Pocket Prep Treatment Planning Flashcards
A counselor has been meeting with a client, Jim, for over three years at the same time every week. The counselor is looking for new clients to add to his practice and receives a call from a potential client who would like to come in during the same time slot as Jim. The counselor tells the new client that he is free at that time and thinks, “Jim will understand. I’ll just ask him to come at a different time for a while.” This is a violation of all of the following ethical principles except which one?
Veracity
Justice
Autonomy
Fidelity
Correct answer: Autonomy
There are many principles that underlie counselors’ ethical decision making. These include beneficence, the desire to work for the good of the client as well as for society; nonmaleficence, avoiding harm; autonomy, respecting the client’s right to self-determination; justice, treating individuals fairly; fidelity, honoring commitments; and veracity, being honest and truthful. By prioritizing a new client over another client, this counselor is violating the principles of fidelity, justice, and veracity. Ethically, the counselor should reserve the appointment time for the existing client and attempt to find another time to meet with the new one.
Which of the following is an acceptable objective of a counseling program?
Counselors in the student counseling department will build relationships with each other in order to build a greater sense of community and trust
The counseling department will attend suicide risk trainings this year to better assess suicidality in the student body
By the end of the program, students’ in-school suspensions will decrease from four per semester per student to two per semester
Students will experience improved self-esteem over the course of the counseling group
Correct answer: By the end of the program, students’ in-school suspensions will decrease from four per semester per student to two per semester
When developing a counseling program, counselors should define goals and objectives. Goals refer to broad statements about the program’s intent, whereas objectives are more specific and measurable. By clearly defining the decrease in the number of in-school suspensions that will be reached by the end of the program, program developers can quickly and easily communicate the aim of the program to participants and others. The remaining answer options are examples of broad goals, not specific objectives.
Which of the following is an acceptable objective of a counseling program?
Counselors in the student counseling department will build relationships with each other in order to build a greater sense of community and trust
The counseling department will attend suicide risk trainings this year to better assess suicidality in the student body
By the end of the program, students’ in-school suspensions will decrease from four per semester per student to two per semester
Students will experience improved self-esteem over the course of the counseling group
Correct answer: By the end of the program, students’ in-school suspensions will decrease from four per semester per student to two per semester
When developing a counseling program, counselors should define goals and objectives. Goals refer to broad statements about the program’s intent, whereas objectives are more specific and measurable. By clearly defining the decrease in the number of in-school suspensions that will be reached by the end of the program, program developers can quickly and easily communicate the aim of the program to participants and others. The remaining answer options are examples of broad goals, not specific objectives.
What psychologist published Counseling and Psychotherapy in 1942?
Irvin Yalom
Gilbert Wrenn
Carl Rogers
Sigmund Freud
Correct answer: Carl Rogers
Carl Rogers was a psychologist most well-known for his client-centered approach to psychotherapy. In his second book, Counseling and Psychotherapy, Rogers suggests that the client can resolve problems and gain insight into life struggles through a relationship with an empathetic, accepting therapist.
Which of the following produces the best results for individuals with depression, according to research?
No treatment
Cognitive therapy
Elective surgery
Anti-depressants
Correct answer: Cognitive therapy
Though the causes of depression are many and varied, studies have shown that cognitive therapy produces more stable results and fewer relapses as opposed to anti-depressant psychopharmaceuticals.
Surgery and no treatment are not usually considered in treatment planning for depression.
Which of the following produces the best results for individuals with depression, according to research?
No treatment
Cognitive therapy
Elective surgery
Anti-depressants
Correct answer: Cognitive therapy
Though the causes of depression are many and varied, studies have shown that cognitive therapy produces more stable results and fewer relapses as opposed to anti-depressant psychopharmaceuticals.
Surgery and no treatment are not usually considered in treatment planning for depression.
A school counselor is asked to meet with a student whose grades have plummeted over the past two months. While talking with the counselor, the student discloses that her uncle began sexually molesting her on the weekends about two months ago. What is the counselor required to do?
Have the girl call the proper authorities to tell them directly about the abuse
Report the sexual abuse to the proper authorities and tell the girl’s parents
Report the sexual abuse to the proper authorities
Tell the girl’s parents and let them decide what to do
Correct answer: Report the sexual abuse to the proper authorities
Counselors are mandated reporters, meaning that they are legally required to report any suspicion or allegation of abuse of children under the age of 18. This includes physical abuse, sexual abuse, emotional abuse, verbal abuse, or neglect. Some states also require counselors and other professionals to report when abuse of elders or individuals with disabilities is suspected. In this situation, the counselor is not required to talk to the girl’s parents, though he may choose to do so depending on the circumstances.
What does cost-benefit analysis suggest about the effectiveness of psychotherapy?
Cost-benefit analysis suggests that psychotherapy has no effect on mental health expenditure in the community
Cost-benefit analysis suggests that psychotherapy reduces mental health expenditure in the community
Cost-benefit analysis suggests that psychotherapy increases mental health expenditure in the community
Cost-benefit analysis suggests that the effect of psychotherapy on mental health expenditure cannot be accurately measured
Correct answer: Cost-benefit analysis suggests that psychotherapy reduces mental health expenditure in the community
The effectiveness of various sorts of mental health treatment is a necessary focus of treatment planning. Cost-benefit analysis suggests that psychotherapy reduces mental health expenditure in the community. However, integrating this conclusion into the understanding of managed care and insurance firms is an ongoing effort.
Which of the following is true about treatment for eating and elimination disorders?
They may involve family counseling as a frontline treatment
They have a biological/medical basis
They are usually factitious in character
Dialectical behavior therapy is not indicated for these disorders
Correct answer: They may involve family counseling as a frontline treatment
Eating and feeding disorders are different in many ways from other mental disorders detailed in the DSM-5. They are not usually seen as having a biological/medical basis, and they are not factitious in character; they are real phenomena and not attempts for attention or malingering.
Treatment for these disorders is variable, but in many cases, dialectical behavior therapy can help and family counseling is a key. Often, the entire family is enrolled as partners in treatment for these disorders.
A woman with schizophrenia has an individual therapist she meets with once a week and a psychiatrist she sees every other month for medication. What is the best type of group for this individual?
Secondary
Support
Tertiary
Primary
Correct answer: Tertiary
Tertiary groups are best for those with more serious types of pathology, such as severe depression or psychosis. Many participants in tertiary groups also see an individual therapist on a regular basis.
Primary groups are more focused on healthy living and coping strategies and include support and psychoeducational groups. Secondary groups aim to reduce or prevent the severity of existing problems.
A newly licensed counselor in private practice enjoys working with married couples who are experiencing conflict in their relationships. However, when billing insurance companies for marital therapy, which of the following should the counselor take into consideration?
Many insurance companies do not reimburse for marital therapy
Marital therapy is reported to the counseling licensure board to ensure counselors do not commit fraud
The counselor may not be legally certified to provide marital therapy
One member of the couple may not agree with marital therapy
Correct answer: Many insurance companies do not reimburse for marital therapy
Many counselors are on health insurance panels in order to collect payment for services to clients. Payment, however, is not automatic and depends on several factors, such as whether the counselor is licensed in their state. In addition, marital therapy is not reimbursed by many insurance companies and claims may have to be filed as family therapy instead.
Which of the following medications requires strict monitoring to avoid liver damage as part of treatment?
Ritalin
Valium
Ativan
Lithium
Correct answer: Lithium
Although all medication has the potential to damage organs and systems with overdose, Lithium depends on strict monitoring to avoid liver damage as part of the expected treatment with the medication. Lithium is used to treat bipolar disorder.
Ativan, Ritalin, and Valium do not require this level of therapeutic monitoring in the usual course of treatment.
Which of the following is true about civil commitment laws?
They are matters of federal legislation
They are matters of civic jurisdiction
They are matters decided by healthcare entities
They are matters of state legislation
Correct answer: They are matters of state legislation
Every state has laws and regulations concerning civil commitment, which amounts to a person being deemed a danger to themselves or others and needing to be placed in a facility in order to preserve their own and the public’s safety. Most often, the laws deciding the nature of civil commitment in each state are handled by that state’s legislature.
There may be broad federal directions regarding civil commitments, and there may be jurisdictional qualifications and details decided at the local level. Overall, civil commitment is a matter of state law.
A counselor following Salvador Minuchin’s approach to family therapy would most likely focus on which of the following?
Metacommunication in families
Connections between family members that keep the system in balance
Transaction patterns in the family
Differentiation of self among family members
Correct answer: Transaction patterns in the family
Salvador Minuchin is best known for his development of structural family therapy, which is concerned with the transactional patterns between family members. The structure of these transactional patterns is the focus of family therapy, as the therapist attempts to change the patterns in order to redefine boundaries and restructure the family system.
Which of the following is true regarding the Family Educational Rights and Privacy Act of 1974?
It allows parents of students under 18 to access their counseling records
The intent of the act was to prevent students from restricting parents’ access to records
It permits students under the age of 18 to prevent parents from seeing their educational records
It allows students, age 18 and older, to access information in their educational records
Correct answer: It allows students, age 18 and older, to access information in their educational records
The Family Educational Rights and Privacy Act of 1974 (FERPA), also known as the Buckley Amendment, was created with the intent of protecting the privacy of students. FERPA allows students age 18 and older to access information in their educational records, not necessarily their counseling records. FERPA also allows parents of students under age 18 to access educational records.
During a session with a client, a counselor notices that the client has not bathed in several days and looks unkempt. The client makes statements such as “it would be better if I weren’t around” and tells the counselor that they would use a gun that is now in their house to kill herself if they felt hopeless enough. When the counselor asks the client whether they might end their own life soon, the client replies that they aren’t sure. What is the best option for the counselor at this time?
Call the client’s close family members and friends so they can provide 24/7 observation
Give the client her personal number and instruct the client to call counselor when and if they decide to commit suicide
Inform the client of the counselor’s duty to protect them, and advise them to go to the closest crisis center or hospital
Call law enforcement so they can take the client to be evaluated
Correct answer: Inform the client of the counselor’s duty to protect them, and advise them to go to the closest crisis center or hospital
Counselors should be knowledgeable in assessing for suicide risk. There are several warning signs of suicide, including previous attempts, verbal threats of suicide, having a plan in place and access to fatal means, depression and hopelessness, giving belongings away, and a history of drug or alcohol abuse. Counselors who determine that clients are an imminent danger to themselves (or others) are obligated to protect the client. The counselor in this question should advise the client to seek emergency treatment at a hospital or crisis center; if the client refuses to seek treatment then the counselor may be required to obtain an involuntary commitment.
n which style of counseling would goals include the overcoming of inferiority as a barrier?
Adlerian
Transactional analysis
Freudian
Rogerian
Correct answer: Adlerian
The technique of individual psychology as popularized by Alfred Adler seeks to help a client overcome their sense of inferiority and achieve a sense of superiority while identifying appropriate interests.
Rogerian techniques focus more on self-realization. Freudian techniques involve the deep exploration of inner conflict. Transactional analysis deals with relational dynamics and their impact on the self.
What is the main reason counselors should assign diagnostic codes to clients?
To give clients a reason to continue with counseling
To obtain reimbursement from insurance companies
To be able to explain in clear terms why clients are experiencing symptoms
To guide intervention and treatment
Correct answer: To guide intervention and treatment
When documenting clients, counselors often assign diagnostic codes in order to guide intervention and treatment and to better conceptualize the client’s symptoms. Counselors should never assign diagnostic codes to obtain reimbursement from insurance companies or to give clients a reason to continue with counseling. Diagnostic codes simply classify collections of symptoms, but often don’t clearly explain why clients are experiencing the symptoms.
Which of the following would be the most appropriate first step in treating someone with a somatic symptom disorder?
CBT
Medication
Counseling interventions
A physical exam
Correct answer: A physical exam
Somatic symptom and related disorders have their own section in the DSM-5, involving symptoms that a person feels are real but for which there is little to no medical evidence. In such cases, the best course of action is to rule out possible medical issues, so a physical exam is generally the first intervention that might be suggested.
After a medical issue can be ruled out, other treatment modalities can be engaged, such as counseling and perhaps cognitive behavioral therapy (CBT). Medication may also be called for, but it will most likely be psychopharmaceutical and not meant to address the presenting medical symptom for which there is no demonstrable physical issue.
An individual wants to quit smoking, but has found it difficult to do so for an extended period of time. What type of group is the best option to help this individual reach their goal?
Behavioral counseling
Rational emotive behavior counseling
Transactional analysis
Gestalt theory
Correct answer: Behavioral counseling
Behavioral counseling groups are typically led by a counselor who is directive and goal-oriented. The main purpose of these groups is to extinguish unwanted behaviors (such as smoking) by using behavioral modification techniques such as reinforcement and extinction. The other answer choices refer to group approaches that are more involved and intense than behavioral counseling, and they often focus on improved relationships and emotional functioning, which is not what the individual in the question is seeking.
Which of the following is false about group psychotherapy?
It is usually conducted in institutional settings
It is usually a short-term therapy modality
It is usually a long-term therapy modality
Its goals include assistance with decreasing suicidal ideation
Correct answer: It is usually a short-term therapy modality
Group psychotherapy is a treatment modality most often seen in institutional settings such as mental hospitals, and, as opposed to shorter-term interventions, is meant to help individuals deal with chronic issues of anxiety, depression, and even suicidal ideation.
Over the past several decades there has been increasing evidence that there are strong relationships between the psyche, nutrition, medications, and body functions. What is the main reason counselors should acknowledge this connection?
Counselors who understand this connection better typically earn more money and attract more clients
Insurance companies are requiring more intensive explorations of all aspects of clients’ well-being
Many counselors are returning to school to become psychiatrists or dieticians
Some behavior is likely rooted in biological and brain functions
Correct answer: Some behavior is likely rooted in biological and brain functions
A significant amount of recent research shows that much behavior may be rooted in biological and brain functions. Because of the ways nutrition, medications, body functions, and mental states can affect behavior, it is important for counselors to seek out training and workshops to maintain competence in this area.
Which of the following is true about the Affordable Care Act of 2010?
It allows insurance companies to discriminate based on preexisting conditions
It gives states the power to decide whether to expand public and private insurance coverage
It outlawed mandates and subsidies for health insurance
It requires that mental health care services be treated the same as regular health care
Correct answer: It requires that mental health care services be treated the same as regular health care
The Affordable Care Act (ACA) was passed in 2010 as a way to increase the quality and coverage of health insurance while lowering cost and barriers to healthcare. Under the ACA, mental health services are to be treated the same as medical services, and insurance companies are required to use the same terms and conditions for mental health conditions as for general medical conditions.
Which therapeutic approach was developed by Eric Berne and operates from the belief that a life script develops in childhood and influences a person’s behavior throughout adulthood?
Gestalt therapy
Psychoanalysis
Transactional analysis
Existential therapy
Correct answer: Transactional analysis
Eric Berne is the founder of transactional analysis, which is based on the idea that a life script develops in clients’ childhoods and influences a lifetime of behaviors. The goal of transactional analysis is to recognize ego-state functioning and analyze one’s own transactions with others.
Which of the following is true about solution-focused brief therapy (SFBT) in treatment planning?
Not all problems are suitable for SFBT
SFBT encourages reflection on past issues
SFBT explicitly addresses thought disorder
Traumatic issues are suitable for SFBT
Correct answer: Not all problems are suitable for SFBT
SFBT is suitable for a wide variety of problems in counseling, especially when a problem can be named, understood, strategized, and dealt with in a relatively brief time (probably no more than six or seven sessions of treatment). The burden is on the client to use the lessons and plan arrived at in conjunction with the therapist to proceed to solve their problems.
However, SFBT is not suitable for many problems. It would not, for example, offer the appropriate length or depth for a thought disorder or a worthwhile exploration of past issues or trauma.
All of the following are functions of Chi Sigma Iota except which one?
To provide mediation when an ethical conflict arises
To contribute to the development of leaders in the counseling field
To promote research in counseling
To educate counselors in ways to maintain professionalism in counseling relationships
Correct answer: To provide mediation when an ethical conflict arises
Chi Sigma Iota, the Counseling Academic and Professional Honor Society International, aims to promote scholarship, research, professionalism, and excellence in counseling. Chi Sigma Iota also tries to promote the development of leaders in the field of counseling. Chi Sigma Iota does not provide mediation when an ethical conflict arises.
Which of the following would a treatment plan be expected to do, at a minimum?
Provide a working plan for a patient’s functioning once the episode of care is complete
Direct care professionals as to how to interact with a patient
Help an individual resolve problems for better functioning and move to a less restrictive environment
Document historical data that are significant to the patient’s current presentation
Correct answer: Help an individual resolve problems for better functioning and move to a less restrictive environment
Though individual types of treatment plans vary widely across settings, the essential purpose of a treatment plan is to resolve current problems for better functioning and to provide a way for an individual to move to a less restrictive environment. The most formal and scrutinized treatment plans are usually performed at the inpatient level, where reaching goals is a means to less confined care.
A treatment plan is meant to address the goals of the episode of care itself, not what happens afterward. It may or may not contain some relevant historical data, but it is more a plan of action than a history. It will do more than direct staff behavior toward a patient.
What type of approach to group therapy is based on the cognitive behavioral theories of Albert Ellis?
Reality theory
Rational emotive behavior counseling
Transactional analysis
Psychoanalytic theory
Correct answer: Rational emotive behavior counseling
Rational emotive behavior counseling groups are based on Albert Ellis’ cognitive behavioral theories focused on improving overall functioning. These groups are meant to help group members identify and correct faulty thought patterns while accepting oneself and others.
A group counselor finds out that two members of the group have regularly been spending time together between group sessions to talk about group issues and other members. What should the counselor do?
Meet with both individuals to explain that group issues should not be discussed outside of group sessions, and suggest that they wait until the group has terminated to continue with their social gatherings
Ask the group if they would like the individuals to stop socializing outside of the group
Praise the individuals for forming a meaningful social relationship and encourage them to invite other group members to spend time with them between sessions
Inform the group members that they have violated the confidentiality of other group members and that they are no longer welcome in the group
Correct answer: Meet with both individuals to explain that group issues should not be discussed outside of group sessions, and suggest that they wait until the group has terminated to continue with their social gatherings
Questions of appropriate relationships between group members often arise in group counseling situations. In general, group members are discouraged from developing relationships with each other outside of group sessions, as extracurricular relationships can affect group dynamics. Group members should also respect the confidentiality of information shared in the group and should not discuss this outside of sessions. In this situation, the counselor should speak with the specific group members to address these concerns.
Which of the following accurately states the guidance of the CDC with respect to medication for children with ADHD?
Medication therapy should be attempted first for all children to reduce symptoms
Medication therapy should be used in conjunction with behavior therapy for all children
Behavior therapy is contraindicated in almost all cases for those 6 and under
Behavior therapy is suggested before medication for those 6 or under
Correct answer: Behavior therapy is suggested before medication for those 6 or under
The Centers for Disease Control and Prevention (CDC) recommend that behavior therapy should be used as a primary treatment for ADHD before medication is attempted for children 6 or under.
Although medication can reduce symptoms, behavior therapy is a better overall clinical intervention as a first line of treatment for those in this age group.
A counselor works for a company, and her main job is to provide referrals for company employees who are having substance abuse or mental health issues. This counselor most likely works in the:
Veterans Administration
employee assistance program
department of social services
company president’s office
Correct answer: employee assistance program
Many companies have Employee Assistance Programs (EAPs) to assist workers with mental health and substance use issues. The duties of counselors working in EAPs vary depending on the company, but typically include identifying, counseling, and referring out individuals for a variety of reasons. Some EAP counselors work for the company and others work for a contract agency.
A basic tenet of Dialectical Behavior Therapy (DBT) is helping clients increase emotional and cognitive regulation. All of the following are modules that include a variety of skills learning in DBT except which one?
Mindfulness
Interpersonal effectiveness
Distress tolerance
Logotherapy
Correct answer: Logotherapy
Dialectical Behavioral Therapy (DBT) assists clients in learning ways to regulate their emotions and thoughts by identifying the triggers that lead to undesired behaviors. There are four DBT modules that include a variety of skills: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.
Logotherapy is a therapeutic approach that is based on the idea that clients’ primary motivation is to find meaning in life.
What counseling approach gives the most control and responsibility to the client?
Gestalt therapy
Narrative therapy
Individual psychology
Reality therapy
Correct answer: Reality therapy
William Glasser developed reality therapy, which asserts that individuals are in charge of their own lives and therefore determine their own fate. According to reality therapy, people have five genetically based needs: survival, love and belonging, power or achievement, freedom or independence, and fun. Taking responsibility is a key concept of reality therapy.
In rational emotive behavior therapy (REBT), what does the “A” in A-B-C-D-E mean?
Accept
Action
Affect
Approach
Correct answer: Action
Rational Emotive Behavior Therapy (REBT) is based on the belief that the way we interpret events, not the actual events themselves, is most important. REBT involves five parts: an Action (A) that occurs externally from the individual; a Belief (B) that is a form of self-verbalization; a Consequent affect (C) that can be rational or irrational; Disputing (D) the irrational belief that leads to the behavior; and an Effect (E), the change in the self-verbalization.
All of the following are essential to counseling program planning except which one?
A mission statement or general philosophy of the program
A pilot study
Development of goals
A needs assessment
Correct answer: A pilot study
When planning a counseling program, it is important to take orderly and careful steps to ensure that the program is thoughtfully executed. Essential steps in program planning, in order, are conceptualization, which includes examining broader systems, establishing a philosophy, and assessing needs; development of goals and objectives of the program; implementation; and evaluation of the program, including whether goals and objectives were met. While a pilot study can be helpful to identify any major problems before full implementation, it is not essential to program development.
Which client would most likely benefit from eye movement desensitization and reprocessing (EMDR)?
A student with depression
A homeless person with schizophrenia
A war veteran with PTSD
A parent who has a substance abuse problem
Correct answer: A war veteran with PTSD
Eye movement desensitization and reprocessing (EMDR) is a technique that uses eye movement to help those suffering from PTSD. The technique is thought to allow the sufferer to “rewire” experiences by using eye movement and traumatic focus.
The war veteran with PTSD is a much more likely patient for this technique than the others listed unless they also had a traumatic component to their issues that could be identified and treated.
How could a clinician use contextualism as a concept in treatment planning?
In putting behavior in its proper cultural context
In assessing how culture has caused pathology
In bringing in the client’s family for collateral information
In considering the support system of a client
Correct answer: In putting behavior in its proper cultural context
Contextualism as it applies to the treatment of mental illness and the specifics of treatment planning refers to the idea that, rather than being a purely idiosyncratic phenomenon, mental illness is inflected by one’s participation in culture. In short, behavior should be considered within the context of culture in order to be properly assessed.
The concept does not refer to considering a client’s support system or bringing in their family for collateral information, nor does it refer to how culture may or may not cause pathology.
Does the DSM-5 provide formal treatment recommendations on a diagnostic basis?
Yes, in all circumstances
No, except for developmental disorders
No, under no circumstances
Yes, under some circumstances
Correct answer: No, under no circumstances
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides a wealth of data dealing with diagnosis of mental illness. In this regard, it provides useful information on comorbidities, differential diagnoses, cultural factors, and so on. It does not provide formal treatment recommendations according to those diagnoses, though it may comment on treatment.
The DSM-5 is a diagnostic tool and not a treatment-planning resource per se.
Which of the following is true about clients and counselors in terms of their similarities?
Clients have better outcomes with counselors who are similar to themselves
Clients tend to prefer counselors who are similar to themselves
Clients do better with counselors who are different from themselves
Clients do not care about who they get services from
Correct answer: Clients tend to prefer counselors who are similar to themselves
In most cases, clients tend to prefer counselors who are similar to themselves in terms of various factors such as race, nationality, culture, and so on. However, research is less clear on the outcomes of these therapeutic relationships.
Which of the following is the right course of action for co-occurring disorders in treatment planning?
Schedule a separate intake for those concerns
Integrate treatment in that episode of care
Deal with the issues sequentially
Triage the more acute concern and treat it first
Correct answer: Integrate treatment in that episode of care
In terms of treatment planning, at the current time, a high number of individuals present with co-occurring disorders. Many of them will present with a substance use issue as the co-occurring diagnosis, making decisions about treatment planning and level of care more complex.
When presented with co-occurring disorders, a professional’s best course of action is to integrate treatment with the proper professionals as opposed to waiting to treat what could be a major client concern.
How many divisions of the American Counseling Association are currently in existence?
100
18
50
80
Correct answer: 18
The American Counseling Association (ACA) consists of 18 divisions. In many cases, counselors may join a division but are not required to join ACA. These divisions include the Association for Child and Adolescent Counseling, the National Employment Counseling Association, and Counselors for Social Justice.
Association for Adult Development and Aging (AADA) Association for Assessment and Research in Counseling (AARC) Association for Child and Adolescent Counseling (ACAC) Association for Creativity in Counseling (ACC) American College Counseling Association (ACCA) Association for Counselor Education and Supervision (ACES) Association for Humanistic Counseling (AHC) Association for Multicultural Counseling and Development (AMCD) American Rehabilitation Counseling Association (ARCA) Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) Association for Specialists in Group Work (ASGW) Counselors for Social Justice (CSJ) International Association of Addictions and Offender Counselors (IAAOC) International Association of Marriage and Family Counselors (IAMFC) Military and Government Counseling Association (MGCA) formerly ACEG National Career Development Association (NCDA) National Employment Counseling Association (NECA) Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE)
Which of the following is the most significant factor in client success?
The relationship between counselor and client
The specific technique of the counselor
The knowledge of the client
The level of expertise of the counselor
Correct answer: The relationship between a counselor and a client
Much research evidence affirms that the most important factor in client success is the quality of the relationship between a counselor and a client. This is more of a determination of success than the specific technique of the counselor, the level of expertise of the counselor, or the level of knowledge the client has been able to attain.
In which of the following ways does mental health counseling differ from the typical medical model?
Mental health counseling does not formally assess illness
Mental health counseling focuses on symptoms and deficits
Mental health counseling attends to systems and stresses wellness
Mental health counseling does not focus on psychopathology
Correct answer: Mental health counseling attends to systems and stresses wellness
Mental health counseling focuses on wellness and, among other differences from the typical medical model, sees individuals as members of interlocking systems rather than suffering from pathology.
Mental health counseling does formally assess illness when appropriate and does put substantial effort toward symptoms and deficits while still attempting to treat a whole, complicated individual who—in many cases—is the best expert about their needs for treatment.
In which of the following areas is specialty counselor certification not yet possible?
Mental health
School
Addictions
Career
Correct answer: Career
The National Board for Certified Counselors (NBCC) grants generic counselor certification as National Certified Counselor (NCC). Individuals who are NCCs can also obtain specialty counselor certification in the areas of school counseling, mental health counseling, and addiction counseling. Career counseling is not one of these specialties.
Which of the following is a legal concept?
Privileged communication
Reciprocity
Disclosure
Confidentiality
Correct answer: Privileged communication
Privileged communication is a legal term that refers to the fact that in a court of law the counselor does not have to reveal what the client said during counseling sessions. However, counselors are obligated to break privileged communication in several situations, including times when the client is a danger to himself or others, when child abuse or neglect is suspected, when a client asks that counseling records be released, when a lawsuit is filed against the counselor, when involuntary hospitalization is considered, when supervision of the counselor is taking place, or when the counselor’s records are subpoenaed by a judge.
Are medical interventions appropriate for those suffering from substance-related disorders?
Yes, in some circumstances
Yes, in tandem with psychotherapy
Yes, in tandem with mindfulness training
No, under no circumstances
Correct answer: Yes, in some circumstances
The DSM-5 contains a section that is dedicated to substance-related and addictive disorders. This section details 10 different classes of drugs and the clinical criteria used to diagnose them.
In terms of treatment, a variety of modalities have proven successful, some of which can be medical, such as the use of substitute medication for substances of concern. Treatment modalities are highly variable and may contain psychotherapy and/or mindfulness in addition to medical interventions when indicated.
How are individuals covered by TRICARE different than many other clients?
They are all under age 18
They must provide a written request to TRICARE in order to get mental health services
They are much sicker and have more acute needs than other clients
They must get a physician referral before seeing a counselor who is not a TRICARE Certified Mental Health Counselor
Correct answer: They must get a physician referral before seeing a counselor who is not a TRICARE Certified Mental Health Counselor
TRICARE is the health insurance provider for United States Armed Forces personnel, retirees, and their dependents. Individuals who are covered by TRICARE are permitted to seek services from a TRICARE Certified Mental Health Counselor. Other counselors can provide services to individuals covered by TRICARE, but only if they practice under a TRICARE-authorized physician.
A counselor has been meeting for several months with a man whose wife recently died after a terminal illness. During one session, the client states that he has been considering shooting himself in the head to “end the pain” and “to see my wife again.” The counselor determines that the man has a high risk of suicide, as he continues to state that he is going to kill himself that night with the gun he has in his house, and he will not take himself to the closest crisis center. What should the counselor do?
Respect the man’s decision and allow him to attempt suicide
Take steps to obtain an involuntary commitment
Stay with the client at his home to make sure he is safe
Keep the man with her until he agrees not to shoot himself
Correct answer: Take steps to obtain an involuntary commitment
Counselors may be faced with ethical dilemmas when confidentiality needs to be broken. These situations occur when the counselor feels there is imminent risk of danger to the client or others, when a lawsuit is filed against the counselor or a court orders information about a client, when supervision or consultation is needed, when insurance companies request information, when the client requests that counseling records be released, or when administrative professionals in the office handle client information.
In this situation, the client appears to be at serious risk of harming himself; he has a motive and a clear plan to commit suicide. Though the counselor will have to break confidentiality, he or she must attempt to obtain an involuntary commitment to have the client admitted to the hospital for his own safety if he will not admit himself.
man with her until he agrees not to shoot himself
What is the purpose of establishing a feedback loop throughout the planning of a counseling program?
To help establish goals and objectives for the intervention
To assess various areas of need in the program
To make sure development is proceeding appropriately
To provide a system of checks and balances to show insurance companies that their money is well-spent
Correct answer: To make sure development is proceeding appropriately
An important step in the counseling program planning process is processing information as the planning moves forward. It is best to have a clear structure of individuals who can obtain and relay feedback about goals, objectives, needs, philosophy, and the broader system to the planning team to ensure that the planning process is as relevant and thorough as possible.
What does a needs assessment measure?
The difference between where a program started and where it is now
The difference between what is and what is desired
The discrepancies between different individual players in a counseling program
The similarities between a particular program and other programs like it
Correct answer: The difference between what is and what is desired
A needs assessment is an important element of program planning, as it defines the differences between what currently exists and what is needed or desired to change the situation. Needs assessments can be conducted through questionnaires, surveys, interviews, focus groups, or other methods. Random sampling should be used when possible in order to obtain an accurate representation of needs.
Which of the following is an example of a counselor structuring for a client?
Deciding with the client which intervention to use
Telling the client ahead of time what to expect out of the next session
Defining the limits, goals, and nature of the counseling process
Instructing the client to remain silent while the counselor speaks
Correct answer: Defining the limits, goals, and nature of the counseling process
In order to convey messages clearly to clients and to create a safe, secure space for them to share during sessions, counselors should define the nature, limits, and goals of the counseling process. This process is called structuring and may also include a description of the roles of the client and counselor.
About how many clients from ethnic minorities quit counseling after the first session?
50%
20%
25%
80%
Correct answer: 50%
Estimates suggest that about 50% of ethnic minorities quit counseling after only one session, in the belief that they will not get what they want out of it. This highlights the importance of culturally relevant treatment planning that is responsive to the different ways clients may express (or not express) their needs to those they see as dominant treatment providers.
Under which of the following circumstances may privileged communication be broken?
When a client’s spouse wants information about the client’s sessions
When a lawsuit is filed against the counselor
When a client has psychosis
When a client dies
Correct answer: When a lawsuit is filed against the counselor
Privileged communication is a legal term that refers to the fact that, in a court of law, the counselor does not have to reveal what the client said during counseling sessions. However, counselors are obligated to break privileged communication in several situations, including times when the client is a danger to himself or others, when child abuse or neglect is suspected, when a client asks that counseling records be released, when a lawsuit is filed against the counselor, when involuntary hospitalization is considered, when supervision of the counselor is taking place, or when the counselor’s records are subpoenaed by a judge.
A counselor is meeting with a 12-year-old boy who she believes would benefit from adventure-based counseling. What outcomes might be expected for the client with this type of counseling?
More clarity about what diagnosis the client might have
Better understanding of what aspects of socialization the boy struggles with
Better awareness of how early childhood experiences have affected his relationships
Increased self-confidence and communication skills
Correct answer: Increased self-confidence and communication skills
Adventure-based counseling is a unique intervention that is designed for children and adults. This type of counseling consists of an experiential set of outdoor activities such as challenge courses, hiking, camping, and other activities designed for individuals or groups. The goals of adventure-based counseling include increased self-awareness and self-confidence, improved communication skills, and camaraderie. Diversity sensitivity and multicultural skills may also be developed through adventure-based counseling.
About how many clients present with co-occurring substance use issues?
Up to 25%
Up to 75%
Up to 30%
Up to 50%
Correct answer: Up to 50%
In treatment planning discussions, the issue of co-occurring disorders is an important concern. Many estimates suggest that up to 50% of clients entering care have a co-occurring substance use issue in addition to their presenting diagnosis.
Which of the following would represent a standard progression through a continuum of care?
Inpatient hospitalization, independent living, group home care, day hospital care
Independent living, day hospital care, group home care, inpatient hospitalization
Day hospital care, independent living, group home care, inpatient hospitalization
Inpatient hospitalization, day hospital care, group home care, independent living
Correct answer: Inpatient hospitalization, day hospital care, group home care, independent living
A continuum of care refers to the way in which a client can move best through the most appropriate level of care for their situation. Though a client can have setbacks, and there is variability in what might actually happen in any case, the intention of such a continuum is to provide a reasonable progression of the most appropriate level of care for a client with the goal of providing the greatest amount of autonomy possible. Thus, a client could reasonably be expected to go from inpatient hospitalization to day hospital care, group home care, and finally independent living.
The other progressions do not represent a progression from a more to a less intensive level of care
Which of the following would be most appropriate for treating trauma- and stressor-related disorders?
Psychotherapy alone
Psychopharmacology alone
Psychopharmacology and psychotherapy
Hypnosis and psychopharmacology
Correct answer: Psychopharmacology and psychotherapy
The section on trauma- and stressor-related disorders in the DSM-5 deals with the impact of traumatic or stressful events on a person’s life and well-being, such as adjustment disorders, acute stress disorder, and post-traumatic stress disorder.
As these disorders deal with idiosyncratic events in a person’s life experience, resilience, and other factors, a wide variety of psychopharmacology and psychotherapy approaches can be used to treat them, either together or separately. These approaches might include hypnosis and many other kinds of alternative treatment.
Which of the following accurately describes the current consensus regarding spirituality in treatment?
Counselors should not discuss clients’ spiritual concerns
Counselors must be willing and able to address spiritual concerns
Counselors should routinely use spiritual assessments at intake
Counselors should present their spiritual beliefs transparently
Correct answer: Counselors must be willing and able to address spiritual concerns
About 90 percent of the population of the United States believes in a power greater than themselves. Though this can be somewhat vaguely defined, spiritual concerns are part of the presentation of clients and therefore a useful focus of counseling study. There is a discussion about how and when to best introduce the topic, but the current consensus is that the client should drive this part of the counseling conversation.
A counselor might or might not use a spiritual assessment at the beginning of care but should not present spiritual issues of their own without prompting, as this might alienate many clients. Counselors must be willing and able to engage with this topic with their clients.
What would be the best use of a token economy in treatment planning?
To shape behavior around desired goals
To create accountability around outcomes
To elicit feedback about cognitive issues
To suggest further clinical directions
Correct answer: To shape behavior around desired goals
A token economy’s purpose is to shape behavior around desired goals for an individual. It usually takes place in treatment settings in which most of the client’s behavior can be observed and documented, with good behavior rewarded with small, meaningful motivators.
The point of a token economy is not to elicit feedback, create accountability, or suggest further clinical directions.
Which of the following is mandated by the Mental Health Parity and Addiction Equity Act?
Health insurance plans may not request information from providers without a signed consent
Health insurance plans may not deny coverage based on preexisting conditions
Health insurance plans must provide the same level of coverage to those with mental health needs as to those with medical needs
Health insurance plans must cover employee assistance counseling as well as professional mental health services
Correct answer: Health insurance plans must provide the same level of coverage to those with mental health needs as to those with medical needs
The Mental Health Parity and Addiction Equity Act was passed as an attempt at providing the same level of coverage to individuals with mental health issues as to those with medical issues. This legislation applies only to private sector health plans that cover 50 or more employees, along with state and local government plans.
When faced with an ethical dilemma, a counselor should use a typical problem-solving process with the addition of what step?
Consultation
Observation
Assessment
Evaluation
Correct answer: Consultation
When faced with ethical dilemmas, counselors can use the steps found in the problem-solving process, such as assessment and evaluation. However, consultation is particularly important when dealing with an ethical dilemma, because various viewpoints and opinions may be valuable when attempting to make a difficult decision.
In terms of treatment planning and client engagement, what does structuring mean?
Helping a client understand the nature, limits, and goals of treatment
Helping a client reorganize their time for more effectiveness
Helping a client define the treatment-planning process
Helping a client cognitively rearrange their thoughts
Correct answer: Helping a client understand the nature, limits, and goals of treatment
In terms of treatment planning and client engagement, structuring refers to helping a client understand the nature, limits, and goals of treatment by defining all these items in a way the client can understand. In addition to being good customer service, it also promotes client engagement.
The term does not refer to helping a client reorganize their schedule or their thoughts, and clients do not define the treatment-planning process.
Which of the following would be the minimal effective level of a treatment plan?
Resolving issues sufficient to warrant a less restrictive environment
Creating a roadmap to self-actualization
Enhancing well-being enough to be noticeable
Resolving issues sufficient to help a patient terminate treatment
Correct answer: Resolving issues sufficient to warrant a less restrictive environment
A treatment plan is a therapeutic outline of goals and interventions that is meant to address well-defined, specific issues in the life of a patient. Minimally speaking, a treatment plan would be one that allows a person to transition to a less restrictive environment, which would indicate concrete therapeutic progress.
Enhancing well-being to a noticeable level may not have the specificity needed. A roadmap for self-actualization may contain needed benchmarks but would be a lofty goal. Resolving issues so that a patient can terminate treatment may be desirable but is not the most minimal effective level presented here.
Which of the following is the most significant difficulty in treating personality disorders?
They tend to be unresponsive to medication
They are persistent conditions throughout a client’s life
They are factitious in character
They tend to be unresponsive to counseling interventions
Correct answer: They are persistent conditions throughout a client’s life
Personality disorders are difficult to treat in practice; they are persistent, pervasive conditions that are seen as lifelong. In other words, such a disorder impacts nearly every facet of the client’s life with maladaptive affective strategies.
Personality disorders in individual presentation may or may not be responsive to medication or counseling interventions, but they are real in the sense that the client is most likely not making up their difficulty and distress for some other motive.
Which of the following is true about individuals from non-majority cultures?
They seek out services more often and withdraw from them later
They seek out services more often but withdraw from them sooner
They seek out services less often and withdraw from them sooner
They seek out services less often and withdraw from them later
Correct answer: They seek out services less often and withdraw from them sooner
In forming treatment plans for individuals from minority cultures, particularly when they are to be treated by individuals or organizations representing the majority culture, providers must remember the tendency for individuals from these cultures to seek out services less often and withdraw from them sooner. This is likely due to a variety of factors such as trust, language differences, financial limitations, and other forms of socioeconomic stress.
What two factors influence treatment planning in addition to diagnosis?
Client specifics and medical staffing
Client specifics and counselor orientation
Client specifics and hospital orientation
Client specifics and medical acuity
Correct answer: Client specifics and counselor orientation
In arriving at treatment plans, many factors are important to consider. In addition to the diagnosis of the client, there will be an array of client specifics that must be understood and included in treatment planning, such as cultural background, age, etc. Also, the counselor’s therapeutic orientation must also be considered, as it will drive the interventions selected.
Medical staffing and the patient’s medical acuity are important factors, but they would already be considered as part of the diagnostic impression.
