TDC exam 1

Question 1

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. The therapist should FIRST:

Answer 1

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

Question 2

Obtaining informed consent from clients is:

Answer 2

. Both legal and ethical.

Question 3

A 72-year-old elderly widower is brought for an evaluation to a clinic by his daughters, both of whom live an hour away from where he still resides in the family home. The daughters are concerned that there is “no one to look after Dad.” When they came to visit him, they found the house in complete disarray: full trashcans, sink overflowing with dirty dishes, clogged toilet, and no clean clothes. The neurological and mental status exam reveals no dementia. The man is ambulatory although a cane is recommended. The daughters want to place him in an assisted living facility, but the father is adamantly opposed and wants to stay in his home. The therapist’s course of action is to:

Answer 3

. respect the client’s right to self-determination and arrange for an in-home evaluation.

Question 4

When developing a private practice a therapist should consider all of the following to ensure continuity of care, except:

Answer 4

Providing clients with three additional referrals at onset of therapy.

Question 5

A therapist, who was formerly employed as a financial planner, now treats couples with relationship issues. Occasionally, the therapist will assist a couple he is treating with financial planning when that is one of the sources of their conflict. The therapist’s behavior is:

Answer 5

Unacceptable because it is outside his scope of practice.

Question 6

A therapist has been treating a woman for depression in private practice for four months. During an emotional session the client discloses that she was sexually molested when she was eight by her neighbor. The therapist has minimal training in treating childhood sexual abuse. The therapist should:

Answer 6

Seek consultation immediately.

Question 7

A therapist has been treating a client with Generalized Anxiety Disorder for five months. The client’s symptoms have disappeared and the client is functioning well. The therapist enjoys the sessions with the client so she has been reluctant to bring up termination. Also, the client pays full fee and the therapist is worried about losing the income. The therapist’s behavior is:

Answer 7

Unethical.

Question 8

A therapist receives a court order to testify in a hearing for a client accused of child abuse. The therapist should FIRST:

Answer 8

consult with a lawyer regarding the matter.

Question 9

A 13-year-old girl is referred by her teacher for therapy for depression. The therapist determines she is mature enough to consent for her treatment. LEGALLY the therapist should first:

Answer 9

Determine whether her parents should give consent.

Question 10

A family consisting of a mother, stepfather, 13-year-old son and 11-year-old daughter seeks family therapy after the recent marriage of the mother and stepfather. From whom should the therapist obtain informed consent?

Answer 10

A. All of them

Question 11

A new client comes to the initial therapy session in crisis. The therapist does not inform the client of the fee prior to the initial session. When the client receives the bill, she refuses to pay. In this situation, the therapist should:

Answer 11

accept client’s refusal to pay.

Question 12

A client suffering from Bipolar I Disorder commits suicide after leaving the psychiatric hospital. The client had been seeing a therapist for five months. The client’s legal representative contacts the therapist and requests access to the client’s records. How should the therapist respond?

Answer 12

Allow representative access to the records after signing a release.

Question 13

A school counselor refers a 14-year-old boy to therapy following an altercation with another student. The client reports a good relationship with his parents. The therapist should first:

Answer 13

determine how the client feels about his parents consenting to treatment.

Question 14

A private practice therapist has decided to not use insurance companies for payment to protect their clients’ confidentiality .Also in the interest of protecting client confidentiality, the therapist keeps the client records secured in a locked file cabinet and include only the dates of treatment and whether the client was “better” or “worse.” Is the therapist in compliance with professional guidelines?

Answer 14

No, because there is insufficient documentation.

Question 15

A therapist in a small rural community has decided to consult with a colleague about a client who does not seem to be progressing in therapy. As part of the consultation the therapist should:

Answer 15

Obtain a release from the client since the colleague might know him/her.

Question 16

A single father seeks the assistance of a therapist in a family service agency. In the initial session, the client asks the therapist who will have access to what he talks about in session. The therapist’s MOST appropriate response to him is:

Answer 16

Explain the agency policies and limits of confidentiality.

Question 17

A client seeks treatment for relationship issues and wants to use her insurance. After the initial assessment, the therapist determines that the client does not meet the criteria for a medical diagnosis to bill the insurance. When the therapist informs the client, the client states that she won’t be able to attend therapy if she can’t use her insurance and states that she really needs help. The therapist should:

Answer 17

Provide the client with a list of low fee providers.

Question 18

A new client in treatment reports feelings of wanting to hurt the client’s parent who was the perpetrator of domestic violence during the client’s upbringing. After the disclosure, the therapist should NEXT:

Answer 18

determine whether the client has a plan.

Question 19

During the initial therapy session with a new client, a therapist becomes aware that the client recently ended a romantic relationship with another client. It is apparent that neither of the clients is aware that the other is seeing the therapist for therapy. The therapist is unsure if providing therapy to both clients is ethical. After the therapist reviews the ethical standards, what else should the therapist do to resolve the issue?

Answer 19

consult with knowledgeable colleagues.

Question 20

What action should a therapist take when a client reports intentions to steal from a store?

Answer 20

Maintain the client’s confidentiality.

Question 21

A therapist meets with a client who has recently lost her husband. After the session, the sister telephones the therapist expressing concern about her sister’s increased drinking. How should the therapist respond?

Answer 21

Explain that information cannot be disclosed without a client’s consent.

Question 22

A patient in therapy reports that she visited her 83 year-old mother in a nursing home and that her mother had bruises on her wrists and bed sores. The patient said her mother seemed fearful and would not say how she got the bruises. The therapist should:

Answer 22

File a mandated report with the police immediately.

Question 23

A therapist is treating a self-referred 14-year-old adolescent for depression. The client’s parents are divorced and although he spends weekends with his mother, his father has sole legal custody. The client’s mother attempts to contact the therapist to find out how therapy is progressing. How should the therapist respond?

Answer 23

Refuse to speak with the client’s mother unless the son has signed a release.

Question 24

A therapist receives a call from his individual male client who is panicking after learning that he is HIV+. His girlfriend is scheduled to come in for a session but he says he does not want to tell her for fear of being abandoned. He asks his therapist not to share this information. The therapist knows the couple is trying to get pregnant. How should the therapist respond to the client’s disclosure?

Answer 24

Assure him that confidentiality will be maintained and encourage him to tell his partner.

Question 25

A therapist receives a subpoena for a client who is in the midst of a custody battle with her ex-husband. When he informs the client of the subpoena, the client says “I have nothing to hide, give them my records”. The therapist is concerned that the release of the records would be harmful to the client and her case. The therapist should next:

Answer 25

discuss concerns with client.

Question 26

Following an injury, a client becomes involved in a lawsuit and the therapist’s testimony has been requested by the client’s lawyer. The client waives privilege and tells the therapist that he would like him to testify in court. The therapist does not believe the testimony is in the client’s best interests but he insists. How should the therapist proceed?

Answer 26

Obtain a release to consult with the client’s lawyer to explain concerns.

Question 27

A therapist is treating a client 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. The therapist should FIRST:

Answer 27

assert privilege on behalf of the client.

Question 28

A 15-year-old client reports that he has been having sex with his new girlfriend. The therapist is unsure of the girlfriend’s age, but knows she is younger than the client. The therapist believes the client is too young to be having sex. How should the therapist handle the client’s disclosure?

Answer 28

Remind the client of the limits of confidentiality as it relates to sex between minors.

Question 29

A therapist learns that a patient’s mother-in-law recently disciplined her child with spanking that left red marks. The patient is very upset and doesn’t know how to approach her mother-in-law about the incident. The therapist’s initial interventions should include:

Answer 29

inform the patient that you must make a report of suspected child abuse.

Question 30

A therapist is leading a group for high school kids with truancy issues. During the group, one of the members shares that his friend emailed him naked pictures of a female classmate. The therapist should:

Answer 30

File a child abuse report immediately.

Question 31

A client wants to see his records. The therapist determines that there is high risk of detrimental consequences to the client if the client were to see the records. The therapist should:

Answer 31

Deny the request to access the records.

Question 32

A 16-year-old client informs the therapist that her past therapist touched her inappropriately in a sexual manner when processing past trauma. What should therapist do?

Answer 32

Make a child abuse report.

Question 33

A therapist in a community clinic meets with a client for the first time. The client appears wary of the therapist and asks several questions about how the information in the interview will be used. He goes on to state that he wants to tell the therapist “everything,” but is afraid of, “saying too much and getting others in trouble.” The therapist’s MOST appropriate response is to:

Answer 33

Review the client’s understanding of the limits of confidentiality.

Question 34

A female client with a history of suicide attempts comes to session and reports that she wants to end it all. After further assessment, the therapist learns that the client has a plan to take pills she has hidden at home. What should the therapist do NEXT?

Answer 34

Discuss voluntary hospitalization.

Question 35

A client who has been in treatment for five months for Major Depression recently lost her job and tells her therapist that she can no longer afford her full co-payment but wants to continue therapy. The therapist should:

Answer 35

Reduce her co-payment temporarily, but inform the insurance if that’s done.

Question 36

A therapist is working in a small rural town and is the only provider within the area. A neighbor from a nearby farm requests that her son receive counseling services. The therapist has seen the boy on several occasions in the local store, but has minimal interaction with him or his mother. How should the therapist initially respond to the request?

Answer 36

Agree to provide therapy to her son.

Question 37

A 15-year-old client comes to therapy because her parents are concerned about her new relationship with an older boy. During the sixth session the client shares that she and her 20 year-old boyfriend have started having sex. The therapist should:

Answer 37

Maintain confidentiality.

Question 38

A therapist receives an order from the court for a former client’s records. The therapist is concerned that the release of the records will cause harm to the client. The therapist advocates to the court to limit the scope of the release. The court declines the request. The therapist must:

Answer 38

provide a copy of the records immediately.

Question 39

A 53-year-old female, married for 25 years, self-refers to therapy as she has been losing weight and not sleeping. She states that her husband screams and yells when he gets very angry and has hit her in the past. How should the therapist initially respond to the client’s disclosure?

Answer 39

Refer the client to a doctor for a medical evaluation and assist the client in developing a safety plan.

Question 40

Over coffee, a neighbor tells a therapist that she saw another neighbor hit his 12-year-old child in the face. Legally, the therapist:

Answer 40

Has no obligation.

Question 41

A 78-year-old reports that she is afraid of her daughter-in-law because she keeps threatening to kick her out of the house where they live and swears at her if she wakes her up. The therapist should:

Answer 41

Explore how the daughter-in-law’s behavior is affecting the client’s mental health.

Question 42

A couple brings their 16-year old son to a therapist for a first appointment. The mother is concerned that the son has been withdrawn recently and seems depressed. The father reports that he recently found homoerotic material on his son’s computer. After the parents consent to the son’s treatment the father demands to know, “When will you be able to tell me if my son is gay?” What would be the therapist’s most appropriate response?

Answer 42

Explain the limits of confidentiality to the son and parents.

Question 43

Which of the following situations could be considered a breach of ethical conduct by a therapist:

Answer 43

inviting the client to attend a concert.

Question 44

A 69-year-old diabetic client is referred by her doctor. She recently had her leg amputated because she hasn’t been following her insulin and diet plan. The client cries in session and tells you that she is paying her daughter to take care of her but she frequently leaves on extended trips with her new boyfriend and the client has to “fend for herself”. She adds “I just can’t manage all this and I don’t see it getting better.” Which of the following actions should the therapist take first?

Answer 44

Assess client for potential suicide.

Question 45

A therapist in private practice has worked with children for several years when suddenly she loses a child of her own in a car accident. Ever since the therapist has returned from a leave she finds herself drifting off into her own thoughts and memories when working with kids. The therapist notices that she is consistently staring past the children and daydreaming about her child. Which of the following actions should the therapist take?

Answer 45

Address grief and loss issues in personal psychotherapy.

Question 46

During a session, a client makes a vague threat toward his former boss. When the therapist asks what the client means by the statement, the client ignores the question. What should the therapist do NEXT:

Answer 46

Insist on clarifying the nature of the statement.

Question 47

A couple seeks therapy to improve their communication. During an initial session, the couple reports that their arguments frequently get physical because the wife makes the husband so mad. The therapist should FIRST:

Answer 47

Refer each of them to individual therapy.

Question 48

A court-ordered client with a history of violence shares that he is really pissed off at his former boss and is “going to wait for him after work one of these days to make him pay.” When the therapist asks the client what he means by the statement, the client tells him angrily to “forget it”. How should the therapist proceed?

Answer 48

Inform the police.

Question 49

During the third session, a client discloses that he murdered someone one year ago. After clarifying the person was not a minor, the therapist should:

Answer 49

keep the client’s disclosure confidential.

Question 50

While doing an intake assessment with a 22-year-old girl, the client reports to the therapist that she recently has been feeling sad and anxious due to recent family problems. She also states that before coming to meet the therapist she took an entire bottle of Advil, saying that she wants to kill herself. The therapist should FIRST:

Answer 50

Call 911 immediately.

Question 51

Which of the following situations would constitute an unethical dual relationship?


Answer 51

A therapist continues to receive services from a massage therapist who became a client after having provided services for the therapist.

Question 52

A 27-year-old male with a history of hospitalizations for bipolar and alcohol abuse recently stopped taking his medication, became manic, and resumed drinking. At his landlord’s request, the police took him to the hospital and arranged an involuntary admission to the acute psychiatric unit. The client has all of the following rights except the right to:

Answer 52

Leave the hospital when he chooses.

Question 53

A couple brings their adult son to meet with his therapist. The son is diagnosed with schizophrenia and lives with them. The couple reports that the previous night the son assaulted the father and now they are afraid of him. They are not sure he is taking his medication. In the interview, the therapist finds that the client is psychotic, agitated, and unwilling to be hospitalized. What should the therapist do first?

Answer 53

Work toward emergency psychiatric commitment.

Question 54

A sixteen-year-old girl seeks treatment. She was referred by her school because her grades have been dropping and she falls asleep in class. She shares that her mom’s boyfriend recently moved in with them and she doesn’t like him. You notice bruising on her wrists. She doesn’t want her mom to find out she’s talking to you. At this point, legally you should:

Answer 54

Ask how she got the bruises on her wrists.

Question 55

A therapist has been seeing a client with a history of depression for over a year. The client reports feeling bad and having suicidal ideation, but denies having a plan and promises not to take any action on those feelings. The therapist still feels concerned about the client. How should the therapist respond?

Answer 55

Suggest making contact between sessions.

Question 56

A client comes to therapy on the advice of her sister. She shares that she is unhappy in her current relationship but is afraid to leave. She states that her boyfriend is very jealous and gets physically aggressive when she makes him angry. She adds that he is also very loving most of the time and can’t imagine not being with him. The therapist should FIRST:

Answer 56

acknowledge her ambivalence.

Question 57

A therapist in an outpatient setting is treating a woman diagnosed with a psychotic disorder but with no history of violence. During a session, the woman presents as delusional and paranoid. She tells the therapist that she is convinced that her husband is going to kill her. The client then becomes increasingly agitated, tells the therapist that she is going to kill her husband before he can kill her, and runs out of the office. What is the best course of action for the therapist?

Answer 57

Call the police and warn them of the client’s statement and behavior.

Question 58

A client is admitted to an emergency room with a broken jaw. She claims that she fell down the stairs and doesn’t want to talk about it. Her boyfriend shows up an hour later, brings her flowers, and then leaves for work. After completing the initial assessment, the therapist should:

Answer 58

Provide the client a referral to domestic violence shelter.

Question 59

A 17 year-old girl informs you that she was recently raped by her 21-year-old neighbor and is worried she may be pregnant but does not want her parents to find out. What legal obligations does the therapist have?

Answer 59

Report child abuse.

Question 60

A therapist would be in violation of California law regarding record keeping if the therapist:

Answer 60

Backdated therapy sessions when they received a request for records.

Question 61

All of the following items are required by law to be included in a summary of records EXCEPT:

Answer 61

Informed consent for treatment.

Question 62

A therapist with a part time private practice is subletting an office from another therapist. There is no room for an additional file cabinet in the office. The therapist’s legal obligation is?

Answer 62

Secure a locked file cabinet elsewhere with clients’ files.

Question 63

A therapist has recently discovered that a colleague at the same agency has developed a platonic outside relationship with a client’s spouse while providing couples therapy for them. The therapist’s FIRST action should be to:

Answer 63

Meet with the colleague to address the ethical violation.

Question 64

A therapist in private practice decides to start accepting health insurance. She invests in an electronic system that bills the insurance electronically. In order to do this legally she must:

Answer 64

comply with HIPAA requirements.

Question 65

A therapist is enrolled in a training to advance his skills in couples counseling. As part of the training, the therapist will be recording several sessions with a couple and sharing it with a consulting therapist. What should the therapist do before recording sessions?

Answer 65

Explain purpose of recording, discuss who will have access to recording, obtain written consent.

Question 66

A client diagnosed with generalized anxiety disorder who is currently stabilized on medication seeks therapy for relationship issues. The client’s managed care company considers treatment for this diagnosis medically unnecessary and denies the claim. The therapist disagrees with the company’s decision. Which of the following actions should the therapist take in this situation?

Answer 66

Appeal the managed care company’s decision.

Question 67

A therapist at a mental health clinic was recently assigned to work with a client who has severe Anorexia Nervosa. The therapist does not have experience working with this type of client and is not knowledgeable in the treatment of eating disorders to provide appropriate services. What should the therapist do in this situation?

Answer 67

Employ the use of supervision with someone who specializes in treating eating disorders.

Question 68

A therapist is seeing a client with Major Depressive Disorder whose insurance allows for weekly counseling services for a maximum of three months. After working with a client for two and a half months and developing a strong rapport with the client, the therapist realizes the client is approaching the maximum allotted sessions and has located appropriate alternative resources. The client reports that he would like to continue therapy with the current therapist and does not feel comfortable meeting with someone new. Ethically, what should the therapist do next?

Answer 68

Appeal to the insurance company to allow for more sessions.

Question 69

During a utilization review phone call, a therapist in private practice is informed that one of her clients who has a diagnosis of PTSD is only authorized for two more sessions. The therapist disagrees and asserts that the client needs 10 more sessions in order to be sufficiently able to deal with the demands of everyday life. However, the utilization review agent maintains that insurance will not pay for more than 2 sessions. The therapist knows that the client is unemployed and will be unable to pay without insurance. The therapist should:

Answer 69

Continue to see the client and explore an alternative payment plan.

Question 70

The purpose of laws and regulations pertaining to psychotherapy advertising is to ensure:

Answer 70

The public is well-informed and not misled.

Question 71

A therapist starting a new practice would like to advertise in her community. What are potential ethical concerns?

Answer 71

There are no ethical concerns.

Question 72

A gay couple comes in to see you for the first session. They state that they have been referred by one of the partner’s individual therapist. The referring therapist told them that you have extensive experience in working with gay couples. In actuality, you have treated a good number of heterosexual couples, but have seen only a few gay couples. As their therapist you should:

Answer 72

Correct the inaccurate information with both the couple and the referring therapist without divulging your client’s identity.

Question 73

A therapist has been providing therapy for an 85-year-old client who is terminally ill. During the most recent session, the client reports that he doesn’t see a point in “prolonging the inevitable” and that he has plans on committing suicide in the near future. A safety contract is created with the client; however, the therapist still feels uncertain as to how to proceed with the case. What is the BEST course of action for the therapist to take?

Answer 73

Seek out consultation to discuss the need for ensuring the client’s safety and recognize the importance of the client’s right to make his own decisions.

Question 74

A therapist sees a new client for severe anxiety and panic attacks. The client is a recent immigrant from Asia and has difficulty understanding and speaking English. What should the therapist do first?

Answer 74

Determine the client’s specific language.

Question 75

A therapist sees a 16-year-old and her mother because of increased anger, family conflict, and defiance at home. The mother reveals that the teenager was sexually abused at an early age, and has never talked about this with anyone. How should the therapist handle the disclosure:

Answer 75

inform the family that the therapist must file a child abuse report.