with mother-in-law in the past.

D. Inform the client that child abuse must be reported and process her reaction.

Answer 45

CORRECT = D

D. Inform the client that child abuse must be reported and process her reaction.

Question 46

#46: A 36-year-old lawyer is referred by his couple’s therapist for individual therapy. The client and his wife have been in couple’s therapy for 2 months. They initiated therapy after the wife caught the husband cheating on her with his co-worker.  The client reports that he has ended the affair but is uncertain whether he wants to stay married to his wife of four years. The wife is willing to make amends and is eager to start a family.  The client reports that he thinks he’d be an awful father and doesn’t know if he should have kids.  
How would a Client-Centered therapist proceed in the initial phase of treatment?

A. Engage in reflective listening; determine whether client wants to stay married; clarify his current situation and feelings

B. Explore client’s early relationships; accept the client and his past; clarify his current situation and feelings

C. Engage in reflective listening; accept the client and his past; identify client’s underlying beliefs about the situation

D. Engage in reflective listening, accept the client and his past; clarify his current situation and feelings

Answer 46

CORRECT = D

D. Engage in reflective listening, accept the client and his past; clarify his current situation and feelings

Question 47

47: Maricel, a 37-year-old single Filipino woman, is referred by her mother’s doctor for anxiety. 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.”

Which of the following human diversity issues should the therapist consider when developing the comprehensive treatment plan in the case presented in the vignette?

A. Maricel’s acculturation difficulties and her departure from traditional Filipino roles 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

Answer 47

CORRECT = B

B. Maricel’s spiritual beliefs regarding end-of-life issues and the influence her Filipino culture plays in this situation.

Question 48

#48: A 26-year-old client who tested positive for HIV five months ago seeks therapy on the advice of his friend. During the fifth session the client shares that he’s been “feeling less depressed and even went out to a bar and met new people for the first time in months.”  The client then admits his intention to not inform sexual partners of his diagnosis.  
How should the therapist clinically manage the ethical issues in this case?

A. Discuss AIDS prevention activities with the client.

B. Encourage the client to inform the client’s partners of the positive test.

C. Inform the client that the therapist must inform the police because Tarasoff Duty to Warn has been triggered.

D. Explore the client’s resistance to sharing his diagnosis with his sexual partners.

Answer 48

CORRECT = D

D. Explore the client’s resistance to sharing his diagnosis with his sexual partners.

Question 49

49: Alicia, a 22 year-old female, is court-mandated to therapy as part of her conditions of parole. She was recently released after spending two years in prison for stealing. She reports a history of heavy alcohol and crack use. She is living with her aunt but reports that she can’t find a job with her background. Angrily she adds, “I don’t see how therapy is going to help.”

What factors require primary consideration by the therapist in developing the initial treatment plan?

A. Her motivation for treatment and history of substance use.

B. Her lack of social support and history of substance use.

C. Her vocational skills and housing instability.

D. Her current substance use and vocational skills.

Answer 49

CORRECT = A

A. Her motivation for treatment and history of substance use.

Question 50

50: A 58-year-old woman is referred to therapy by her oncologist. The client was recently diagnosed with breast cancer. While her prognosis is good, the client has become very depressed and withdrawn. She shares with the therapist that the cancer has forced her to look at her life and she doesn’t like what she sees. She admits that she was a workaholic when her two children were young and now has little contact with them. She also shares that she feels like her husband is a stranger.

What intervention would an Existential therapist employ during the middle phase of treatment?

A. Explore the client’s understanding of her early relationships and how they impact her current situation.

B. Encourage the client to “play out” scenarios of choices she faces and acknowledge the accompanying fears and anxieties.

C. Teach the client communication skills to better engage with her family members.

D. Identify the underlying thoughts and beliefs that lead to her troubling feelings.

Answer 50

CORRECT = B

B. Encourage the client to “play out” scenarios of choices she faces and acknowledge the accompanying fears and anxieties.

Question 51

51:) A 17-year-old comes to therapy referred by his school’s attendance office. He reports being in a gang and shares that a few months ago he saw his friend get killed in a drive-by shooting. He frequently oversleeps and misses school. During the initial assessment he reports that he’s lost a lot of weight in the past month. His school counselor reports that he is fighting with others and having arguments with teachers.

What is DSM 5 diagnosis should the therapist consider at this point?

A. PTSD and Major Depressive Disorder

B. Conduct Disorder and Major Depressive Disorder

C. PTSD and Oppositional Defiant Disorder

D. Acute Stress Disorder and Antisocial Personality Disorder

Answer 51

CORRECT = A

A. PTSD and Major Depressive Disorder

Question 52

#52:) A 48-year-old client in treatment for anxiety is going on a three-week trip with her husband.  She requests to use email to communicate with her therapist while she is away.  
How should the therapist clinically manage the client’s request?

A. Find out whether the client is going to be in or out of the state in which therapist is allowed to practice.

B. Inform the client about the limitations and risks of electronic communication.

C. Provide a list of therapists in the area where the client will be staying.

D. Offer the client a home telephone number for weekly check-in sessions.

Answer 52

CORRECT = B

B. Inform the client about the limitations and risks of electronic communication.

Question 53

#53:) A young couple seek therapy.  They lost a child to serious illness 6 months prior and state that they are now having problems in their marriage.  They both feel alone in their grief and are dealing with the loss in different ways. The child’s mother has been keeping herself busy with gardening, community service work, and charitable activities. The child’s father has been spending a lot of time home alone unable to participate in much of anything besides his job.  
Why would referring this couple to a bereavement group for parents who have lost children be beneficial to them?

A. Reduce isolation; Increase communication skills between the couple; Allow them to revisit their relationship without their child.

B. Reduce Isolation: Encourage expression of grief around people that can understand; Hear how other couples have dealt with similar life tragedy.

C. Help the couple learn new coping skills; Help them focus on their relationship; Learn to grieve together.

D. Allow them to revisit their relationship without their child; Build community; Share an experience together.

Answer 53

CORRECT = B

B. Reduce Isolation: Encourage expression of grief around people that can understand; Hear how other couples have dealt with similar life tragedy.

Question 54

#54:) A therapist responds to a flyer advertising bookkeeping services. During the phone conversation, the therapist realizes that the bookkeeper is a former client. The former client states that she works with many therapist practices and can provide excellent bookkeeping.  
How should the therapist respond?

A. Inform the client it would be illegal to hire her and decline services.

B. Inform the client it would be unethical to hire her and decline services.

C. Hire the client if it has been more than one year since termination.

D. Explain that if the former client is hired she won’t be able to return to therapy with the therapist.

Answer 54

CORRECT = B

B. Inform the client it would be unethical to hire her and decline services.

Question 55

#55:) A client with a history of anger issues and aggressive behavior has been seeing a therapist for therapy for two months. During a heated session, the client storms out. The following day he delivers a letter demanding his records or he will take legal action.  The therapist believes that releasing his records will cause him serious harm. 
What action should the therapist take FIRST in this case?

A. Seek legal consultation regarding the threat to sue.

B. Document in the record both the request and the rationale for non-release.

C. Develop a safety plan knowing that the client will not be happy with the outcome.

D. Schedule a session to discuss the client’s desire to obtain records.

Answer 55

CORRECT = B

B. Document in the record both the request and the rationale for non-release.

Question 56

#56:) A 38-year-old man seeks therapy after his wife of three years tells him he drinks too much and she wants him to stop or she is going to leave him. He says he doesn’t think he’s an alcoholic but doesn’t want to lose his wife.  
In order to establish a collaborative relationship with this client, what questions might the therapist ask to assess the client’s readiness for change:

A. What is your view of your alcohol use? What if anything do you think you should do about your alcohol use? To what extent do you feel your alcohol use is a problem?

B. How much do you drink each day? Why is your wife so concerned about your drinking? Have you been sober in the past?

C. When do you think your drinking became a problem for your wife? What amount of alcohol do you think is too much? How old were you when you first started drinking?

D. Was anyone in your family an alcoholic? Would you be willing to go to an Alcoholics Anonymous meeting? Can you drink less to appease your wife?

Answer 56

CORRECT = A

A. What is your view of your alcohol use? What if anything do you think you should do about your alcohol use? To what extent do you feel your alcohol use is a problem?

Question 57

#57:) A 56-year-old single woman seeks therapy following a diagnosis of terminal cancer. The client reports that she had fought it twice in the past, but doesn’t want to go through any more experimental treatments.  
The therapist believes the client shouldn’t give up. How should the therapist proceed in this case:

A. Schedule a meeting with the patient and medical team.

B. Seek consultation regarding the values conflict.

C. Share the therapist’s views of her choice and process it with client.

D. Express concerns that the client should get a second opinion.

Answer 57

CORRECT = B

B. Seek consultation regarding the values conflict.

Question 58

#58:) A 26-year-old client seeks therapy during a leave from business school. Over the phone he shares that he “did something really awful and needs help dealing with it.” During the initial session, the client appears fearful and anxious and blurts out “I need to be sure that everything I tell you will stay between us.”  
How should the therapist proceed clinically in this case?

A. Validate the client’s fear and anxiety because therapy can be scary.

B. Review with the client the limits to the therapist/client confidentiality.

C. Remind the client that the therapist is a mandated reporter.

D. Assure the client that everything they discuss will be kept confidential.

Answer 58

CORRECT = B

B. Review with the client the limits to the therapist/client confidentiality.

Question 59

#59:) A 28-year-old veteran of the Iraqi war comes to therapy for PTSD symptoms.  She reports having flashbacks and nightmares not only from being in direct combat zones but also from being sexually harassed by the men in her platoon over the two years she was deployed.  She is currently dropping out of community college because of her symptoms.  After 3 months of therapy she is finding relaxation techniques helpful when she feels triggered.  
How should the therapist proceed with treatment in this case?

A. Continue therapy; Participate in Prolonged Exposure Therapy to reduce fear and avoidance associated with trauma; Teach mindfulness meditation.

B. Refer to an EMDR therapist; Re-apply to College program; Refer to group for sexually assaulted women.

C. Teach thought stopping techniques; Share trauma stories in detail; Encourage her to press charges against the men who harassed her.

D. Continue therapy; Mobilize the client’s support system; Refer to a veteran’s support group.

Answer 59

CORRECT = A

A. Continue therapy; Participate in Prolonged Exposure Therapy to reduce fear and avoidance associated with trauma; Teach mindfulness meditation.

Question 60

60:) An Asian-American college student seeks therapy for depression. She reports that she isn’t doing well in her pre-med classes even though she studies all night. She reports having a difficult time staying awake during class and isolating herself from her roommate and friends. The therapist assesses for suicidal ideation and the client reports thinking about killing herself a lot. The client shares that her parents don’t know how bad things are because she doesn’t want to worry them.

How should the therapist proceed with the initial treatment plan?

A. Determine if client has the means; Have client sign a no-harm contract; Initiate a 5150.

B. Determine if client has the means; Discuss informing parents; Create a safety plan.

C. Have the client sign a no harm contract; Refer to a psychiatrist; Create a safety plan.

D. Determine if client has a plan; Discuss informing parents; Initiate a 5150.

Answer 60

CORRECT = B

B. Determine if client has the means; Discuss informing parents; Create a safety plan.

Question 61

61:) Kim, age 5, is brought to therapy with a Solution Focused therapist after being sexually molested by an older neighbor with whom she no longer has contact. Her kindergarten teacher reports that she is provocative and aggressive with her peers so they avoid her. Her mother reports that she is also aggressive at home with her little brother. The therapist utilizes a sand tray in the initial session and asks her to show her school. Kim places the figure representing herself far from the other kids in the tray. They decide that “making friends” would be an appropriate goal for treatment.

What interventions would the therapist utilize to reach this goal?

A. Assist Kim in identifying her aggressive impulses by highlighting them in the session; Ask Kim what she thinks would help her “make friends”; invite her younger brother to session to practice new skills.

B. Use puppets to play imaginary games together; Use puppets to practice how to play with friends at school; Describe times when Kim did play successfully with other kids at school.

C. Interpret her aggression toward her peers as displaced aggression toward her abuser; Use dolls to process the molestation by the neighbor; Acknowledge the feelings Kim expresses during the session.

D. Ask Kim to describe what a “miracle day” at school would look like; During each session have Kim rate her previous days at school; Praise Kim when she rates her weeks high.

Answer 61

CORRECT = B

B. Use puppets to play imaginary games together; Use puppets to practice how to play with friends at school; Describe times when Kim did play successfully with other kids at school.

Question 62

62:) Alex, a 14-year-old, is referred to therapy by his school after being suspended for fighting. He is brought in by his parents, Carol and Bob, who share that Alex was recently kicked off the soccer team for talking back to the coach. Carol starts crying when she shares that “Alex won’t listen to anyone. I don’t know how to handle him. He is so moody all the time, I am afraid he must be doing drugs.” Alex responds mockingly, “I’m not doing drugs. You’re the one with the problem, it’s the two of you who are always fighting.” Bob ignores both of them and says, “Alex has diabetes, but refuses to monitor it. He’s been hospitalized twice in the past two years. I travel a lot and need to focus on my job because people are being laid off. Alex just needs to grow up.”

Based on the information provided, what initial goals should the therapist consider presenting in this case?

A. Reduce Alex’s substance use; Increase level of social supports; Stabilize Carol’s symptoms of depression.

B. Reduce Bob’s job-related stress; Improve Alex’s health problems; Decrease Alex’s interpersonal conflicts at school.

C. Improve Alex’s academic performance; Improve Alex’s peer relationships; Decrease marital conflict between Bob and Carol.

D. Increase Alex’s compliance with medical treatment; Decrease Alex’s interpersonal conflicts at school; Develop alternative conflict-resolution skills.

Answer 62

CORRECT = D

D. Increase Alex’s compliance with medical treatment; Decrease Alex’s interpersonal conflicts at school; Develop alternative conflict-resolution skills.

Question 63

#63:) A licensed therapist is leading a supervision group for interns at a community mental health clinic that serves a diverse population. The supervisor recognizes that the interns need support dealing with cultural awareness. 
 In order to support the development of cultural competence, what step should the supervisor take first?

A. Provide information regarding clinical themes of different ethnic groups.

B. Explore the interns’ biases regarding different ethnic groups.

C. Encourage interns to identify their own cultural heritage and world views.

D. Teach interns techniques for exploring their clients’ cultural influences.

Answer 63

CORRECT = C

C. Encourage interns to identify their own cultural heritage and world views.

Question 64

64:) A newly licensed therapist is developing a website to promote her private practice. She is trying to decide what content she will include on the different pages.

Which of the following would be unethical for her to include?

A. Highlighting the therapist’s expertise.

B. Share extensive information about the therapist’s training and background.

C. Include information about the therapist’s fees and sliding scale.

D. Collect clients’ testimonials highlighting the effectiveness of treatment.

Answer 64

CORRECT = D

D. Collect clients’ testimonials highlighting the effectiveness of treatment.

Question 65

#65:) A therapist is treating a 54-year-old man who is involved in a contentious custody battle with his ex-wife. The therapist receives a subpoena for client’s records from the wife’s lawyer.  
How should the therapist proceed?

A. Contact the client and discuss the pending release.

B. Provide a copy of the records immediately.

C. Consult with a lawyer regarding the matter.

D. Assert privilege on behalf of the client.

Answer 65

CORRECT = D

D. Assert privilege on behalf of the client.

Question 66

#66:) A 42-year-old stylish and sophisticated actor seeks therapy on the advice of his uncle. The client describes a history of falling in love with many beautiful, wise women, marrying them, but being disappointed shortly after getting into the relationship with them.  Each of his 3 marriages has ended in a bitter divorce.  With his eyes looking down, the client notes: “All I want is to be loved and nurtured, but none of them lives up to the image they initially present. “ 
How would an Object Relations therapist conceptualize this case?

A. View his marriages as attempts to overcome the client’s perceived inferiorities.

B. Appreciate the client’s repressed sexual instincts and wonder about his feelings of jealousy towards his father.

C. See the client’s inner world as filled with idealized representations of women that come into conflict with the realities of what these women are actually like.

D. Hypothesize that the early relationships with his caregivers lacked empathy and nurturance and inquire about the way his parents were raised.

Answer 66

CORRECT = C

C. See the client’s inner world as filled with idealized representations of women that come into conflict with the realities of what these women are actually like.

Question 67

67:) Nick, a 22-year-old male, is court-mandated to receive therapy. He recently spent time in a psychiatric hospital because he was hearing voices and was in a catatonic state. Nick shares that he has been sober for three months and is living in a sober living facility. He reports that he started using crystal meth at age 14. Nick states, “I hate taking my meds, but I want to get my life together. I dropped out in ninth grade. I get really stressed out thinking about my future. I don’t want to end up like my dad. My parents were never around when I was a kid, I don’t really know how to talk to them.”

What factors require primary consideration by the therapist in developing the initial treatment plan?

A. His motivation for treatment; His medication compliance; His substance use history.

B. His motivation for treatment; His early childhood history; His psychiatric history.

C. Family history of substance use; His current substance use; His social supports.

D. Family history of substance use; His social supports; His psychiatric history.

Answer 67

CORRECT = A

A. His motivation for treatment; His medication compliance; His substance use history.

Question 68

#68:) A 28-year-old graduate student seeks therapy for relationship problems and stress at school. During the initial session, the client mentions that she has been hospitalized several times for “severe depression." The client becomes tense and guarded when the therapist attempts to explore the hospitalizations, saying that “it’s in the past". She also states adamantly that she won’t give permission to get those records.  
How should the therapist proceed in this case?

A. Assess her current level of depression.

B. Reassure her that the focus will be on the present.

C. Acknowledge her right to decide about releasing her records.

D. Explore her resistance to sharing her records.

Answer 68

CORRECT = C

C. Acknowledge her right to decide about releasing her records.

Question 69

69:) Cindy, an 8-year-old African-American girl, is brought to therapy by her mother, Nancy. They were referred by Cindy’s school because Cindy was crying when her mom dropped her off each day. Nancy reports that Cindy has been afraid to sleep by herself at night because she is having nightmares. Nancy says, “I’m so exhausted after work, I can’t deal with her neediness. I have to lock her in her room to get any sleep.” Nancy tears up and adds, “I have enough to deal with. Her older brother was hit by a car two months ago and he’s still in the hospital having surgeries. He’s the one that really needs my attention and prayers right now. She needs to toughen up. All she wants to do is talk about the accident.”

What additional information should the therapist obtain in order to create a comprehensive treatment plan?

A. Cindy’s exposure to the accident; Details of mother’s discipline and parenting practices; Cindy’s functioning at school.

B. Cindy’s trauma history; Whether the family has adequate health insurance; Cindy’s functioning at school.

C. Cindy’s exposure to the accident; How the mother responded to the accident; Cindy’s functioning at school.

D. Mother’s understanding of Cindy’s misbehavior; Nature of the family’s social support system; Severity and nature of Cindy’s sleep problems.

Answer 69

CORRECT = A

A. Cindy’s exposure to the accident; Details of mother’s discipline and parenting practices; Cindy’s functioning at school.

Question 70

70:) An 18-year-old female client seeks therapy for anxiety and depression. She shares that she doesn’t want her parents to know she’s going to therapy because they’ll say that it’s only going to make her worse. During the second session the client reports that she had consensual sex with a previous therapist when she was in a treatment facility two years ago.

How should the therapist respond to her disclosure?

A. Report the therapist to the board.

B. Provide the client with brochure “Professional therapy never includes sex.”

C. File a child abuse report.

D. Contact the director of the facility and report the therapist.

Answer 70

CORRECT = B

B. Provide the client with brochure “Professional therapy never includes sex.”

Question 71

71:) Stanley, a 69-year-old Chinese man whose wife died four months ago, is referred by his doctor. He recently moved in with his son’s family. When Stanley arrives at your office, he does not make eye contact and walks with a limp. His Caucasian daughter-in-law, Nancy, brings him at her husband’s request. According to Nancy, Stanley has been “acting very strange for a while and he is less and less capable of taking care of himself.” Nancy stares at Stanley angrily and appears frustrated when Stanley tells you, “I don’t want to be a burden to anyone.” Nancy adds that her husband expects her to take care of Stanley.

How should the therapist proceed initially in this case?

A. Assess potential elder abuse and create a safety plan.

B. Contact Adult Protective Services to report elder abuse and assess for suicide.

C. Interview Stanley alone to assess elder abuse and suicide potential

D. Normalize Nancy’s anger and frustration toward Stanley and identify community resources for caregiver support.

Answer 71

CORRECT = C

C. Interview Stanley alone to assess elder abuse and suicide potential

Question 72

#72:) A therapist has been meeting with an El Salvadorian family for eight months on a sliding scale fee.  The family informs the therapist they plan to bring homemade food to the final session as a thank you for all that the therapist has done.  
How should the therapist respond?

A. Accept the offer and thank the clients for their thoughtfulness.

B. Deny the offer and explain the therapist cannot accept gifts.

C. Seek consultation to determine the appropriateness of the gesture.

D. Determine if giving a gift is part of the El Salvadorian cultural norm before accepting or declining the gift.

Answer 72

CORRECT = A

A. Accept the offer and thank the clients for their thoughtfulness.

Question 73

#73:) A therapist receives a court order for a client’s records.  The therapist is concerned that the release of the records will cause harm to the client.  The therapist contacts the client and the client states that he doesn’t want the record released. 
The therapist should NEXT:

A. Invoke privilege on behalf of the client.

B. Advocates to the court to limit the scope of the release.

C. Inform the client that the full record must be released.

D. Limit the release to only pertinent information.

Answer 73

CORRECT = B

B. Advocates to the court to limit the scope of the release.

Question 74

74:) A 28-year-old client attends therapy for relationship issues with her girlfriend. During the assessment the client tearfully reports that each time they are intimate, she has flashbacks of her step-father molesting her when she was a younger girl. She reports she has two younger siblings, ages 15 and 17, who continue to live with her mother and step-father.

How should the therapist manage the legal obligations in this case?

A. Report child abuse since there are younger children in the home who are at risk.

B. Process the client’s trauma and address her sexual problems.

C. Refer her to a sex therapist to address sexual problems.

D. Ask the client if she has concerns for the safety of her siblings.

Answer 74

CORRECT = D

D. Ask the client if she has concerns for the safety of her siblings.

Question 75

75:) A 52-year-old woman bring her 86-year-old mother to therapy. The woman reports that her mother has seemed depressed since she relocated from another state and moved into an assisted living facility nearby. The mother confirms that she’s been feeling really down since the move but denies any suicidal ideation.

What approach should the therapist consider in this case?

A. Psychodynamic therapy to understand her relationship patterns

B. Reminiscence therapy to review her life

C. Cognitive therapy to confront her negative thought patterns

D. System therapy to improve her communication with her family

Answer 75

CORRECT = B

B. Reminiscence therapy to review her life

Question 76

76:) Sylvia, a 68-year-old woman, is referred by her priest from her church after a below-the-knee amputation due to complications from diabetes. Sylvia begins to cry and shares that “life is too hard without her leg.” She lives alone and her daughter visits her once a week but she lives an hour away. She tells the therapist that her doctor wants her to take medicine for depression but she is scared. She adds, “I don’t think this talking stuff is going to help me.”

What factors require primary consideration by the therapist in formulating the initial treatment plan?

A. Premorbid coping skills; Sylvia’s motivation for treatment; Sylvia’s religious community

B. Sylvia’s feelings of shame; Sylvia’s motivation for treatment; Sylvia’s lack social support system

C. Premorbid coping skills; Sylvia’s psychiatric history; Sylvia’s motivation for treatment

D. Sylvia’s substance use; Sylvia’s adaptation with activities of daily living; Sylvia’s lack of family support

Answer 76

CORRECT = A

A. Premorbid coping skills; Sylvia’s motivation for treatment; Sylvia’s religious community

Question 77

77:) A couple, Joe, age 39 and Marni, age 45, seeks therapy to determine whether they should stay together. They have been together for ten years but have never married. They report that they rarely argue but have a difficult time communicating. They deny any domestic violence or substance use problems.

In formulating the initial treatment plan what should the therapist assess first?

A. How they handle conflict.

B. Why they are seeking therapy.

C. Their reasons for not getting married.

D. Their views of potential separation.

Answer 77

CORRECT = A

A. How they handle conflict.

Question 78

78:) 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?

A. Create a family map to explore the roles of the parents’ family of origin.

B. Align with the father.

C. Explore the parent’s beliefs about parenting roles.

D. Direct the father to work more.

Answer 78

CORRECT = B

B. Align with the father.

Question 79

79:) A 16-year-old girl is referred for therapy after a brief hospitalization for a suicide attempt. The client is adamant that she does not want her parents involved in her treatment.

After obtaining signed informed consent, how would a psychodynamic therapist initially proceed with treatment?

A. Review client’s plan to stay safe from self-harm.

B. Encourage the client to allow her parents to participate in treatment.

C. Obtain a release to speak to referring hospital.

D. Identify client’s dysfunctional defense mechanisms.

Answer 79

CORRECT = A

A. Review client’s plan to stay safe from self-harm.

Question 80

80:) During supervision, the supervisee invites the supervisor to a dinner party to celebrate the supervisee’s birthday. The supervisor likes the supervisee and would like to attend.

The supervisor should:

A. Accept the invitation because other people from work will be at the party as well.

B. Tell the supervisee that the supervisor has other plans.

C. Acknowledge the invitation and the desire to attend, but explain the importance of professional boundaries.

D. Politely decline the offer.

Answer 80

CORRECT = C

C. Acknowledge the invitation and the desire to attend, but explain the importance of professional boundaries.

Question 81

81:) 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?

A. Determine what the best plan is for the mother and help them implement it.

B. Explore what they each see as an ideal outcome and identify resources.

C. Identify the mother’s strengths to determine if it is appropriate for the mother to continue living alone.

D. Enlist the extended family to make the best decision.

Answer 81

CORRECT = B

B. Explore what they each see as an ideal outcome and identify resources.

Question 82

82:) 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:

A. Contact the parents and inform them of incident.

B. File a child abuse report immediately.

C. Facilitate a discussion about the disclosure with the group members.

D. Provide psychoeducation about the dangers of substance abuse.

Answer 82

CORRECT = C

C. Facilitate a discussion about the disclosure with the group members.

Question 83

83:) A 20-year-old client seeks therapy for symptoms of anxiety and depression. She attended college but dropped out after one year. She is currently living with a friend and working in a department store but hates her job. She reports that she has a difficult relationship with her parents and has a hard time trusting people.

How would a psychodynamic therapist conceptualize this case?

A. Her symptoms are due to problematic thinking patterns.

B. Her symptoms are due to disengaged boundaries with parents.

C. Her symptoms are due to unresolved conflicts with her family of origin.

D. Her symptoms are due to socially constructed norms of how to behave.

Answer 83

CORRECT = C

C. Her symptoms are due to unresolved conflicts with her family of origin.

Question 84

84:) A 4 year-old is brought in by her parents for help with her tantrums. The parents share that they differ in how they respond. The father states, “my wife always gives in.” The mother states, “he just ignores her completely.” The therapist works with them to develop a consistent, age-appropriate behavioral plan. After three days the mother calls and states that her 4-year-old’s tantrums are getting worse since they have started implementing the behavioral plan. She informs the therapist that they want to stop therapy.

How should the therapist respond to the mother’s statement?

A. Discuss the potential impact of premature termination.

B. Explore her concerns about the interventions.

C. Inform mother that an increase in problematic behavior is common at the onset of behavioral therapy.

D. Validate client’s feelings and encourage the client to stick it out.

Answer 84

CORRECT = C

C. Inform mother that an increase in problematic behavior is common at the onset of behavioral therapy.

Question 85

85:) A 19-year old client seeks therapy after her freshman year at college. She reports that she is unable to control her eating patterns and that she eats excessively to the point of discomfort a couple times each week and feels disgusting afterward. She denies purging. It is evident that she has a distorted body image.

What DSM 5 diagnosis should be considered based on the symptoms present?

A. Unspecified Eating disorder

B. Body Dysmorphic disorder

C. Bulimia

D. Binge eating disorder

Answer 85

CORRECT = D

D. Binge eating disorder

Question 86

86:) A 6-year-old is referred to therapy for treatment of separation anxiety. During the intake, the mother begins sobbing and shares that her husband recently left her for his secretary. The daughter appears very concerned as her mother talks.

How would a psychodynamic therapist proceed?

A. Refocus the conversation on the needs of the 6-year-old.

B. Provide psychoeducation to mother about the importance of her own mental health and how that can impact daughter.

C. Engage in play therapy with the daughter during the session.

D. Instruct the mother that she needs her own therapy.

Answer 86

CORRECT = B

B. Provide psychoeducation to mother about the importance of her own mental health and how that can impact daughter.

Question 87

87:) 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?

A. Identify ways to strengthen the boundaries with their extended family.

B. Explore their communication styles and conflict resolution skills.

C. Instruct the couple to schedule arguments after seeing in-laws.

D. Explore how each of their families of origin deal with conflict.

Answer 87

CORRECT = C

C. Instruct the couple to schedule arguments after seeing in-laws.

Question 88

88:) 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?

A. Ask the client what the therapist could be doing differently.

B. Identify ways the group has helped him.

C. Invite the client to meet following group to discuss his concerns.

D. Explore other group members’ reactions.

Answer 88

CORRECT = D

D. Explore other group members’ reactions.

Question 89

89:) Melissa is a 32-year-old, twice-divorced woman living by herself who is referred by her EAP. Melissa’s clothes are disheveled but she appears clean. She states she was recently demoted at her current job but adds that she has always had a hard time keeping a job. She complains, “People at work are always talking about me. Nobody seems to understand me or appreciate how hard I try. My boss yells at me all the time! I could kill them! I can’t take it anymore!” Melissa groans loudly, slumps on the couch, and goes on, “I am really lonely. I have no close friends, but I get overwhelmed so easily that sometimes I just stay home and drink rather than try.”

What clinical issues must the therapist consider in formulating the treatment plan in this case?

A. Melissa’s limited social supports; Melissa’s impaired impulse control; Melissa’s history of multiple divorces

B. Melissa’s alcohol use; Melissa’s lack of vocational skills; Melissa’s conflictual interpersonal relationships

C. Melissa’s alcohol use; Melissa’s on-going employment instability; Melissa’s conflictual interpersonal relationships

D. Melissa’s limited self-care; Melissa’s limited social supports; Melissa’s motivation for treatment

Answer 89

CORRECT = C

C. Melissa’s alcohol use; Melissa’s on-going employment instability; Melissa’s conflictual interpersonal relationships

Question 90

90:) 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?

A. Explain to the African American partner the fact that shame is a common issue in Chinese culture.

B. Explore how their cultural backgrounds influence their relational dynamics.

C. Discuss how their families of origin view their relationship.

D. Identify their cultural views of lesbian relationships.

Answer 90

CORRECT = B

B. Explore how their cultural backgrounds influence their relational dynamics.

Question 91

91:) A Caucasian, female client in her mid-twenties seeks therapy at the college counseling center. She reports feeling very nervous about her final exams despite being two weeks into her first college semester. She also reports a history of eating disorders she feels she “has a handle on right now but who knows.” She complains of lack of sleep, headaches, an inability to concentrate and concerns about her roommate, who she thinks might be stealing her food. The therapist has a history of eating disorders.

What should the therapist’s first action be?

A. Identify her level of functioning and refer her to an eating disorder group off campus.

B. Seek consultation regarding countertransference issues.

C. Identify her physical symptoms and recommend a medical evaluation in conjunction with therapy.

D. Normalize client’s feelings of being overwhelmed given such a major life transition.

Answer 91

CORRECT = C

C. Identify her physical symptoms and recommend a medical evaluation in conjunction with therapy.

Question 92

92:) A 16-year-old is brought to therapy by her mother and step-father. Her mother reports that her daughter has become withdrawn and only wants to hangout with her friends. In the initial session with the daughter, she shares that her mother is very intrusive and expects her to share everything with her. The client expresses concern that the mother will want to know everything they talk about in therapy.

How should the therapist respond?

A. Suggest a joint session with the mother to discuss their relationship and expectations of therapy.

B. Provide psychoeducation to the mother about healthy adolescent development.

C. Discuss the client’s right to confidentiality and its possible limits.

D. Assure the client that even though therapist might have to disclose some of the information client provides, it will not be to the mother.

Answer 92

CORRECT = C

C. Discuss the client’s right to confidentiality and its possible limits.

Question 93

93:) A 36-year-old woman seeks therapy for depression following a recent break up with her long-term boyfriend. During the initial session, the client begins sobbing, has a difficult time breathing and is unable to speak.

How would a Gestalt therapist proceed?

A. Use an empty chair to help the client process her feelings about the boyfriend.

B. Acknowledge her difficulty speaking and suggest the client to take deep breaths to help her calm down.

C. Sit quietly until the client calms down.

D. Ask the client if there is anything the therapist could do to support her.

Answer 93

CORRECT = B

B. Acknowledge her difficulty speaking and suggest the client to take deep breaths to help her calm down.

Question 94

94:) Joan is a 35-year-old single woman who is referred by her EAP. She states she was recently transferred to a new department and was given a “write-up.” She complains, “My old supervisor was threatened by me. This always happens—I work hard and then get penalized for it! People in charge always think they know better.” Joan shakes her head and goes on, “You really can’t trust anyone these days.”

What factors in Joan’s personal history need to be considered to establish a therapeutic alliance in this case?

A. Joan’s relationship difficulties may diminish her capacity for trust.

B. Joan’s history of difficulties with authority may cause her to reject help.

C. Joan’s anxiety may block her communicating in an unguarded manner.

D. Joan’s history of misinterpreting the motives of others may contaminate the therapy.

Answer 94

CORRECT = B

B. Joan’s history of difficulties with authority may cause her to reject help.

Question 95

95:) A 22-year-old client is referred by his lawyer after being accused of burglary. The lawyer claims that the client is depressed and wants him to be assessed and treated. When the therapist meets with the client, there are no symptoms of a mood disorder but there are signs of Antisocial Personality Disorder.

How should the therapist proceed with treatment?

A. Inform the lawyer that he does not meet the criteria of depression.

B. Refer the client to another therapist.

C. Inform the client that he does not meet the criteria of depression.

D. Inform the client that he may have Antisocial Personality Disorder.

Answer 95

CORRECT = C

C. Inform the client that he does not meet the criteria of depression.

Question 96

96:) A 24-year-old client seeks treatment at a community mental health center. During the initial intake, the therapist notes that the client is dirty, confused, and appears to be responding to auditory hallucinations.

How should the therapist proceed?

A. Obtain an informed consent and refer for a psychiatric evaluation.

B. Complete a full mental status exam and initiate a 5150.

C. Discuss the client’s goals and psychiatric history.

D. Contact the client’s family members to complete the assessment.

Answer 96

CORRECT = B

B. Complete a full mental status exam and initiate a 5150.

Question 97

97:) A 13-year-old boy is referred to therapy by his youth minister who shares that both of the boy’s parents are “heavy drinkers”. During the first session, the client shares that he is being harassed and pushed around at the school by a few of the older boys. He says he has told the teacher but that only made it worse.

How should the therapist proceed clinically in this case?

A. Contact his parents and inform them of the bullying.

B. Assess for child abuse.

C. Refer the client to a social skills group.

D. Work with client to identify safety strategies.

Answer 97

CORRECT = D

D. Work with client to identify safety strategies.

Question 98

98:) A 28-year-old medical school resident seeks therapy after moving to a new city. She reports that since she moved three months ago she’s been feeling tense, has had difficulty sleeping and worries about performance at work and her future. She adds that she and her girlfriend have been arguing a lot since she moved because the long distance is “taking a toll”?

What diagnoses should the therapist consider initially in this case?

A. Generalized Anxiety Disorder, Adjustment Disorder with Anxious Mood, V. Relationship Distress with Spouse or Intimate Partner

B. Unspecified Anxiety Disorder, Substance Use Disorder; V. Relationship Distress with Spouse or Intimate Partner

C. Post Traumatic Stress Disorder, Adjustment Disorder with Anxious Mood, V. Occupational Problem

D. Unspecified Anxiety Disorder, Adjustment Disorder with Anxious Mood, V. Relationship Distress with Spouse or Intimate Partner

Answer 98

CORRECT = D

D. Unspecified Anxiety Disorder, Adjustment Disorder with Anxious Mood, V. Relationship Distress with Spouse or Intimate Partner

Question 99

99:) A therapist documents in his progress notes that a client confessed to Medi-Cal fraud in order to receive treatment and services.

The therapist finds out that the client’s file is going to be audited next week, what should the therapist do?

A. Alter the note and omit the statement about fraud.

B. Leave the note as is.

C. Request a release from the client to share the information.

D. Delete the note all together.

Answer 99

CORRECT = B

B. Leave the note as is.

Question 100

100:) Bill, a 42-year-old Asian-American corporate lawyer, presents for therapy on the advice of his partner. Bill states that for the past year he has had problems concentrating, moodiness, and lack of appetite. He occasionally sleeps during the day, missing work due to tiredness. He shares that he started drinking again, and admits to having four or five drinks most nights to help him fall asleep, when it used to only take two drinks. At work, Bill has been reprimanded by his supervisor for his arguments with co-workers and his decline in job performance. Bill adds, “I don’t enjoy anything. My partner can’t stand me this way, and I can’t stand to go on this way, either. I’ve even thought about moving out until things can get better.” Continuing, he adds, “What would my friends and family think if they knew I came in for help?”

What client factors must the therapist consider in planning Bill’s initial treatment?

A. Bill’s motivation for seeking treatment; Bill’s feelings regarding his loss of control and need for help; Bill’s lack of social support from friends and family.

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.

C. Bill’s motivation for seeking treatment; Bill’s feelings of guilt about falling behind at work; The couple’s expectations for Bill’s treatment outcome.

D. Psychological stressors underlying Bill’s substance use; Bill’s poor impulse control as demonstrated by his conflicts at work; Bill’s lack of social support from friends and family.

Answer 100

CORRECT = B

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.