Mock 2 Sample Questions Review

A 17-year-old client is brought to therapy by her parents who consented to treatment. During the intake session the client shares that she is questioning her sexuality but does not feel ready to tell her parents. The client looks nervously at the therapist and asks if what she shares in therapy will be shared with her parents. What action should the therapist take to clinically manage the issue of confidentiality? A. Explore her concerns and review what information may or may not be shared. B. Assure her that information she shares in therapy is considered confidential and will not be disclosed. C. Encourage client to share the information with parents since they consented to treatment and can request access to records. D. Explore the pros and cons of the client sharing the information with her parents.

A

A 21-year-old woman seeks treatment for anxiety at a community agency. She brings her 18-month-old daughter with her to the session. The woman becomes angry with her daughter when she pulls things off the desk and shelf. The woman becomes frustrated and says "she never listens, she's such a bad girl." What should the therapist do NEXT? A. Acknowledge the client's frustration with her daughter. B. Request client find childcare for next session so they can focus on her anxiety. C. Normalize the child's age appropriate behavior. D. Explore client's early childhood history.

A

A 24-year-old Asian-American client reports feeling desperate since her partner of two years broke up with her a month ago. She states that her depression ruins all of her relationships and she is sure she is never going to find anyone who will want to be with her. The client denies any suicidal ideation. How would a Psychodynamic therapist proceed with the assessment in this case? A. Ask for details about the nature of her relationship difficulties with her partner and other people. B. Explore her early childhood history to identify patterns in her behavior. C. Clarify the client's understanding of the reason she and her boyfriend broke up. D. Monitor the therapist's feelings and reactions toward the client.

A

A 24-year-old client diagnosed with schizophrenia has been given a prescription for medication by a psychiatrist. The client has stopped the medication, complaining of unpleasant side effects. The therapist does not notice any improvement in the client's affect, mood, or cognitions. Which of the following actions should the therapist take? A. Refer the client back to the psychiatrist. B. Contact the client's psychiatrist to report client's noncompliance with medication. C. Explain that the client cannot be seen unless the client is taking the prescribed medication. D. Continue to work with the client since the absence of medication appears not to have had a negative effect.

A

A 26-year-old woman seeks therapy to address her fears of getting married. The client shares tearfully that she worked as a prostitute in college to help pay for her tuition. She adds that her fiancé thinks she worked as a stripper but he doesn't know about the prostitution. She doesn't want to tell him, but she feels bad keeping it from him. During the fourth session she reports feeling guilt about her past. How would a Client-Centered therapist respond in the middle phase of treatment? A. Express appreciation of her struggle to accept that aspect of herself, highlighting the fact that she did eventually choose to leave it. B. Facilitate a discussion about the pros and cons of sharing her past with her fiancé. C. Engage in reflective listening conveying unconditional positive regard for her feelings of guilt. D. Normalize client's fears of sharing her past with her fiancé and role play the discussion with fiancé.

A

A 32-year-old woman who has been in treatment for five months goes through a major crisis and calls the therapist many times during that period. After the crisis passes, the client continues to call the therapist excessively. The therapist should: A. Track the number of calls and confront the client. B. Tell the client that you will only accept a certain number of calls. C. Inform the client you will start billing them for phone calls. D. Recommend the client meets with you more frequently because it is clear he needs higher level of care.

A

A 42-year-old client seeks therapy after losing his job as a sales manager three months ago. His wife has been supportive, but he can tell she is very stressed because they rely on his income and won't be able to afford their mortgage. He shares that he is distraught and doesn't know how to deal with something like this. After ruling out risk of suicide what intervention would a Solution-Focused therapist consider? A. Find out how the client has been coping with the loss. B. Assess client's history of mood disorders. C. Find out what the client's support network is like. D. Determine how the client has coped with loss in the past.

A

A 46-year-old single woman seeks therapy for relationship issues and low self-esteem. She works as a clerk at a law firm and reports that her boss was initially nice, then "something switched and now he's just a slave driver." She shares that she's been dating a guy who is pretty distant and she worries, "he's too laid back." She reports that she finds herself second-guessing herself and criticizing her interactions with others. In formulating a treatment plan, what would the primary goal of an Object Relations therapist be in the case provided? A. Helping her to develop the capacity for a more balanced, integrated view of self and others. B. Helping client to understand the role of her family-of-origin in her current functioning. C. Helping client to understand her transference to the therapist and applying that to relationships in the world. D. Helping client to learn how to challenge her underlying beliefs of the world that she introjected from her family of origin.

A

A 9-year old boy has been referred for therapy by his teacher. The teacher noted that the boy is often disruptive and distracted in class, which interferes with his learning. In the initial session, the client often loses his train of thought when talking about his hobbies. In addition to talking to his parents, what else should be included in assessing this client during the initial phase of treatment? A. Refer to school's special education department for an evaluation; Request a medical evaluation; Obtain a release of information to talk to the client's teacher. b. Complete an ADHD symptom checklist; Request a medical evaluation; Refer parent to an ADHD family support group. I C. Bring in the family to discuss coping strategies for the client; Refer to school's special education department for evaluation; create a behavior chart for the client to use during school. D. Obtain a release of information to coordinate treatment with teacher; Refer for a neuropsychological evaluation; Administer the Beck Depression Inventory.

A

A lesbian couple, Karla, age 40 and Felicia, age 38, seek therapy for parenting issues. They have two adopted children, Jane, 5 and Lila, 7. Felicia reports that Karla "blows her top" when the kids don't listen and it makes everything worse. Karla replies, "They aren't going to learn how to behave if you just let them do whatever they want." Turning to the therapist she adds, "You agree, right? They need firm discipline." At the end of the session, Felicia ask, "You can bill our insurance for this right?" What ethical obligations does the therapist have based on the case presented in the vignette? A. Manage the fees; Explore clients' expectations of therapy; Inform clients of the limits of confidentiality B. Disclose fees; Provide clients with information about the therapist's background; Inform clients of the limits of confidentiality C. Manage issues of countertransference that may arise; Discuss risks and benefits of treatment; Obtain signed informed consent for treatment D. Maintain a no secrets policy; Set fee prior to the first session; Inform clients of the limits of confidentiality

A

A therapist at a charter school leads a group for pregnant adolescents with the purpose of developing the members' coping skills and decision-making capabilities. The group has met weekly for three months with minimal gains. To facilitate growth in independence, the therapist should: A. Give the group members control over as many decisions as possible. B. Encourage the members to make decisions within school guidelines. C. Educate the members regarding assertiveness techniques. D. Assign clear roles to each of the group members.

A

A therapist has been seeing a husband and wife for just over a year to address intimacy and trust issues following an affair. Between sessions, the wife calls the therapist because she tested positive for HIV . She tells the therapist, "I can't tell my husband, he's finally starting to trust me again and this will ruin it all. Please don't tell him." What action should the therapist take? A. Assure her that confidentiality will be maintained and continue to explore her concerns about sharing her HIV status. B. Inform her that it would be clinically unadvisable to continue seeing them unless she is willing to disclose her HIV status to the husband. C. Encourage her to tell the husband and continue to explore her fears. D. Remind her of the "no secrets" policy and encourage her to tell the husband.

A

A therapist has seen a lesbian couple for two sessions. Eloise is a 50-year-old Caucasian woman with a history of alcohol abuse. She is 10 years sober, attends AA meetings regularly and is a sponsor to others in recovery. Jenny, a 30-year-old African-American, met Eloise in AA. Jenny also has a history of alcohol abuse. She states she is four years sober, but doesn't continue attending the meetings. The couple reports frequent loud, angry arguments, but no physical fights. Following the second session the therapist gets a distraught phone call from Eloise saying that she has found a bottle of vodka among Jenny's things. She says she is afraid to confront Jenny about it and doesn't want the therapist to mention her discovery yet. How should the therapist clinically manage this situation? A. Ask Eloise why she is afraid to confront Jenny. B. Tell Eloise that the therapist will hold the secret for a short period of time, but will eventually want this brought into their work. C. Remind Eloise of the "No-secrets" policy and ask that she bring this issue to the next session. D. Offer an individual session to Eloise.

A

A therapist receives a call from a 34-year-old woman who has been in treatment for two months. She has just been raped by her ex-boyfriend who broke into her apartment while she was sleeping. He left her alone in her apartment and threatened to come back. What should the therapist do first? A. Instruct her to file a police report and go to the emergency room. B. Help her create a safety plan and file a police report on her behalf. C. Encourage her to file a police report and assess her current safety. D. Suggest that she goes to the emergency room and file a police report on her behalf.

A

A therapist sees a 60-year-old man who reports feeling irritable and unhappy in his 35-year marriage. The man also describes loss of interest in his longtime hobbies, and trouble sleeping. Six months ago he had a serious heart attack and is currently on disability after working all his adult life. The therapist should first: A. Determine when the client's problems first began. B. Refer the client for psychiatric evaluation. C. Obtain a signed release to consult with client's doctor. D. Determine if the client is open to couples therapy.

A

A therapist working in a hospital setting is asked to evaluate an elderly man who was admitted to urgent care after a neighbor called 911 because he appeared to be hallucinating and they were concerned for his safety. When the therapist initially meets with the man, he is agitated and is talking incoherently to himself. What initial action should the therapist take when working with this client? A. Conduct a mental status exam with the client to evaluate the severity of his hallucinations and level of risk. B. Attempt to contact the man's relatives or other emergency contacts to gather additional background information. C. Initiate a 5150 because he appears to be actively hallucinating. D. Engage the client to understand the content of his hallucinations and evaluate whether or not they are dangerous.

A

An 36-year-old Ethiopian woman seeks therapy for marital issues. She is a professor at a local university. She reports that she and her husband have been fighting about having children and her career. She states that he doesn't understand her history and why working is so important to her. She mentions that she misses her family but cannot afford to fly to visit them. In order to ensure a culturally competent evaluation, what should the therapist explore? A. Client's immigration status; Immigration story; Connections with her country of origin B. Client's professional goals; Immigration story; Connections with her country of origin C. Client's social support network; Client's professional goals; Connections with her country of origin D. Client's expectations of treatment; Immigration story; Connections with her country of origin

A

Brian, age 38, and his wife Melody, age 35, come in with their two children, Mark, age 9, and Sara, age 6. Their insurance panel referred them after Melody's doctor encouraged them to get therapy. Melody was diagnosed with cancer three years ago and recently found out that it has come back in several areas in her body. Brian, an Army officer, says, "We'll fight it like we did last time. We're fine." Melody cries and says, "I am worried about my kids. Brian is deployed a lot and I worry about who will take care of them if something happens to me. He doesn't want to deal with reality." Sara looks at her mom with concern, starts crying, and says, "I'll take care of you mommy." Mark stares at the floor, motionless. Brian asks about fees because of all the medical expenses. How would a Systems therapist treat this family in the middle stage of therapy? A. Explore their patterns of interaction when they are dealing with stressful issues and assist the family in identifying supports outside of the immediate family. B. Rearrange the family members in the room to encourage expression of feelings and explore how their families of origin coped with illness and loss. C. Maintain healthy boundaries regarding the discussion of grief and model effective communication and utilize role playing in session. D. Facilitate a discussion with all family members about plans in the event of Melody's death and explore how their families of origin coped with illness and loss.

A

Chad, an 18-year-old male diagnosed with Bipolar Disorder II has been attending therapy since he was 15, when his parents consented to his treatment. The therapist received a distressed message from the client's parents requesting to speak with the therapist about recent details discussed in therapy. His parents are frantic because they have been unable to reach him for three days. The therapist shares in the parents' concerns for his safety because of his behavior during the last session. Chad presented as depressed and spoke of "drinking until he passed out." The therapist also recalls Chad mentioning a desire to get on a bus to go visit a friend to "get away from the drama." Legally, what actions should the therapist take to respond to the parents' request for information? A. Contact the parents to express shared concerns for client's safety and share knowledge of his plan to visit a friend. B. Inform the parents that information disclosed in session can only be shared if client signs a release. C. Attempt to reach client's emergency contacts to determine the whereabouts of the client and ensure his safety. D. Maintain the client's confidentiality since he is now considered an adult.

A

Ida, a 23-year-old college student comes to therapy at the recommendation of her sister. Ida is 6 weeks pregnant and has decided to terminate her pregnancy since she is unable to care for a child at this time. She is somewhat anxious about the procedure, but she is mostly concerned with the response she is going to get from her religious community. "I know everybody is going to condemn me. I grew up in this church and now I will lose my community forever. That is the hardest part to make peace with." How would a Cognitive Behavioral therapist incorporate Ida's religious beliefs into the treatment plan based on the case presented in the vignette? A. Explore Ida's thoughts about her faith and religious values with an accepting attitude; inquire about other possible ways her faith might view this situation; identify the ways in which her faith affects what she thinks of herself and her future. B. Explore Ida's thoughts about her faith and religious values with an accepting attitude; consult with her minister to better understand her faith; enable Ida to challenge distorted thinking by discussing alternate religious beliefs with her. C. Explore Ida's thoughts about her faith and religious values with an accepting attitude; present the other ways her faith would view this situation; encourage Ida to increase her involvement in her church. D. Recommend that the client considers other religious communities that are more accepting; clarify Ida's thoughts and feelings; identify the ways in which her faith affects what she thinks of herself and her future.

A

Mark is a 35 year-old, single, gay male. He is referred to therapy by his roommate. He reports that he feels on edge and uneasy and often participates in self-destructive behaviors. Furthermore, he reports that his thoughts represent "catastrophic tendencies." When developing a treatment plan, what initial interventions would a Satir/Communications therapist utilize after rapport has been established? A. Conduct a family life chronology; Explore effects of social messages about homosexuality; Assess Marks verbal and non-verbal communication patterns and survival stance. B. Invite Mark to sculpt himself in relation to others; Transform Mark's family rules into guidelines; Use metaphors to facilitate communication and emotional expression. C. Conduct a family life chronology; Identify emotional triangles in family-of-origin; Model communication using "I" statements. D. Invite Mark to sculpt himself in relation to others; Explore effects of social messages about homosexuality; Use metaphors to facilitate communication and emotional expression.

A

Martha is a 65-year-old single librarian who was recently hospitalized for congestive heart failure. She is referred by her physician due to excessive crying, insomnia, and irritability. Martha complains of waking up at night in a cold sweat and having chest pain. She states, "I feel very alone and worry about my health and having to retire. I don't know where I will get the money to live on or to pay for medical insurance if I get sick again. I am too old, and it is just too difficult to go on." Martha's hair is uncombed and her clothes appear rumpled. Which of the following factors presented in the case in require immediate assessment in order to evaluate risk? A. Pre-morbid coping skills; Mental status; Suicide potential B. Mental status; Medical history; Suicide potential C. Psychiatric history; Lack of social support; Elder neglect D. Psychiatric history; Suicide potential; Lack of social support

A

Melissa, a 34-year-old Caucasian woman, is court-referred to family therapy with her two children, Kendra, age 11, and Sam, age 6, whose clothes are slightly worn and soiled. Melissa says she is currently in a "nasty custody battle" with her ex-husband, whom she describes as "mean, vindictive, and stubborn." Melissa tears up as she reports, "He refuses to pay any child support. I can barely pay the bills, but I don't have the energy to get a job." During a separate interview with the children, Kendra complains, "I hate her! She won't let us see Daddy anymore. All she does is sit around smoking and watching TV or sleeping all day. I don't think she even cares about us." Sam begins to cry. How would a Narrative therapist incorporate the issue of Melissa's depression into the middle phase of treatment based on the case described in the vignette? A. Identify how the depression has affected Melissa and her family; Help the clients state their preferences regarding future effects of the depression B. Have family members express their authentic reactions about her depression; Restructure family system to exclude depression C. Encourage the clients to write letters to the depression; Identify how Melissa being depressed affects the family D. Map out family's strengths; Have family members express their authentic reactions to her depression

A

Sara, a 15-year-old girl, is brought to therapy by her foster mom, Vanessa. Sara was removed from home when she was 6 years old following a violent incident that took place with her mother who has a diagnosis of Schizophrenia disorder. Her mother thought Sara was the devil and tried to strangle her. A neighbor heard Sara screaming and came to help. She has been in the foster care system ever since. Her foster mom Vanessa stated that Sara has run away from home a number of times and was found prostituting herself on the streets. Sara is currently on probation. As part of the court case, Sara was court mandated to attend therapy for 15 sessions. Who has the right to authorize counseling for this client and who is the holder of privilege in this case? A. The 15-year-old client and/or the judge can authorize treatment and she is the holder of privilege. B. The 15-year-old client can sign her own consent to treatment and she is the holder of privilege. C. The 15-year-old client and her biological mother are able to authorize counseling and the court of the holder of privilege. D. The 15-year-old client and her probation officer can sign a consent to treat this minor and the court of the holder of privilege.

A

A 16-year-old boy is brought into therapy by his parents who are concerned with his recent acting-out behaviors. His parents report that over the past year, he has been spending time with the wrong crowd and his grades have fallen. In the first session with the therapist, the boy states that he does not want to be there and wishes his parents would just "get off his back." He expresses his belief that he is behaving like a normal teenager and his parents keep making big deals out of little things. He tells the therapist he has been in therapy in the past and did not like his therapists, stating, "My parents are the ones who should be in therapy. They're the ones who are constantly upset." How would a Cognitive Behavioral therapist initially address the client's resistance to therapy in the early stages of treatment? A. Acknowledge the boy's resistance to being in therapy and discuss how therapy could be different. B. Explore how past therapists disappointed him. C. Encourage the family to begin family therapy to address the relationship problems between the son and parents. D. Provide psychoeducation regarding CBT and what to expect from treatment.

B

A 23-year-old Caucasian client with a history of crystal methamphetamine addiction is court-ordered for therapy as part of his terms of probation. While reviewing the informed consent the therapist explores the client's expectations of therapy. The client states defiantly, "Hey, I have to be here so I'll be here but I know this isn't going to do anything good." What approaches should the therapist utilize in the initial phase of treatment in order to enhance the client's motivation for treatment? A. Provide information about the value of therapy and the therapist's background. B. Focus on the client's strengths and respect the client's autonomy. C. Confront the client's negative attitude and remind the client you must report to the probation officer their level of engagement. D. Explore the client's past experience with therapy and his history of trauma.

B

A 28 year-old woman is referred by her medical doctor after he ruled out a medical condition as a cause for her insomnia. The client reports that she rarely leaves her apartment, smokes marijuana to take the edge off, and finds herself continually checking the locks on her door and windows. Upon further assessment, the therapist learns that the client recently relocated to California, escaping a violent relationship she had with a woman for two years. How would a therapist utilizing trauma informed care proceed: A. Obtain a detailed account of the past abuse and client's social supports. B. Provide psychoeducation on common symptoms of trauma and ask client to list the positive and negative consequences of each of her symptoms. C. Provide psychoeducation on the cycle of violence and refer the client to a domestic violence support group. D. Explore client's understanding of her symptoms and refer to a psychiatrist for a medication evaluation.

B

A 28-year-old client is referred by her Employee Assistance Program for interpersonal issues at work. After the first session, the client begins arriving early for sessions, dressing more stylishly and asking questions about the therapist's personal life. How should the therapist clinically manage this situation? A. Share observation with the client and remind the client of the treatment goals. B. Share observation with the client and explore the significance with her. C. Confront client's behaviors and advise her that these behaviors are inappropriate. D. Interpret client's behavior as attraction to the therapist and consult with colleague regarding countertransference.

B

A 32-year-old client is referred by his EAP for missing work as a computer programmer. The client shares that he no longer likes his job but doesn't know what he wants to do with his life. During the 2nd session, the client shares that his boss wants to know what they are talking about in therapy. How should the therapist address this issue? A. Discuss the benefits of being open with his boss. B. Explore client's reaction to boss's request. C. Inform the client that the boss's request is inappropriate. D. Tell the client his boss has a right to the information because the EAP is paying.

B

A 35-year-old man is referred to therapy by his wife. He reports that he drinks on a daily basis to help him cope with his job as a product manager. He shares that his wife is tired of his drinking and so is he. He adds that his father was an alcoholic so it's no surprise that he is one too. What question would a Narrative therapist ask during the initial phase of treatment? A. "How long have you been an alcoholic?" B. "Have there been times when you did not use alcohol to cope?" C. "What story do you tell yourself about your drinking?" D. "What would your life be like if you didn't have a drinking problem?"

B

A 55-year-old man presents for treatment six weeks after the death of his dog. Prior to this incident, he worked full time and enjoyed many hobbies. Since then, he has started missing work and isolating himself, stating that he misses his "best friend" and feels he doesn't have a reason to get up anymore. What initial interventions should the therapist consider? A. Refer to psychiatrist for a medication evaluation; Assess for suicidal ideation; Refer to grief support group. B. Assess for suicidal ideation; Provide psychoeducation on grief process; Identify coping strategies and social support. C. Assess for suicidal ideation; Provide psychoeducation on cycle of grief; Refer to grief support group. D. Refer to psychiatrist for a medication evaluation; Refer to grief support group; Identify coping strategies and social support.

B

A 72-year-old wheelchair-bound man is referred by his doctor who is concerned he is exhibiting signs of depression. The man shares that he recently had back surgery to address chronic pain and has been reliant upon the wheelchair to get around for over a year. He expresses doubt that the surgery will help and frustration with his children for not providing the care he depends on and that they promised him. The client cries in session and tells the therapist, "I'm just so tired of it all. I am done fighting." What actions should the therapist take to clinically manage the legal issues in this case? A. Get a release to speak to the man's children and assess for possible neglect. B. Assess client for potential self harm and possible elder abuse. C. Get a release to consult with the doctor about his treatment and process the need to file a report with Adult Protective services. D. Assess for suicide and obtain a release before speaking with his children.

B

A couple brings their 11-year-old child to therapy stating the child is withdrawn and has trouble sleeping. The child has had several recurring health problems. The mother states she had a difficult pregnancy and delivered early. In addition, the family has moved five times since the child was born. Which of the following diagnostic conclusions should the therapist make based on this assessment information? A. The symptoms are a sign of anxiety resulting from internal family conflicts. B. The symptoms are a sign of anxiety resulting from environmental influences. C. The symptoms are a sign of depression resulting from a genetic predisposition. D. The symptoms are a sign of depression resulting from intergenerational family dynamics.

B

A couple is referred for therapy by the wife's individual therapist. In the initial session the husband states that he doesn't want to be there and is only attending because his wife gave him an ultimatum. How should the therapist proceed? A. Normalize husband's reaction and provide him psychoeducation on risks and benefits of therapy. B. Explore the husband's feelings about the ultimatum and what they both would like to achieve in therapy. C. Obtain a release to speak with the wife's therapist and discuss what they hope to achieve in couples therapy. D. Ask the wife why she thinks they need couples therapy and provide them psychoeducation on the risks and benefits of therapy.

B

A couple married for 30 years seeks help at a community clinic. The husband describes his wife's emotional behavior as erratic. He comments on a radical change in her appearance and dress, which is contrary to their religious beliefs. The wife talks openly and happily about spending more time outside the home with her friends, revisiting old hobbies, and her desire to work for the first time. The therapist should assess the couple for evidence of: A. Problems with communication and relational satisfaction. B. Issues related to family transition and individual life stages. C. Difficulties with aging process and midlife crisis. D. Psychiatric issues and emotional health.

B

A couple, Jim, age 36, and Marco, age 29, presents with a history of conflict. They accuse each other of behaving like their respective parents. Which of the following interventions would the therapist use to help the couple understand the impact of their parents on their present situation? A. Create an enactment of one of their arguments. B. Construct a genogram of at least two generations. C. Reframe their conflict as each attempting to control the other. D. Interpret their conflict as an expression of abandonment anxiety.

B

A licensed therapist employs an intern in his private practice. During a supervision session, the intern discloses that she has engaged in a sexual relationship with one of her adult clients. She tears up and says, "I know it was wrong. I ended it. It won't happen again." The intern is still treating the client. How should the supervisor clinically handle the situation? A. Terminate the supervisory relationship. B. Provide the client with the BBS brochure and facilitate termination. C. Report the incident to the BBS. D. Direct the intern to provide the client with the BBS brochure.

B

A married mother of two young children is referred to a therapist by her employer for an inability to maintain expected standards at work. The initial assessment reveals that the client has recently experienced the sudden death of her younger sister who was a single mother of two young children. The children are now in the client's care. The client's mother and one brother are in prison. The client's husband is employed, but they need her paycheck to make ends meet. How would a Strategic Family therapist approach this case? A. Explore her coping skills and social supports. B. Provide clear directives to help change symptomatic behaviors. C. Invite the whole family for the next session and to assess attachment dynamics. D. Collaborate in problem solving around her most pressing needs.

B

A parent brings a four-year-old child to a family services agency because the child is having bad dreams of being chased by a giant and a tiger and has nightmares of running in terror. How would a Narrative therapist further assess the situation? A. Ask the child to tell a story about the fantasies and nightmares. B. Ask how the "Dream Intruders" have been affecting the child and the family. C. Refer the child for play therapy. D. Determine when the child's problems began and how parents are responding.

B

A recently married couple seeks family therapy for frustrations related to parenting their blended family. During the initial session the wife's children sit with her on one couch, and the husband's children sit with him on the other couch. The parents acknowledge that they have very different parenting styles. While they are speaking the kids watch the teenagers phone. How would a Systems therapist proceed with treatment? A. Map the family structure and discuss its impact. B. Vividly describe the family's pattern of relating as it occurs in session. C. Identify how the parents are creating the problem. D. Join the family by sitting in between the two couches.

B

A therapist is asked by a lawyer to evaluate his client for a diagnosis of major depressive disorder. The therapist conducts a full assessment and determines the client does not meet the requirements for major depressive disorder. However, the therapist finds the client's symptoms do meet the criteria for generalized anxiety disorder. What information should the therapist disclose to the client's lawyer? A. Inform the lawyer that the client does not meet the criteria for a diagnosis of major depressive disorder. B. Inform the client of the diagnosis and have the client relay the information to the lawyer to avoid breaking confidentiality. C. Inform the lawyer the client's symptoms do not meet the criteria for major depressive disorder, but meet criteria for a diagnosis of generalized anxiety disorder. D. Inform the lawyer the client's symptoms do not meet the criteria for major depressive disorder, but acknowledge the client likely met the criteria for it in the past.

B

A therapist meets with an adolescent who frequently misses school and is having academic problems. Psychological testing found the client is above average in intelligence, but has poor impulse control and is at high risk for antisocial behaviors. The therapist completes the social history to: A. Explain the client's developmental progress. B. Understand factors that affect the client's behavior. C. Identify client's social support system. D. Assess current coping mechanisms.

B

A therapist starts a process group for adults with relationship issues. After several sessions into group therapy, the members started to have conflict with each other. What is the clinical significance of the conflict? A. The therapist did not thoroughly screen clients. B. They are more comfortable and internal issue are emerging. C. They are putting their guard down and becoming expressive. D. The therapist has lost control of the group dynamic.

B

Arthur, a 21-year-old male, is referred to therapy at a local low fee clinic by his rehab counselor. He shares that he has been living on the streets for the past six months. He appears fatigued, disheveled and reports having difficulties with sleeping and eating. Which of the following factors is key to the initial evaluation? A. Family relationships and support systems. B. Health status and ability to provide basic care. C. Social isolation and interpersonal functioning. D. Financial status and ability to access resources.

B

Brenda, an 81-year-old woman, is referred by her doctor. She has heart and kidney problems, has started losing her vision, and can no longer see the TV or play cards. She arrives with her 52 year-old-son who says he is concerned about his mother's behavior since his dad died seven months ago. He says he has found her talking to his father through his picture, and that she has been refusing meals. She starts crying and shares that she can still feel the father's presence and that he comes and kisses her every night and whispers "join me." At this point, her son responds loudly, "Mom, you cannot leave and join dad now. You need to take care of yourself. I need you right now and your grandchildren need you here." What additional information would help the therapist determine the initial treatment plan in this case? A. Brenda's compliance with medical treatment; Brenda's current substance use; Brenda's views of the grief process. B. Brenda's spirituality or religious beliefs; Brenda's compliance with medical treatment; Brenda's views of suicide. C. Severity of Brenda's vision loss; Level of Brenda's suicidality; Brenda's lack of social support. D. Brenda's compliance with medical treatment; Brenda's understanding of her medical conditions; Brenda's spirituality or religious beliefs

B

Brian and Pam bring their four-year-old adopted daughter, Lucy, to therapy because she is not making friends at preschool. Lucy was adopted at age two, having been placed previously in three different foster homes. Since Lucy was adopted the family has moved twice for Pam's job. Lucy sits quietly throughout the session, answers questions with monosyllabic words, shows little emotion, and doesn't make eye contact with the therapist or her parents. Which of the following diagnoses should the therapist consider? A. Selective Mutism because Lucy speaks so little. B. Reactive Attachment Disorder because of Lucy's behavior in session and history of caregiving disruptions. C. Social Anxiety because Lucy doesn't make friends in her peer group. D. Adjustment Disorder because of Lucy's recent moves.

B

Darla, age 42, and Robert, age 47, are referred for couples counseling. They have been considering divorce but are trying to work it out for the sake of their three children, ages 4, 9, and 12. Darla states, "It is all this wild drinking, partying, and excessive spending you've been doing for weeks now!" states Darla. "He's done this before. Last time he quit his job to start a pizza joint. It's so embarrassing. Everyone at church is talking about us!" Robert replies, "You and that stupid church. Maybe if you paid more attention to me than to that pastor, our marriage would be better." Darla replies, "How about you stop drinking and pill popping?" How would a Bowenian therapist incorporate the issue of religion into the treatment plan based on the case described in the vignette? A. Have Darla and Robert tell the therapist directly how a potential divorce would impact them spiritually; Interpret Darla's preoccupation with her pastor as a way of avoiding the problems in her marriage. B. Assist the couple in understanding the religious values of their family of origin; Explore whether Darla is using the church to avoid marital issues and intimacy. C. Teach them how to use "I" statements in order to increase spiritual differentiation; Use a family map to understand parenting roles in their family of origins. D. Identify what their relationship would be like without involvement in the church; Interpret Darla's preoccupation with her pastor as a way of avoiding the problems in her marriage.

B

During an initial couples session the therapist learns that the husband is emotionally cold and the wife wants a more intimate relationship. Upon further assessment, the husband discloses that he is estranged from his family and gets overwhelmed by his wife's emotional demands. What treatment objective would a Bowenian therapist have in this case? A. Assist the wife in differentiating from her husband. B. Facilitate reconciliation between the husband and his family. C. Identify the triangulation in the relationship. D. Clarify their underlying beliefs and assumptions about their families of origin.

B

Elizabeth, age 8, is an African-American girl brought to therapy by her single, African-American grandmother Adele, age 61. They were referred by Elizabeth's teacher. Adele has been caring for Elizabeth since Elizabeth's mother died of a drug overdose last year. Elizabeth recently changed schools to be closer to her grandmother's house. Adele reports that Elizabeth lies, steals food, talks back, and has let her grades fall. Adele adds, "Her teacher says Elizabeth doesn't even play with her friends anymore. When I come home from work at night, she won't even come out of her room." Elizabeth appears thin and tired. Adele angrily complains, "It was easier when it was just me. I am too old for this attitude! I have to work long hours to pay all the bills. I can't be driving her here for therapy every week! How much is this gonna cost me? She is just like her mother." During the session, Elizabeth looks away, fighting back tears. What interventions would a Psychodynamic therapist use in treating Elizabeth during the middle phase of treatment? A. Use art therapy to express her feelings of sadness and provide a safe place for Elizabeth to process her grief. B. Utilize sand tray and art to promote expression of feelings and use interpretations of Elizabeth's feelings about therapist to inform interventions. C. Ask what "she's just like her mother" means to the client and explore the child's thoughts about her situation with grandmother. D. Use dolls to represent her grandmother and direct Elizabeth to express her anger as well as maintain a safe place for Elizabeth to process her grief through play.

B

Luisa is a 24-year-old, Native American college graduate who seeks therapy for feelings of intense sadness and loneliness since her girlfriend ended their 2-year relationship a few months ago. Luisa shares that she had been unfaithful and doesn't understand why she cheated and then lied about the affair. She shares she feels confused and uncertain about how to move forward with her life. How would a Solution-Focused therapist determine appropriate treatment goals in this case? A. Allow Luisa to tell her story while listening for strengths and ask about times when she didn't feel sad or lonely. B. Ask her how she would know then she was "better." C. Identify current strengths and explore the severity of her symptoms. D. Explore how her Native American heritage impacts her problem.

B

Marge is a 72-year-old woman who has been residing with her daughter and her son-in-law since an accident that left her with limited use of her legs. Marge reports being very active in the community before the accident; however, since the accident she reports being "stuck at home." She adds that she feels "really down and lonely." After mapping the problem, how would a Narrative therapist proceed with treatment? A. Determine how her Down-ness and Loneliness are effecting different areas of her life. B. Have Marge identify how she has "taken a stand against" the Down-ness and Loneliness. C. Inquire how the accident has changed Marge's view of herself. D. Encourage Marge to invite an audience to witness Marge's new story.

B

Maria, a 64-year-old Salvadorean woman, is brought to therapy by her son and daughter-in-law. They are concerned about Maria's behavior since her husband died three months ago. The son says that Maria still cooks for her husband and talks to him like he is still there. Maria recently moved in with them, but she won't leave her room except for going to church. The son shares that he has taken over Maria's finances, but she refuses to do the paperwork to sell her house. How should the therapist proceed with the initial assessment with this family? A. Explore Maria's views of grief and mourning. B. Inquire about how cultural issues are influencing the presenting problem. C. Assess for potential elder abuse based on social isolation and financial abuse. D. Provide psychoeducation about the normal grief process.

B

Mike, a 28-year-old, single Japanese-American man, is referred by his employer. Mike presents with a flat affect but appears nervous. He states that he was promoted three months ago to a supervisor position at his tech firm. He says, "My father says I should be happy at this promotion but I am just so stressed out all the time now. I really don't like dealing with other people. I never have. I'd rather just work alone." He shares that he has recently started drinking to help himself sleep because he is so tense. He adds, "This is my first time to therapy. It feels weird to talk to someone. My boss says it helped him but my brother said it's for people who can't handle their problems. I just don't want to disappoint anyone, that's too much for me." What clinical issues must the therapist consider in formulating the initial treatment plan in this case? A. Mike's limited social supports and his motivation for treatment. B. Mike's substance use and his cultural views about therapy. C. Mike's substance use and his psychiatric history. D. Mike's impaired social skills and coping skills.

B

The therapist is meeting with a family of four: Jim, 45, Shannon, 43, Parker, 13, and Grace, 10. During the first session, Shannon is discussing how devastated she feels about the recent loss of their youngest child, Sam, five months ago. "Sam drowned in our family pool when the nanny looked away for just a few seconds. The fence around the pool was accidentally left open and Sam crawled right to the edge. By the time our nanny realized that he was not inside, Sam was gone." While Shannon is talking, the therapist begins to feel very uncomfortable and unable to focus due to the therapist's own recent loss of younger sister. What action should the Satir Family Therapist therapist take in this case? A. Seek consultation and help members of the family understand how their experiences have shaped their present views of themselves. B. Acknowledge every family member as an important member of the group and set up personal therapy to work through grief of losing a younger sister. C. Attempt to create an atmosphere of trust and hope and continue seeing the family weekly while monitoring personal emotions and reactions. D. Remain authentic and tell the family about unresolved grief issues and refer them out.

B

Tina, a 24-year-old single Chinese-American woman, is referred by her thesis advisor. Tina appears nervous and her clothes are disheveled. She states that she is in the last year of her PhD in microbiology. She tears up during the third session when she shares that the results of her year-long research revealed no meaningful findings and so she will have to "start all over." She says she is too ashamed to tell her parents who expect her to have a job already. She says she knows of another student who altered her data and she's tempted to do the same. How should the therapist respond to the client's disclosure? A. Encourage the client to report the fellow student to the disciplinary board. B. Explore the pros and cons of altering her research data. C. Remind the client that altering her research data would be unethical. D. Process the client's feelings about starting over with her research

B

Tobias, age 32, and Vince, age 29, have been dating for nine months. Tobias refuses to accept Vince's drinking habits. "He drinks most nights of the week" he says. "Tobias is overreacting! That's all," Vince exclaims, "I was drunk the first time we met. That didn't seem to bother you." After several sessions of them constantly arguing over Vince's drinking the couple remains at an impasse. How should the therapist clinically manage the situation presented in the vignette? A. Arrange for a complete alcohol use evaluation for Vince and ask him to discuss the pattern of his substance use. B. Ask the couple how their relationship would change if the drinking stopped. C. Provide a comprehensive list of local Al-Anon meetings for Tobias. D. Suggest that the couple work on other relationship issues that are not related to Vince's substance use in order to regain trust with each other.

B

A 13-year-old who is being treated for depression is concerned about disclosing his homosexuality to his parents who are homophobic. The boy's father, who only has physical, but no legal custody, wants to be more involved in his son's life and requests to see the records. How should the therapist manage the legal and ethical responsibilities in this case? A. Deny father's request because he is a non-custodial parent. B. Grant father's request because non-custodial parents can have access to records. C. Deny father's request because releasing the records will be detrimental to the therapeutic relationship. D. Deny father's request because the client consented to his own treatment and is paying the bill.

C

A 19-year old is brought to a family service agency by the parents who report a history of school truancy, fights with classmates, and problems with authority. In order to make a diagnosis of antisocial personality disorder, which of the following would need to be true? A. Client has a history of bullying, deliberately destroying property, and stealing. B. Client has been lying to both his parents and his teachers since age of 12. C. Client has a history of setting fires, being hostile and vindictive before age 15. D. Client has had one incident of killing a neighbor's cat and refusing to take responsibility for it at age of 16.

C

A 23-year-old woman is brought to the first session by her mother. The mother reports that her daughter has been acting strange for the better part of the last year. The daughter shares that she has been hearing voices for a while and thinks that the actors on her favorite show are talking to her. For the past month the client has refused to get out bed, been crying a lot and has been sleeping most of the day. What DSM 5 diagnosis should the therapist consider in this case? A. Schizophrenia B. Schizophreniform Disorder C. Schizoaffective Disorder D. Major Depressive Disorder with Psychotic Features

C

A 26-year-old client seeks therapy for help with mood swings and relationship problems. She says she doesn't understand why it's so hard to make friends. Over the course of treatment the client becomes aware of the abuse she experienced as a young girl. The client becomes enraged with the therapist for bringing these issues to light. How would a Psychodynamic therapist proceed? A. Explain to the client that this is a normal part of therapy. B. Redirect the client's anger toward her family. C. Accept the client's anger and help her make sense of it. D. Assume that this is important transference and allow the client to vent.

C

A 32-year-old, twice divorced, client is referred by her EAP for work problems. The client shares that she has a hard time keeping a job for very long and that everyone at her work is out to get her. She says she drinks most nights because it's the only way she feels better. She starts crying in session and says she knows the therapist is going to help her. What diagnoses should the therapist consider initially in this case? A. Schizoid Personality Disorder; Alcohol Use Disorder; V. Occupational Problem B. Borderline Personality Disorder; Major Depressive Disorder; Unspecified Anxiety Disorder C. Borderline Personality Disorder, Alcohol Use Disorder, V. Occupational Problem D. Schizoid Personality Disorder; Major Depressive Disorder; V. Occupational Problem

C

A 34-year-old woman seeks therapy eight months after the death of her husband. She reports that for the first few months she was "numb and going through the motions of life". However, lately she has been filled with rage and doesn't understand why she is having these outbursts. What intervention would a Psychodynamic therapist use during the initial stage of treatment? A. Discuss how she has dealt with loss in the past and interpret her anger as a projection of her grief. B. Establish a safe holding environment and provide psychoeducation on the cycle of grief. C. Explore her relationship with her family of origin and provide psychoeducation on the cycle of grief. D. Establish a safe holding environment and interpret her anger as a projection of her grief.

C

A 35-year-old accountant seeks therapy because she has a hard time in social settings. She presents with a depressed mood and shares that sometimes she stays home and drinks rather than going out with her friends. How should the therapist proceed with the assessment in this case? A. Refer the client to substance abuse treatment for an assessment. B. Provide psychoeducation about how her substance abuse could be affecting her mood. C. Determine the frequency and amount of client's alcohol use. D. Ask if client experiences any symptoms of tolerance or withdrawal.

C

A 35-year-old single woman is referred to a community mental health clinic for parenting support and treatment of anxiety. She has two sons, ages 6 and 8, who attend the local school. She shares that they were recently evicted because the owners were selling the complex and adds that they have been sleeping in her van for the past 2 weeks. She says she feels overwhelmed and doesn't know how to get back on her feet. How should the therapist proceed? A. Inform the woman that a child abuse report must be filed due to the family being homeless. B. Refer the family to a shelter. C. Complete a full assessment including social supports and coping strategies. D. Recommend family therapy to ensure that the children are safe.

C

A 53-year-old military veteran is experiencing a great deal of frustration and anger in his relationship with his 12-year-old son. He complains, "My son doesn't listen to me. I know my wife is turning him against me." How would a Solution Focused therapist intervene to assist this client? A. Directly realign the executive subsystems with expectations for change. B. Devise strategies to eliminate symptoms, thereby leading to change. C. Collaboratively design a situation with expectations for change. D. Rewrite the problem for the client, thereby leading to change.

C

A 54 year-old man who is recently divorced and has been forced into early retirement comes to therapy for the treatment of depression. He finds it hard to get out of bed in the mornings, doesn't take any interest in former activities, and has increased his consumption of alcohol from "mostly weekends" to "every night." After having assessed for suicide and found no risk, what further interventions should the therapist consider? A. Inquire about social supports; get details on alcohol consumption; suggest the client join a group of divorced men. B. Inquire about social supports; ask when he had his last full physical; suggest the client join a group of early retirees. C. Inquire about social supports; get details on alcohol consumption; identify past and current coping strategies. D. Inquire about social supports; get details on alcohol consumption; suggest the client increase his exercise routine.

C

A 54-year-old woman seeks therapy for anger and depression. She shares that her 82-year-old mother with dementia moved in with her three months ago and she feels overwhelmed taking care of her. The woman reports, "Sometimes I just leave the house all day, because I can't deal with all her neediness. She's like a whiney baby." The client adds that as the only child, it is all on her to deal with her mother. How should the therapist proceed in this session? A. Normalize her reactions toward her mother and refer her to a psychiatrist for medication evaluation. B. File an elder abuse report and process it with the client. C. Determine who is caring for mother when client is gone all day and explore her experience of being overwhelmed. D. Identify other family support and refer client to respite care services.

C

A client with a history of Major Depressive Disorder who has been in therapy for ten months comes to session and abruptly informs the therapist that he feels much better and will be ending therapy that day. He thanks the therapist for all the help and gives the therapist a favorite painting. What should the therapist do NEXT? A. Refuse the painting because the gift is too valuable. B. Explore the significance of the painting. C. Assess if the client has any thoughts of hurting himself. D. Share concerns about the premature termination.

C

A client with depression expresses suicidal ideation during a session. The therapist and client decide to increase contact between sessions. The therapist does not hear from the client at the scheduled time and when attempting to reach the client gets voicemail and leaves a message. What additional action should the therapist take to address the safety concerns? A. Contact the PET team to initiate a 5150 since client is potentially suicidal and did not follow through on agreed meeting. B. Call 911 and provide them with the client's address. C. Call client's emergency contact to determine if they have knowledge of client's location and status. D. Call client's emergency contact to express concerns regarding client's safety and encourage them to call 911.

C

A couple brings their 4-year-old child to a therapist concerned that the child cannot yet recognize the alphabet. They tell the therapist that they know other 4-year-olds who can say the alphabet and they have tried to teach it to their child without success. They believe something may be wrong with their daughter. The most likely explanation is that: A. The child is experiencing developmental delays. B. The child is malnourished. C. The child may not have reached necessary level of cognitive development. D. Parents are stifling the child with their high expectations.

C

A couple in their 70's seek therapy for family problems. They report that their daughter and son-in-law moved in with them recently and they are afraid of the son-in-law, who expects money from them and has been using their credit cards. They add, "We are afraid of him but don't know what to do." How should the therapist clinically manage the legal issue of elder abuse in this case: A. File an elder abuse report and document it in the notes. B. Assess for elder abuse and create a safety plan. C. Inform them that an elder abuse report needs to be filed and create a safety plan. D. File an elder abuse report and process their reaction.

C

A couple reports increased marital conflicts. The husband notes that his wife has become irritable, isolative, and lethargic since she was laid off from her job three months ago. She worked as an air traffic controller for 26 years and, due to recent budget cuts, the company had to let her go. The wife states she is tired of her husband's constant nagging for her to be more helpful around the house. Both report a lack of physical intimacy and a sense of emotional disconnect from one another, but express a desire to resolve their problems. Which of the following areas should the therapist assess first to identify the degree to which current stressors are impacting the relationship? A. The wife's work history and her prognosis for re-employment. B. The couple's styles of coping and their degree of effectiveness. C. The effect of socio-economic factors on the couple's problems. D. The effect of dysfunctional patterns in the couple's communication.

C

A couple seeks therapy complaining of an inability to communicate. The wife is Japanese and currently a stay-at-home mother. The husband is Caucasian American and manages a local bank. They are expecting their third child in six months. The wife shares that the third child has diminished her career outlook and she feels resentment. The husband reports that she worries too much. What middle phase goal would a Structural Family Therapist consider for a treatment plan in this case? A. Improve co-parenting functioning by increasing father's involvement at home. B. Strengthen each individual's sense of uniqueness and self-esteem. C. Clarify and define relational "rules" for the marital subsystem including cultural issues. D. Decrease the anxiety that underlies the marital subsystem's symptoms.

C

A single mother of two young children is referred by a friend. The client reports feeling overwhelmed with all her responsibilities and shares that she has been experiencing episodes where she is unable to breathe, has a tingling in her body, feels disconnected from the world, and thinks she is going to die. What initial interventions should be considered in this case? A. Identify triggers for the episodes; Refer her to a medical doctor; Assess child neglect; Explore coping skills. B. Complete a mental status exam; Refer to psychiatrist for medication; Refer to parenting classes; Identify coping skills. C. Identify triggers for the episodes; Refer her to a medical doctor; Explore her current stressors; Identify coping skills. D. Complete a mental status exam; Refer to psychiatrist for medication; Encourage exercise; Teach coping skills.

C

A therapist is employed as a clinical supervisor for a Domestic Violence shelter for families. During group supervision one of the interns, who has been working at the shelter for eight months, reports feeling detached from her family and friends, wants to avoid certain clients and has been waking up multiple times at night. How should the supervisor respond to the intern's disclosure? A. Recommend that the intern seek consultation with an MD for sleep disturbance. B. Ask other group supervisees to share if they have had similar feelings. C. Provide psychoeducation on secondary trauma. D. After group, discuss whether intern is able to provide adequate care to clients.

C

A therapist meets with a 30-year-old man who is having relationship problems. He reports that he's been dating a woman for almost a year and is feeling conflicted over the direction of the relationship. He found the therapist through his insurance panel and would like to use his insurance to pay for his sessions. After completing an assessment, the therapist informs the client that his presenting issues will not be covered by his insurance. The man becomes upset, tells the therapist he has to use insurance or he cannot afford therapy, and asks the therapist to help him make it work. What ethical and legal obligations does the therapist have in this case? A. Discuss treatment options and encourage him to find a low or no fee clinic. B. Diagnose the client with adjustment disorder and submit claim to insurance. C. Explain why insurance cannot be used and offer him a list of low fee providers. D. Offer a sliding scale fee to client based on his ability to pay.

C

A therapist who is a HIPAA provider receives a request from an insurance company for the full records of several clients as part of an audit. The therapist maintains psychotherapy notes in addition to the medical records for all clients. The therapist should: A. Provide the insurance company with all components of the clients' files, including psychotherapy notes. B. Review the policy agreement to determine what portions of the clients' files must be provided. C. Provide the insurance company with the medical records only. D. Request additional authorization from clients to provide full records for the audit.

C

After a peer consultation group, a colleague confides to a fellow therapist that he has started engaging in sexual activity with a 67 year-old client, how should the therapist respond to the disclosure? A. Provide the client with brochure "Professional therapy never includes sex." B. File a report with Adult Protective Services. C. Maintain confidentiality. D. Seek consultation.

C

An 11-year-old boy, James, is brought to therapy by his parents to help him deal his grief over the death of his younger brother. In the initial sessions James presents as severely depressed and unable to verbalize his feelings. Once the therapeutic rapport is established what intervention would a Gestalt-oriented therapist consider in the middle phase of treatment? A. Provide the client with finger-paints to express his moment-to-moment feelings. B. Utilize a sandtray to assess how the client views himself in relation to his family. C. Ask the client to make his brother out of clay and then ask him to speak to his brother. D. Direct the client to talk to the empty chair pretending that his "sad self" is sitting there.

C

Carmen, a 31 year-old single mother, and her 15-year-old daughter, Lynda, are referred by Carmen's church. In the intake session, Carmen complains that since Lynda started dating her boyfriend, Jose, age 20, she's been having an attitude with her and refusing to do her homework. Lynda rolls her eyes and says, "Don't pretend like you care." After the session, Lynda calls the therapist and reports that she is two months pregnant and is considering having an abortion. Lynda asks that her mother not be told about the pregnancy. What legal obligations does the therapist have in the case described in the vignette? A. Maintain Lynda's confidentiality regarding the phone call; file report with a child protective services agency; determine need for consent to treat a minor. B. Obtain a consent from Carmen to see Lynda individually regarding pregnancy; negotiate a fee with Lynda if seen individually for the pregnancy; assert privilege for Lynda if mother asks for records. C. Obtain releases for medical provider from Lynda if seen alone for pregnancy; maintain Lynda's confidentiality regarding the phone call; determine need for consent to treat a minor. D. Obtain consent from Carmen to treat minor if seeing mother and daughter together; assert privilege for Lynda if mother asks for records; file report with a child protective services agency.

C

Foster parents, Joan, age 37 and Melissa, age 40, are referred for therapy with their two foster children, ages 4 and 6. The children were placed with them two weeks prior. During the initial session the therapist notes that the foster parents do not interact very much with the children. How should the therapist address this issue? A. Suggest activities the parents can do with the children. B. Acknowledge how difficult it is to be a foster parent. C. Highlight when the parents interact with the children. D. Refer them to a parent education class.

C

Nancy, age 42, John, age 45, and their children, Katie, age 12, Nate, age 10, and Clare, age 5, are referred by Nancy's therapist. The family recently relocated across the country when John got a promotion. Nancy shares that since the move, Katie has been obsessed with her appearance and sometimes refuses to go to school. Katie, who appears a normal weight, says "I'm not leaving the house when I look so fat in all my clothes. The kids here aren't going to like me." Her mother says, "Look at my beautiful Italian princess; she is perfect! How can she worry about her looks? She's so tense all the time." Katie nervously pulls at her hair, looks away from her mother, rolls her eyes, and shakes her head. John flatly adds, "I'm very concerned about Katie. The school called and said she's been throwing up after lunch. That's the real reason we are here." Katie shouts "Don't pretend to care about me! You're always at work and Mom stays in bed all day." Nancy tears up and says, "I'm so sorry I can't help her. Will you be able to fix her?" During the session, Nate plays on his phone. How would a Structural therapist intervene in the early stage of treatment in the case presented in the vignette? A. Observe how the family members interact with each other and join with the family by validating the father's concern about the eating disorder. B. Ask them what their family would look like without this problem and facilitate expression of what they are feeling in the room while talking about their issues. C. Vividly describe the interactions between family members as they unfold in the room and reframe the issues to suggest the entire family seems to be struggling. D. Realign the parental subsystem so that Nancy feels like a better mother and reframe the family's issues so Katie is no longer seen as the problem.

C

39-year-old Earl and 40-year-old Fiona are meeting with the therapist for the first time. They have a 2-year-old Grace, and a 4-year-old son Victor, and now that both of their kids are toddlers, Earl and Fiona find themselves arguing about discipline. "He sends the kids up to their room for a time out any chance he gets," Fiona complains, "and I just don't think that is helpful to them." "All Fiona does is talk to them," Earl retorts, "they need to know clear limits." The couple also reports they've been distant from each other both sexually and emotionally. During the assessment, the therapist notes that both individuals demonstrate a high degree of self-reflection, openness, and are able to set realistic goals. The practice approach utilized by the therapist should emphasize: A. The clients' conflict resolution skills. B. Common characteristics of marital problems. C. The differences in family histories of the two partners. D. Building on the clients' strengths and competencies.

D

A 22-year-old woman seeks therapy for feelings of emptiness and frustration. She shares that her parents got divorced a few years ago and she doesn't have any contact with her father since he remarried and moved away. During the eighth session, she reveals that she occasionally engages in non-suicidal self-cutting, the therapist should FIRST: A. Assess for suicide and insist that the client sign a no-harm contract. B. Determine last incident and refer her for a medication evaluation. C. Express concern about dangers of cutting and assess for suicide. D. Explore the role of the cutting and ask about triggers for cutting

D

A 28-year-old client who has been coming to therapy for two months for depression shares with the therapist that her husband thinks that her therapy is making their relationship worse and that she should stop. The therapist suspects there is domestic violence going on at home. How should the therapist respond? A. Provide psychoeducation on domestic violence and refer to a domestic violence shelter. B. Explore the client's feelings about her husband's views and make a termination plan. C. Provide psychoeducation on domestic violence and confront client's denial about her problems. D. Explore the client's feelings about her husband's views and share concerns about possible domestic violence.

D

A 35-year-old Chinese client who has recently immigrated to the United States seeks therapy to adjust to the client's culturally different spouse. To assess the client's level of acculturation, which of the following concerns should the therapist take into consideration? A. Newly immigrated individuals are often hesitant to challenge cultural traditions in their marital relationships. B. Newly immigrated individuals are resistant to learning the rules of a new country. C. Gender differences cause more discomfort than acculturation issues. D. The pace of acculturation may vary from group to group.

D

A client is court mandated to see a therapist for help with anger control. The client denies having a problem and blames others for initiating fights. The client also states that attending therapy sessions is not necessary. In order to engage the client in the process, the therapist should: A. agree with the client's denial of problems with anger. B. reflect back the client's resistance. C. note that the client's probation officer must be informed of his resistance. D. express understanding of the client's position regarding therapy.

D

A client is seeing a therapist at a family service agency complaining that she has been feeling depressed. She states that she shouldn't feel this way because there are no problems in her life. She has a husband, a good job, and two healthy children. The therapist should first? A. Assess for history of depression in her family. B. Refer the client to an MD for medical evaluation. C. Administer Beck Depression Inventory. D. Clarify what the client means by "depression."

D

A doctor from a local emergency room calls the therapist because one of the therapist's current clients has overdosed on drugs and is in a critical condition. The doctor asks the therapist for details about the client's past drug use history in order to get a better picture of the patient. What action should the therapist take in this case? A. Let the doctor know that the therapist cannot confirm or deny working with said client. B. Immediately contact the client's family for consent to speak to the doctor about the client. C. Ask the doctor to fax a release signed by the client before discussing the client's drug history. D. Answer the doctor's questions since the client is in critical condition and cannot consent.

D

A mother and father seek assistance at a community agency because they are concerned that their 6-year-old son has an Autism Spectrum Disorder. The treating therapist schedules a session to meet with the parents alone. At the initial session both parents are distraught. They report being overwhelmed by having to juggle between running the household and working full-time. The parents note that they "just can't handle one more thing." They talk over one another and argue about how to explain their concerns to the therapist. In addition, they express concern over their son's life potentially being "horrible" and that the extra pressure on their family will be "unbearable." How should the therapist clinically manage the situation presented in the vignette? A. Express empathy for the parents' concerns; make appointments for individual sessions with mother and father; ask parents to have their child assessed by the school psychologist. B). Tell the parents that they are being premature in getting so upset; make appointments for individual sessions with mother and father; ask parents to have their child assessed by the school psychologist. C. Tell the parents that they are being premature in getting so upset; get more details about the specific behaviors that they find concerning; arrange to see the minor client at the next session. D. Express empathy for the parents' concerns; get more details about the specific behaviors that they find concerning; arrange to see the minor client at the next session.

D

A mother calls seeking therapy for her 4-year-old daughter. The mother anxiously tells the therapist that she thinks her daughter has been molested. When the therapist asks what makes her think this she starts crying and says that she has caught her touching herself in her private area multiple times. After normalizing the child's behavior, the therapist should next: A. Invite the mother to bring the child in for a full assessment . B. Find out if mother has a history of abuse. C. Get a release to talk to her school and find out if they have seen a change in behavior. D. Explore mother's reactions to daughter's behavior.

D

A therapist conducts a support group for adults who are caregivers for their elderly parents. During one group meeting, a member begins to describe how she behaves toward her parents when she becomes frustrated. The therapist becomes concerned that the behavior may constitute abuse. How should the therapist clinically manage possible elder abuse in this case? A. Encourage the member to provide more specific information in the group. B. Remind the group about legal obligation to report elder abuse. C. Engage the other members in a discussion of what is acceptable behavior. D. Follow up with the member individually after the group about the situation.

D

A therapist has been working with Kim, a 47-year-old substitute teacher, for four months. Based on Kim's presenting complaints, together Kim and her therapist have set goals of anxiety reduction and increased self-esteem. Over time the therapist begins to notice a pattern of interaction between Kim and the therapist. Any time the therapist offers specific suggestions Kim presents reasons why each suggestion will not work. In order to generate more positive interactions, the therapist should FIRST: A. Assume a non-judgmental stance; Identify attitudes the client carries that limit progress; Work with the client on eliminating negative beliefs. B. Assume a curious stance; Revisit specific goals that the client had identified; Formulate new goals. C. Assume a non-judgmental stance; Focus dialogue on client's strengths; Obtain her view of current progress. D. Assume a curious stance; Share the observation of this pattern with the client; Inquire about her view on the matter.

D

A therapist has been working with a client for 4 months to address depression and substance use. The client is continuing to use substances and, based on scores on the Beck Depression Inventory, continues to experience high levels of depression. How should the therapist initially address the client's lack of progress? A. Inform client that he cannot continue treatment until the client is truly committed to change. B. Terminate treatment and refer to another therapist. C. Discuss lack of progress with client and reformulate the treatment goals. D. Refer client to an intensive outpatient program to address ongoing substance use issues.

D

A therapist who has been working with a 29-year-old client for several months notices that the client sometimes cancels appointments at the last minute, does not show at all for some appointments, and always pays fees late. The client describes frequent fights with friends, but doesn't understand why this keeps happening. An appropriate middle phase intervention for a psychodynamic therapist would be: A. Point out the client's disrespectful behavior; Interpret why client may react this way; Explore alternative behaviors when dealing with friends B. Explore the reason for fights with friends; Role play how client deals with conflict; Talk about the secondary gain from the client's behavior C. Reformulate treatment goals; Remind client of cancellation policy; Discuss the importance of regular therapy D. Explore the situations when she has fights with her friends; Relate the client's behavior with the therapist to that with friends; Process the client's reaction toward the therapist

D

A young man seeks therapy because he is experiencing ruminating thoughts that involve bad things happening to him and his family. He reports that the thoughts are pervasive when he is awake and the only time they stop is when he is sleeping. How would a cognitive behavioral therapist proceed? A. Ask the client for details about his ruminations and explore their underlying meaning. B. Teach the client to utilize thought stopping techniques to eliminate the unhealthy thoughts. C. Utilize the Crystal Ball technique. D. Explore the negative thoughts and precipitating events.

D

An immigrant family is referred to a therapist because of the ten-year-old child's frequent absences from school. In the intake interview, the therapist asks for information from various members of the family, but all the responses come from the father, who speaks sharply and whose facial expression appears angry. The therapist's immediate course of action should be to: A. meet with each family member individually. B. assess for child abuse and domestic violence. C. learn about the communication styles typical of the family's culture. D. respect the family structure and direct the remainder of the questions only to the father.

D

Damon, an elderly gay man with depression and HIV positive status is referred by his doctor. He reports that he doesn't enjoy things like he used to, has trouble sleeping, and has lost his appetite. He tears up when he tells you that he hasn't spoken to his son in years and has no one to talk to. What short-term and long-term goals should the therapist consider presenting to the client? A. Stabilize symptoms; Improve medication compliance B. Increase enjoyment; Improve relationship with son C. Increase social support; Stabilize symptoms D. Stabilize symptoms; Increase social support

D

During a session with a 42-year-old mother, she discloses that her husband came home drunk after he lost his job and got in a physical altercation with their 15-year-old son that resulted in the son getting a black eye. The therapist informs the mother that the therapist is mandated to file a child abuse report immediately. After calling to report the incident to child protective services, what else must the therapist do to fulfill their legal obligations in this case? A. Submit a written report within 24 hours and instruct mother to take son to ER. B. Submit a written report within 36 hours and process her reaction to the report. C. Submit a written report within 24 hours and assess for any other incidents of abuse. D. Submit a written report within 36 hours and document incident in client's records.

D

Janet presents for therapy on the advice of her husband. Janet states that for the past six months she has suffered from headaches, irritability, frequent tearful episodes, and insomnia. To help her sleep she's been regularly taking painkillers that her neighbor gave her. Janet sobs, "My husband can't stand me this way, and I can't stand to go on this way, either. We've even thought about separating. You can help me, right?" What initial interventions should the therapist present to Janet? A. Referral to psychiatrist for a medication evaluation; Parenting support group; Including husband in treatment. B. Couples therapy to address relational issues; Cognitive-behavioral therapy to address depressive symptoms; Support group with other clients recovering from substance use C. Outpatient substance treatment to address client's substance use; Referral to medical doctor; Including husband in treatment. D. Couples therapy to address relational issues; Referral to psychiatrist for a medication evaluation; Outpatient substance treatment to address client's substance use.

D

Jason, a 27-year-old, comes in for an initial session. While in the waiting room it is obvious that Jason is talking to himself and may be experiencing hallucinations. In the session Jason explains that he has never been to a psychiatrist or has taken any medication. He states, "I refuse to see those docs, all they do is push pills and I do not want to take any psychotropic meds." What action should the therapist take in response to Jason's refusal to take medication? A. Continue seeing Jason weekly and work on managing his symptoms without medications. B. Refuse to see Jason until he agrees to be at least be assessed by a psychiatrist. C. Refer the client to another therapist because it is necessary to take medication when experiencing hallucinations. D. Explore the client's resistance to meeting with a psychiatrist or taking the medication.

D

Kyle, a 14-year-old boy, is referred for therapy by his pediatrician. Parents, Dan and Derek, attend the first session with Kyle. Dan shares that his son's grades have dropped over the past few months and says, "He used to like school. Now he just wants to play games online." Derek adds, "I'm really worried about him. I think he's being bullied at school but he won't talk about it with us." Kyle appears pale and avoids eye contact with the therapist. How should the therapist handle the legal requirements if Kyle reports having thoughts of suicide? A. Ask Kyle to sign a no harm contract; Initiate a 5150 if Kyle refuses to sign a no harm contract; Obtain a release to speak with Kyle's pediatrician. B. Obtain a release to speak with Kyle's school counselor; Initiate a 5150 if Kyle has a plan to harm himself; Obtain family history of depression. C. Ask Kyle about prior self harm history; Obtain a release to speak with Kyle's pediatrician; Refer Kyle to a teen depression group. D. Determine if Kyle has a plan; If Kyle has a plan, determine whether he has the means; Initiate a 5150 if Kyle refuses to sign a no harm contract.

D

Paige, a 25-year-old performing arts student, seeks therapy because she is feeling bad about herself. She shares that she is in a lesbian relationship with Harper, a 39-year-old theater actress. They have been together for 3 years and at first Harper was sweet and loving. Slowly though, her temperament began to change and she started to be curt and rude with Paige. "This one time we were at an amusement park and I was really scared of going on this roller coaster. Instead of being understanding and patient with me Harper told me publicly to shut up and stop whining." Paige also reports that most recently Harper started to frequently accuse Paige of cheating and threaten that "neither of them would survive if she ever tried to leave." As initial interventions, the therapist should: A. Rebuild the client's sense of self-worth; Support a sense of empowerment in the client; Encourage her to seek couples therapy. B. Discuss a safety plan; Support the client in verbally expressing her feelings associated with the abuse; Confront the client about making excuses for the perpetrator's behaviors. C. Validate her feelings; Build trust using eye contact and active listening; Help rebuild the client's sense of self-worth. D. Build trust using eye contact and active listening; Clarify the client's experience; Further explore the relationship dynamics.

D

Tom, age 25, and Kathy, age 24, come for couple's therapy because they have been arguing a lot. They have lived together for several years. Tom returned three months ago from a 9-month deployment in Iraq. He shares that he "feels very out of place, like he doesn't belong anywhere." Kathy is concerned because Tom wakes up screaming, has been drinking more, and has angry, unprovoked outbursts. She has caught him crying twice and says he stays in bed all day. Kathy adds that she recently lost her job. They want help because they are committed to each other. What areas should the therapist assess to evaluate risk in this case? A. Severity of Tom's alcohol use; Socioeconomic stress affecting couple; Tom's feelings of not belonging B. Tom's possible suicidality; Severity of domestic violence affecting couple; Severity of Tom's alcohol use C. Tom's level of suicidality; Socioeconomic stress affecting couple; Tom's mental status D. Tom's possible suicidality; Severity of Tom's alcohol use; Tom's mental status

D