TDC exam 2

Question 1

A therapist meets with a 25-year-old woman who lives at home with her parents. The client reports feeling extremely depressed, has a history of self-harm, and after a suicide assessment, the therapist determines she is at a high risk of serious self-harm. The client reports she does not have insurance and cannot afford to be hospitalized. How should the therapist address the ethical and legal issues in this case?

Answer 1

Initiate a 5150 because the client may need to be hospitalized.

Question 2

A 13-year old boy discloses a history of sexual abuse. He informs the therapist that his former therapist touched him during several sessions to demonstrate what is appropriate versus sexually inappropriate touch. What actions should the therapist take to address the legal issues in this case?

Answer 2

Report to CPS and process it with client.

Question 3

A therapist working in a community agency receives a referral for a child with severe PTSD from sexual abuse. The therapist has no training or experience treating children with PTSD from sexual abuse. The therapist should:

Answer 3

Refer the child to appropriate services.

Question 4

After referring a client to an acupuncturist for treatment the acupuncturist calls the therapist and invites him to lunch to discuss how they can work together. He tells the therapist that he is willing to pay for referrals. How should the therapist manage the legal and ethical issues in this situation?

Answer 4

Inform him that he cannot accept payment for referrals.

Question 5

A younger therapist has been treating a 60-year-old Brazilian woman for 3 months and has a particularly ground-breaking session. At the next session, she arrives with a gift, a small plant. After the therapist explains that it would be unethical to accept the gift, the woman appears insulted and quietly mumbles that she wishes to end the session and discontinue therapy. Ethically, the therapist should have:

Answer 5

Accepted the gift and discussed its significance.

Question 6

During the sixth session with a 64-year-old man he breaks down in tears while discussing his relationship with his estranged 40-year-old son. He confesses that when his son was younger the client was physically abusive to his son on a number of occasions, especially when the client had been drinking. He says that besides his wife, he’s never told this to anyone before. How should the therapist manage the legal obligations in this case?

Answer 6

Maintain confidentiality of the reported abuse and document session in his record.

Question 7

A therapist has been treating a 42 year-old, single man for five months. The client is a successful partner at a prestigious law firm. For the past month, the client has noticed improvements in his mood and his relationships with others. Around the holidays the client leaves the therapist a bottle of wine outside the office as an expression of his gratitude. What action should the therapist take to address the ethical issues in the case?

Answer 7

Determine the estimated value of the wine.

Question 8

A therapist attends a group consultation. Another therapist begins presenting a case and based on the information the therapist realizes that she is friends with the client. How should the therapist deal with the realization?

Answer 8

Excuse herself from the discussion of the client.

Question 9

A therapist at a mental health clinic meets with a single mother who recently moved back in with her mom and stepdad after losing her job. She reports that her stepdad has been threatening to kick her out of the house if she does not contribute more to the household needs. The client says that she is afraid to be around him. What should the therapist do FIRST?

Answer 9

Ask the client why she is afraid

Question 10

A long-term client comes to therapy and reports that he has been evicted and is in need of housing immediately. The therapist’s brother owns an apartment building and has an available unit he’s been struggling to rent. The therapist should:

Answer 10

Assist the client in coming up with short and long-term solutions.

Question 11

A client seeks therapy to help deal with problems with a roommate. After two sessions, the therapist realizes that the client’s roommate is a personal friend who has often confided in the therapist about difficulties with this relationship. How should the therapist address the ethical issues in this case?

Answer 11

Tell the client about the therapist’s relationship with the roommate and refer the client to another therapist

Question 12

A long-term client being treated for bipolar disorder announces her pregnancy and her intent to continue taking lithium medication despite possible negative effects to the fetus. Her psychiatrist has informed her of the consequences but agreed to continue monitoring her medication. The therapist has a negative emotional reaction to the client’s decision. Ethically, the therapist should:

Answer 12

take appropriate steps to manage countertransference.

Question 13

A client receives treatment for substance abuse by a therapist who is a recovering alcoholic. During the course of this client’s treatment, the therapist begins to experience cravings and begins to use alcohol after sessions with this client. Which of the following actions should the therapist take in order to address the ethical issues in this situation?

Answer 13

Seek alcohol treatment to address relapse.

Question 14

A woman calls a therapist at an agency and informs the therapist that her brother received therapy from another therapist in the same agency and a business relationship developed between that therapist and the client’s brother. How should the therapist manage the ethical issue in this case?

Answer 14

Confront the colleague regarding the alleged ethical violation.

Question 15

A therapist is meeting with a 16-year-old boy who reports he recently broke into his parents locked liquor cabinet when they were sleeping and got drunk. What legal responsibilities does the therapist have in this case?

Answer 15

Maintain confidentiality and assess for risk.

Question 16

A licensed therapist moves to another city in a different part of the state and relocates his private practice. What are his legal obligations in this case?

Answer 16

Notify the Board of Behavioral Sciences of his change of address within 30 days.

Question 17

A therapist lowered his fee for a client following the client losing his job. The client informs the therapist that he was able to find a new job that pays even more than his former job. The therapist would like to raise fees now that the client’s financial situation has improved. How should the therapist ethically manage the situation?

Answer 17

Reassess the change in client’s situation and raise it in an agreed about amount of time.

Question 18

A therapist has terminated with her client due to presenting issue being outside the therapist’s scope of competence. The client was provided with a referral and has a first session with the new therapist scheduled. Prior to meeting with the new therapist, the client experiences a crisis situation and contacts the old therapist. What are the therapist’s legal obligations in this case?

Answer 18

Talk with client and help address crisis since she has not started with the new therapist

Question 19

A 14-year-old girl consents to her own treatment after the therapist determined it would not be appropriate to involve parents. After several sessions, the girl tells the therapist that she would like to include her mother in treatment. How should the therapist manage the legal issue of fees?

Answer 19

Inform the client that she will continue to be responsible for fees.

Question 20

An 83-year-old man is brought to therapy by his conservator. The conservator is concerned the man is experiencing symptoms of depression and could benefit from therapy. Legally, who should sign the consent?

Answer 20

Conservator

Question 21

A therapist receives a phone call from a former client requesting access to his records. The therapist terminated with the client several months back due to lack of payment and sent the client’s information to a collection’s agency in an effort to collect the outstanding balance. Ethically, how should the therapist respond to the client’s request?

Answer 21

Inform client that he can access his records within 5 business days after therapist receives a written request

Question 22

A therapist is treating a client with a history of suicide attempts and multiple hospitalizations. During a session, the client reports a plan to take all his prescription medications at once. He refuses to contact his psychiatrist. How should the therapist legally manage this crisis?

Answer 22

Call Psychiatric Emergency Team (PET) and initiate 5150.

Question 23

A therapist has been treating a 16-year-old girl for depression and social phobia. The client recently shared that she is being bullied at school by some older girls. The following day her mother calls the therapist and reports that she thinks her daughter took some pills. What should the therapist do NEXT?

Answer 23

Direct the mother to call 911.

Question 24

During a session with a 16-year-old, a therapist learns that the client has been having strong suicidal ideation for the last week. The client has a tentative plan and access to means. What should the therapist do to manage the legal and ethical obligations in this case?

Answer 24

Inform the client that her parents must be informed.

Question 24

A therapist at a women’s shelter is asked to see a woman in crisis who has been abused by her husband. The woman enters the therapist’s office stating that she plans to return home in the morning and “just needed to spend the night somewhere else and talk to someone about this.” What action should the therapist take to manage legal obligations in this case?

Answer 24

Develop a safety plan with the woman.

Question 25

A therapist has been working with a Mexican American family to address communication problems and recent loss of the grandmother. At the beginning of a session, the mother gives the therapist an assortment of freshly baked home goods and expresses her appreciation to the therapist for continued support of the family. How should the therapist manage the ethical issues in this case?

Answer 25

Accept the gift and process the meaning of it with the family.

Question 26

A therapist is completing a psychosocial assessment with a 45-year-old woman. While asking about the client’s current stressors, the therapist learns that the client has been out of work for the past year. The client also reports that she has been emotionally and physically abused by her spouse. The therapist should FIRST help the woman to:

Answer 26

Stay safe by developing a plan of action should the abuse escalate.

Question 27

A 23-year-old female client with a diagnosis of Bipolar I informs her therapist that her father is petitioning the court to be appointed her conservator. The client does not agree with her father’s position and asks the therapist to evaluate her and testify at the court hearing on her behalf. How should the therapist address the legal issue in this case?

Answer 27

Explain the request is outside the therapist’s scope of practice.

Question 28

A client calls the therapist and requests access to her records. The therapist determines that there is no reason to withhold access. Legally, the therapist should comply with the request within which time frame?

Answer 28

5 days to inspect; 10 days for summary; 15 days for copy

Question 29

A school therapist has been meeting with a 16-year-old boy who has been experiencing academic difficulties at school. During the second meeting, the teen reports that he has been having difficulties concentrating in school due to an intimate relationship with another male classmate. The student states that he hasn’t told his parents he is gay and is afraid to do so. The teen’s parents have provided written authorization for the therapist to provide treatment to the student and recently submitted a request for a copy of his records. The therapist had made note in the record of the boy’s relationship with his classmate. What should the therapist do FIRST to manage the legal and ethical issues in this case?

Answer 29

Discuss the request with client.

Question 30

A client seeks therapy for the first time. During the initial session, the therapist learns that the client’s father committed suicide four years ago that month. The client shares that he wonders if his father did the right thing because life is so hard. The therapist should NEXT:

Answer 30

Ask if the client has thoughts of hurting himself.

Question 31

A therapist has been seeing a client diagnosed with Borderline Personality Disorder for several years. The client requests access to her therapy records to figure out “just how crazy” she is. The therapist refuses her request after determining it would be damaging to her well-being if she were to see the records. The following morning, upon arriving at the office, the therapist discovers the client has broken into the office and is rummaging through all of the client files. Legally, the therapist should:

Answer 31

Call the police immediately and notify affected clients, unless clinically advisable not to.

Question 32

A therapist is named in a professional will and after a colleague passes away suddenly the therapist inherits the colleagues clients and files. When reviewing the files of current clients, the therapist notes that the colleague did not keep records according to the standard of care as the files often did not include treatment plans or progress updates. How should the therapist proceed with these new clients?

Answer 32

Create new files for the clients.

Question 33

A couple in therapy receives notice from insurance that sessions are not covered. They ask the therapist to change the diagnosis so they can be reimbursed. How should the therapist respond?

Answer 33

Inform couple the diagnosis cannot be changed because it is illegal.

Question 34

A client is moving and requests a copy of her records. If the therapist is a HIPAA covered entity he must:

Answer 34

Release only the medical record.

Question 35

A 75-year-old man has been in counseling for five months for depression. He has developed a good relationship with the therapist and he has been making significant progress in recent months. The client lives on a fixed income and reports that his rent has increased and he does not think he can afford to continue with therapy. The therapist should initially:

Answer 35

Consider reducing session fees to accommodate his ability to pay.

Question 36

A therapist is contacted by a representative of the managed care company to conduct a utilization review. The representative requests specific details about the sexual abuse incidents the client experienced. The therapist should FIRST:

Answer 36

Review the managed care company contract prior to providing information.

Question 37

A client seeks therapy for depression. She shares with the therapist that she doesn’t have the money to pay for therapy and wants to know if the therapist will bill her under her sister’s insurance. How should the therapist proceed?

Answer 37

Deny her request and provide her with low-fee referrals.

Question 38

A therapist and a colleague share an office suite and decide to joint advertise in a local magazine. Joint advertising is:

Answer 38

Legal and Ethical as long as they notify clients as to whether they are sole practitioners or a legal partnership.

Question 39

A woman is referred by another client and is excited to learn that the therapist is on her insurance panel. She informs the therapist that she has been in therapy in the past for depression and always paid out of pocket. She states that she would like to use her insurance, but expresses concern with how much information the therapist would need to share. How should the therapist respond?

Answer 39

Inform client that the insurance company is able to audit client records at any time and encourage her to read her policy

Question 40

A therapist is developing a website to promote her private practice. It would be unethical to:

Answer 40

Collect clients’ testimonials highlighting the effectiveness of treatment.

Question 41

A 76-year-old woman comes to therapy complaining of depression and loneliness. At the end of the first session she states that she is looking forward to being in therapy since her last therapist helped alleviate her loneliness quite a bit. “He held me in his arms, caressed and kissed me during the sessions. A few times, when I asked him to, we even had sex and that helped me feel better as well.” The therapist’s best course of action is?

Answer 41

Provide the client with the brochure “Professional Therapy Never Includes Sex” and encourage the client to file a report with an ethics board.

Question 42

A client returns to therapy after four years. Legally, the therapist should first:

Answer 42

Obtain a new informed consent.

Question 43

A therapist has been treating a client for 6 months when the client states that she will be leaving town for a few months. The client asks if she can use email to keep in touch with the therapist while she is away. The therapist should FIRST:

Answer 43

Address the limits and risks of using email with the client.

Question 44

When discussing the fee with a potential new client, a therapist learns that the client recently lost her job and is living off her savings. Even after sliding the fee to the lowest amount, the client states that she only thinks she can afford four or five sessions. The therapist should:

Answer 44

Refer the client to low-fee mental health services.

Question 45

For a HIPAA transaction a therapist should use which of the following identifications?

Answer 45

National provider identifier

Question 46

A client has ignored four written requests regarding payment for services rendered from a therapist in private practice. The therapist plans to inform the client of the decision to proceed with termination for nonpayment at the next regularly scheduled session. Before proceeding with termination, the therapist should FIRST:

Answer 46

Make certain that the client fully understands the details of the payment for service agreement.

Question 47

A client seeks therapy for depression and discloses that she engages in non-suicidal cutting and has a history of sexual abuse as a child. The therapist has no experience in this area and feels uncomfortable working with the client. How should the therapist proceed?

Answer 47

Find a therapist skilled in the area to whom the client can be referred.

Question 48

A therapist meets with a single parent struggling to provide adequate housing, food, and health care for himself and his two younger children. What action should the therapist take to manage legal obligations in this case?

Answer 48

Provide client with referrals for services that meet his specific needs.

Question 49

A therapist sees a 75-year old Asian American man whose wife died six months ago. In the intake interview, the client reports that he has lost weight, has very little energy, and has difficulty getting himself to do things. What should the therapist do first:

Answer 49

Complete a suicide risk assessment of the client.

Question 50

A client is being treated for PTSD. The client is engaged and her fiancé has attended collateral sessions. She tells the therapist that she self-harms when she feels overwhelmed by emotions. The client shows up to a session with deep gashes on her arms and when confronted by the therapist, minimizes their severity. Legally, how should the therapist respond?

Answer 50

Maintain confidentiality and develop safety plan with client.

Question 51

A therapist meets with a new client who is court-mandated to attend therapy following a DUI. During the first session, the client tells the therapist he was involved in a hit and run several years back in which a person died. He tells the therapist the incident haunts him every day and he drinks to numb himself. What are therapist’s legal obligation to deal with this case?

Answer 51

Maintain confidentiality and identify treatment goals.

Question 52

A therapist works for a local mental health agency that provides therapeutic services to inmates. The therapist receives a subpoena for one of her clients who is currently serving time for physically assaulting a man who was subsequently hospitalized. What are the therapist’s legal obligations in this case?

Answer 52

Assert privilege on behalf of the client.

Question 53

A therapist works in a group practice with four other therapists. The therapist recently discovered that one of her colleagues is smoking marijuana prior to having sessions with her clients. The therapist confronts her colleague who denies the accusation. What ethical responsibilities does the therapist have in this case?

Answer 53

Consult with other therapists in the practice to determine next steps.

Question 54

A therapist is working with a 29-year-old with a history of substance abuse. The client attends a session and reports that he has been drinking again since his breakup with his long term girlfriend. He shares that he drove home drunk from a bar two times in the past week and feels really bad about it. How should the therapist ethically manage the clinical situation?

Answer 54

Discuss the need for substance abuse treatment and provide appropriate referrals.

Question 55

A 14-year-old shares with her school-based therapist that she attended a high school party over the weekend. She tears up when she adds that she only had one drink then she blacked out and woke up in the morning naked on the bed. She says that she doesn’t remember what happened and she doesn’t want her parents to find out. What are the legal obligations in this case?

Answer 55

File a child abuse report with the appropriate authorities.

Question 56

A recently retired therapist is contacted by a 22-year-old former client. The client submits a written request for the records of the treatment he received from the therapist when he was 14. How should the therapist manage the legal obligations in this case?

Answer 56

Review records to ensure nothing would be harmful to the former client.

Question 57

A 17-year-old is receiving therapy at school. He shares that he is having a lot of problems with his new 15-year-old girlfriend. He states, “sometimes she drives me so crazy, I just want to smack her. If I try to leave, she pleads for me to stay. I just don’t know how to deal with her moods.” How should the therapist manage the legal and ethical obligations in this case?

Answer 57

Maintain confidentiality and document incident in record.

Question 58

A therapist is treating a 15-year-old girl. At the onset of therapy, the client signed a release allowing the therapist to speak with her parents. Three months into treatment the client discloses that she is gay and that she has a girlfriend. That week the parents contact the therapist to find out what is happening in treatment. How should the therapist manage the ethical issues in this case?

Answer 58

Provide parents with general information about treatment.

Question 59

A therapist saw a couple in therapy for several months and is subsequently contacted by the wife who wants him to testify in court on her behalf about an unrelated matter. In this situation, legally the therapist should:

Answer 59

Testify only if both husband and wife provide written consent.

Question 60

During a couple’s therapy session, the 59-year-old wife shares that she was recently designated the conservator of her father’s finances. The client states that now that she has control of her father’s money she finally has extra money to go on “nice vacations”. The client adds that her father is “finally getting what he deserves.” Which of the following actions should the therapist take to address the legal issue involved in this case?

Answer 60

Break confidentiality and contact an adult protective services agency.

Question 61

A client initiates therapy for anxiety following a divorce. The client shares the fact that his realization that he was gay was the reason he got a divorce. The therapist is also a gay male and finds the client very attractive. Which of the following actions should the therapist take to manage the ethical obligation in this case?

Answer 61

Seek consultation to manage the attraction and monitor therapeutic boundaries.

Question 62

An unlicensed therapist would like to address ongoing personal relationship issues she believes are impacting her work with male clients. The unlicensed therapist did not like her previous therapist and is considering asking her clinical supervisor to be her therapist. Which of the following actions should the intern take to manage the ethical issue in this case?

Answer 62

Seek personal therapy from another therapist to avoid a dual relationship.

Question 63

A therapist specializes in treating young professionals with relationship issues. She receives an invitation from a long-term client to connect on a social media website that includes personal information. Which of the following actions should the therapist take to manage the ethical issue in this case?

Answer 63

Decline the invitation and discuss the importance of therapeutic boundaries.

Question 64

A therapist is currently involved in a contentious custody battle with her ex-husband and perceives her spouse as hostile and unreasonable. The therapist begins meeting weekly with a peer for consultation to prevent her frustrations from impacting therapy with her clients. A month later, a client who has been in ongoing therapy for symptoms of panic disorder and anxiety begins describing relationship difficulties that are similar to what the therapist is experiencing. Which of the following actions should the therapist take to manage the ethical issues involved in this case?

Answer 64

provide continued treatment to the client and discuss the case with the colleague to monitor own feelings

Question 65

A 44-year-old client is referred for therapy by his co-worker for complaints of problems in his marriage. The client wants to work on issues that involve only him, but mentions that he was in therapy with his partner a year ago. He wants to obtain the records from the previous therapist, but does not want his partner to know he has sought treatment alone. Which of the following actions should the therapist take in this situation?

Answer 65

Inform the client that the couple must each sign a release for previous treatment records.

Question 66

A therapist is working with a girl who is 10-years-old. The girl lives with her father and her mother is incarcerated. The mother sends a written request for the records. What is the therapist’s legal obligation in this case?

Answer 66

Send the records to mother since therapist received a written request.

Question 67

A school counselor in a high school refers one of his students to the therapist because he is concerned about the student’s behavior. His parents report that he has no friends, stays locked in his room most of the time playing video games, and that he is becoming increasingly withdrawn. They say that he is just shy, and they assure you that he doesn’t have access to a gun. When the therapist meets him, he stares at the wall and mutters that he needs to “get out of here” or he’s going to have to “kill someone at school.” How should the therapist legally manage the situation?

Answer 67

Continue assessing the client, to determine if there is a credible threat against an identifiable victim.

Question 68

A 15-year-old client tells her therapist that she has fallen in love with a 17-year old boy she met at a sleepaway camp. She says they miss each other and have been staying in touch by texting every day and talking on the phone. The client adds that they have also been sending naked pictures to each other while they talk on the phone. The client says she is very self-conscious about her body and not sure if she should be sending photos because she doesn’t want her boyfriend to think she is fat. She adds that the boyfriend told her it’s the only way he’ll feel connected to her. The therapist legally should respond by:

Answer 68

Filing a mandated report to CPS for child abuse.

Question 69

A therapist works as a mental health specialist in a prison. The therapist has completed an intake with a new inmate. The sheriff deputy requests a copy of the inmate’s records. How should the therapist manage the legal obligations in this case?

Answer 69

Obtain a release from inmate.

Question 70

A therapist is meeting with a 75-year-old man who is living in a residential facility. He appears confused as he informs the therapist that he is concerned about his living arrangements, as he is now several months behind in payments to the facility. He has a son who is in charge of his finances and does not understand what is happening with his money. What legal responsibility does the therapist have in this case?

Answer 70

Assess the client’s mental status and determine need to report elder abuse.

Question 71

A therapist is meeting with a new client who expresses concerns about the therapist taking notes during therapy sessions. The therapist relies on the note taking during the initial assessment phase. How should the therapist manage their legal and ethical obligations in this case?

Answer 71

Explore client’s concerns and collaboratively decide how to proceed.

Question 72

A therapist has been working with a couple for almost two years as they worked through issues regarding living together and also preparing to get married. The clients believe the therapist was a huge part of their success as a couple and to them staying together so she was invited to their wedding. The therapist is uncertain whether to attend the wedding. The therapist ethically should:

Answer 72

Politely decline and discuss the impact of the decision on the couple.

Question 73

A therapist is treating a 25-year-old woman for anxiety and depression. The woman reports she has frequent thoughts about suicide, but denies having a plan. Two days later, the therapist receives a frantic call from the client’s mother who is worried about the safety of her daughter. What legal obligations does the therapist have in this case?

Answer 73

Explore mother’s concerns and contact client.

Question 74

A therapist has been treating a 32-year-old woman with severe anxiety for two months. During a session the client shares that she has heard of EMDR from a friend who said that she found it very helpful. The client asks the therapist if he can provide EMDR as part of her treatment. The therapist has no training in EMDR, but agrees to incorporate it into her treatment. The therapist’s action is:

Answer 74

Illegal and unethical.