trial exam
You are a counselor working with a client, Jack, who feels frustrated with their roommate over a recent money issue. Jack makes a comment, "I swear I could kill him, he's so obnoxious." Based on this statement, what should you say next?
Correct answer: "Do you have a plan to hurt your roommate?" In assessing for homicidal ideation, you'd want to assess whether a passive thought is more of an active thought with a plan, intent, and means. You would only breach confidentiality as a mandated reporter if Jack disclosed intending to kill their roommate (or if you had a very strong suspicion their roommate was in grave danger). The most important question to ask here is to clarify if Jack actually has a plan to do something regarding these thoughts (many clients will say things when they feel frustrated, even if they don't mean them.)
A counselor, Brenda, is going through a particularly rough divorce and shows up to work somewhat disheveled and teary. Their concerned client, Maggie, asks if something has happened. What is the best way for Brenda to respond?
Correct answer: "I am okay, and I am here for you. How are you doing today?" Of all the answers offered, this one is the best (even if it feels a little dishonest). The other answers have blatant issues (talking about personal issues is not a legal matter, insisting that we 'focus on you' is somewhat abrasive, and overly self-disclosing can cause the client to feel excessively concerned about the counselor's well-being).
Ophelia is in treatment for methamphetamine addiction that has spanned nearly a decade. She has been abstinent for a month, and she comes to you stating that she's never felt happier and truly feels "a relief she's never known." She reports that her sobriety is the best thing to ever happen to her. As her counselor, what would be the most appropriate response to Ophelia?
Correct answer: "I am so glad you're feeling well and making such progress. However, this is all so new, and it's important that we still focus on building your recovery and being mindful of triggers." This is the best answer. Ophelia is likely in the 'pink cloud' stage of recovery where everything feels exciting and optimistic. This can be a relief for clients, but it can also set the stage for surprise and disappointment when life undoubtedly gets challenging. As a counselor, it's important to validate the progress while also being mindful of relapse potential. You might explore what the best part of her life is right now, but this response is somewhat incomplete. Based on Ophelia's current state, she probably doesn't have any cravings (or they are minimal) and she probably doesn't see herself using methamphetamine again, but that doesn't mean you shouldn't explore the potential risk.
During a counseling session, a client angrily tells you that you're not paying attention to them and that they don't know why they're even bothering to talk to you. You believe this claim is coming out of nowhere, as you assumed you two had a strong rapport. How should you respond?
Correct answer: "I'm so sorry. Let's talk about what's going on between you and me." Ruptures happen in all relationships, including counseling ones, so it's important to acknowledge and apologize for your part, even if you aren't sure what's going on. Asking to talk about it further gives the client a chance to explain themselves. You wouldn't want to invalidate their experience or become defensive, which is an undertone in both of the other responses.
The BEST example of a scaling question is:
Correct answer: "On a scale from 0-10, how strong are your cravings right now?" A scaling question encourages a client to rank the intensity of a certain issue (e.g., cravings). This can be a metric that's measured and tracked over time. The miracle question explores what a miracle might feel like; "If you woke up tomorrow without any cravings, what do you think you would notice first?" is an example of this. "Given what you have experienced, how do you think you're still coping with daily life?" is an example of a coping question, which assesses how well a client is coping with adversity. "What are the top benefits of stopping drugs right now?" is an example of exploring ambivalence and engaging in a decisional balance analysis.
Your client, Mike, tearfully tells you that he just doesn't think he has what it takes to be sober. Which of the following responses MOST aligns with the principles of motivational interviewing?
Correct answer: "This sounds challenging. What's making you think this way right now?" The essence of motivational interviewing is empathy coupled with open-ended questions that explore ambivalence. This is the best strategy for intervening with Mike. Telling him you disagree somewhat aligns with his resistance and creates a power differential. Asking Mike what would feel different if he woke up tomorrow and felt good in his sobriety represents more of a solution-focused miracle question.
Research shows that all of the following populations are at a heightened risk for suicide EXCEPT:
Correct answer: Individuals who are middle-aged women All populations are vulnerable to suicide, but middle-aged women are not at an evidence-based, identifiable risk (middle-aged men are). American Indian/Alaska Natives, LGBTQ+ community members, and military personnel are identified at a heightened risk.
Your client tells you that he feels frustrated by his lack of progress in counseling, stating, "It's been almost a year of recovery, and I still have all these cravings almost every day. When is it going to get better?" To maintain a non-judgmental attitude, how might you best respond NEXT?
Correct answer: "This sounds very hard, and I'm honestly not sure. But I'm here for you, and I'd like to know more about how this is impacting you." This answer is the most empathic and non-judgmental. It conveys the honest truth but also shows your curiosity about how your client is being affected. Many people absolutely have cravings for a long time into recovery, so it's often unhelpful to ask someone why they're having cravings (although you might explore what triggers they've been noticing). Normalizing the experience by talking about other people might be helpful, but this probably wouldn't be your first response to his concern.
A counselor who practices motivational interviewing might respond to a client's ambivalence about attending a detox program by asking:
Correct answer: "What concerns you the most about attending this program?" Motivational interviewing questions are ideally open-ended, empathic, and avoid any coercive, pressuring tactics, and this question exudes empathy and curiosity. "Why don't you think you need detox?" comes across as somewhat controlling and abrasive, as does "When do you think you'll be ready to take care of yourself?" (The client might already think they're taking care of themselves.) "How do you think you'll get better if you don't let people help you?" assumes that the client isn't letting people help them, which we don't know to be true.
A client has been abstinent from alcohol for the past two months. In a counseling session, they tell you that they want to introduce drinking in moderation. Which of the following is the best response?
Correct answer: "What's prompted this thought process?" This question is curious and free from judgment, which are important skills for a counselor to have. Asking "Why don't you try abstinence for another two months to see how you feel?" may introduce more of a power struggle. Asking, "What happens if you can't drink in moderation?" may be a good follow-up question after exploring their motives to see if they have planned for how they might account for problem drinking and/or a relapse. After you have more information about the client's desire to try moderation, you might ask how they intend to do this.
Relapse can occur at any point after initial abstinence, but research shows that a person is most likely to relapse within:
Correct answer: 3-6 months. Research shows that the majority of relapses occur within 3-6 months, although many do not make it past the 30-day mark either. After 1 year, the risk of relapse drops off significantly. However, it's always important to be aware of this risk when working with substance use clients.
Research shows that the prevalence of nicotine dependence in individuals with substance use disorders is as high as:
Correct answer: 85% Up to 85% of people with a substance use disorder are also dependent on nicotine, even though just 25% of the general adult population has nicotine dependence.
Which of the following poses the MOST risk as a dual relationship?
Correct answer: A counselor working with their own former case manager after the case manager recently relapsed Dual relationships refer to having multiple types of relationships with a client. These should be prevented (when feasible). It would be inappropriate for a counselor to work with someone that used to treat them (as there was already a preexisting power differential). Working with an AA member or a parent of someone attending the same school as a counselor's child represents POTENTIAL types of dual relationships, but they pose less risk than working with an old case manager. It is common to work with former clients, and this would not be considered a dual relationship.
What is the main difference between a substance 'slip' and a substance 'relapse?'
Correct answer: A substance 'slip' refers to a single instance of substance use after a period of abstinence whereas a substance 'relapse' refers to a series of slips that have gotten out of control and impacted the ability to regain abstinence. A slip is defined by a single moment of using drugs/alcohol and then resuming on the path of abstinence. This is usually done unintentionally and in response to high stress. It is not a cluster of instances. A relapse to a series of slips that have gotten out of control and impacted the ability to regain abstinence. It doesn't matter if it's 1, 2, or 10+ times (even a single slip can turn into a relapse depending on the context).
What is the FIRST goal a counselor should consider when working with a client who meets the criteria for both a substance use disorder and a psychiatric disorder?
Correct answer: Achieving abstinence from abused substances Achieving abstinence from abused substances is an important goal to start treatment with, particularly when co-occurring disorders (e.g., both a substance use disorder and psychiatric disorder) exist. This is the first step in also achieving resolution from psychiatric symptoms. Ideally, full remission is possible, but abstinence allows for initial stabilization, which is important for doing counseling work.
When is the BEST time to formulate a treatment plan for a client?
Correct answer: After establishing preliminary treatment goals A treatment plan refers to a set of goals and objectives for a client's episode of care. After establishing preliminary treatment goals, you should make a treatment plan with the client — this may occur just after the intake, but not always. You should make a treatment plan regardless of the client's motivation for recovery.
Tina is a counselor working with Mary for her stimulant use disorder. After their third session, Mary goes to Tina's boss requesting that she switch to a new counselor, stating she finds Tina unhelpful and "cold". She reports that she doesn't feel safe working with Tina whatsoever. Based on this information, how should Tina proceed?
Correct answer: Apologize to Mary and support her in transitioning to working with a new counselor Counselors should terminate counseling relationships when a client is not benefiting from the dynamic or when they want to work with someone new (this is honoring the client's autonomy). However, Tina would not just terminate treatment without aiming to support Mary in transitioning to working with someone new. It is clear that Mary has already made her informed decision and another session is likely not appropriate at this time.
What is the BEST example of "meeting a client where they are at"?
Correct answer: Matching treatment interventions to the client's stage of change Meeting a client where they are at includes focusing treatment in a way that represents their current stage of change. This may include using motivational interviewing techniques and honoring their fears about recovery, although neither of these are necessarily universal or applicable to all situations.
Marcus is working with Henry, an adult seeking treatment for opioid use disorder. Henry is in session talking about the intense cravings he often experiences after getting home from a long day at work. Marcus suggests he try "playing the tape" to manage this craving. Which of the following best represents the 'play the tape' counseling technique?
Correct answer: Asking Henry to imagine himself relapsing on opioids, feeling the sensation of being high, and then coming down from that feeling. Playing the tape entails imagining using the drug from beginning to end (which also includes imagining all the consequences/adverse effects after the high has worn off). This allows people to truly consider the impact of their choice and can be valuable for doing a cost-benefit analysis. It's not enough to just stop at the sensation of being high, as this will likely exacerbate cravings. Listing consequences is another possible intervention, but it's not the same as playing the type. Changing the routine may be part of distraction or thought-stopping activities, which can also be beneficial.
A client asks you if you'd be willing to talk to their mother about their progress in treatment. How should you proceed NEXT?
Correct answer: Assess what might be important to share with their mother Assessing is one of the first steps for collaborating with other family members on treatment. It may certainly be appropriate for you to share status updates (with or without the client present). You might coordinate a call in which you review progress together, but you should assess what needs to be shared first.
Valium, Xanax, and Klonopin belong to which drug classification?
Correct answer: Benzodiazepines Valium, Xanax, and Klonopin are benzodiazepines, which are often prescribed to treat insomnia or anxiety. These medications can be used legally, but many clients misuse them. Opioids include drugs like oxycodone, heroin, and fentanyl. Stimulants include drugs like Ritalin, Adderall, and methamphetamine. Hallucinogens include PCP, LSD, cannabis, and ecstasy.
A counselor, Patrick, is working with Christopher, a middle-aged adult with a significant history of depression and polysubstance abuse. Christopher presents with low motivation for change and states they feel hopeless that things will get better. What is the best way for Patrick to respond?
Correct answer: By working on enhancing Christopher's motivation and self-efficacy Ideally, Patrick should focus on strengthening motivation and self-efficacy, which can sometimes be a lengthy process. Challenging the client can cause a power struggle, and we have no indication that they are lying about their recovery. This conversation has nothing to do with suicide, although Patrick should be assessing this risk. Patrick MIGHT ask what Christopher needs to feel more motivated, but this would fall under enhancing Christopher's overall motivation for recovery.
The most commonly used CNS stimulant is:
Correct answer: Caffeine Caffeine is a legal CNS stimulant that is very popular in all parts of the world. Nicotine is also common, but not as common as caffeine. Alcohol is a depressant, not a stimulant.
You and your client, Heather, have been making significant progress toward her treatment goals. Then, she cancels two sessions in a row. The first time, she cites a work conflict. The second time, she tells you that she had car problems and didn't realize until right before she was driving to see you. You have rescheduled a session for tomorrow morning, and you now have an email from Heather asking if you can postpone it to next week, as another work conflict has come up. How should you respond to Heather?
Correct answer: Call Heather and express your concern about her ability to show up for appointments Missed sessions could represent a problem within the counseling relationship, and they can also indicate potential relapse/emotional decompensation. For this reason, it's important to have a compassionate (but frank) conversation about your concerns with Heather. You should not automatically jump to termination unless this is in your practice's policy. You also should not arbitrarily keep rescheduling appointments without confronting this issue.
All of the following statements are true about cannabis and depression EXCEPT?
Correct answer: Cannabis increases the chances of people seeking appropriate mental health treatment. Cannabis appears to lower the chance of people seeking treatment for their mental health, which may explain why cannabis may worsen depression symptoms. However, more people are appearing to self-medicate mental health symptoms with cannabis (perhaps due to legalization and treatment being cost-prohibitive). However, it has not been effectively proven to treat depression.
All of the following populations may be good candidates for a harm reduction-based recovery EXCEPT:
Correct answer: Clients who identify themselves as being 'alcoholics' or 'addicts.' While there is no set formula for determining who can succeed with harm reduction, people who self-identify as being an addict or alcoholics may have more severe substance use disorders, which may indicate a harder time moderating consumption. The other factors (no history of withdrawal symptoms, no significant life disruption, not in acute life crises) MAY suggest that the substance use is milder and/or can be moderated (although this is not always true and varies client by client).
When taken at high frequencies, which of the following drugs is NOT associated with a withdrawal process that requires medical management?
Correct answer: Cocaine Cocaine is a stimulant, and stimulants do not produce withdrawal symptoms that generally necessitate medical management. Xanax and alcohol do, as medical complications (convulsions, delirium tremens, seizures) can occur. In rare—but serious—cases, withdrawing from these drugs can be fatal.
Which of the following screenings is most appropriate for assessing the risk of suicide or self-harm?
Correct answer: Columbia-Suicide Severity Rating Scale (C-SSRS) The C-SSRS is well-known for assessing suicide risk. It is known as being reliable and is currently available in over 100 languages. The 10-Item Drug Abuse Screening Test (DAST-10) would assess substance use disorders. The Mental Health Screening Form-III (MHSF-III) assesses the presence of mental health symptoms. The World Health Organization (WHO) Disability Assessment Schedule 2.0 assesses the global spectrum of health and disability (not specifically suicidal ideation).
When it comes to intravenous substance injection, what happens to an individual's blood levels?
Correct answer: The blood level of the drug increases sharply and then drops off just as sharply. The intravenous route of administration is associated with dramatic highs and dramatic lows. Rapid routes of administration are often associated with higher levels of tolerance and compulsive use. Taking drugs intranasally (snorting) tends to have more of a gradual effect.
A client states that they can no longer afford your fee for counseling services. How should you proceed next?
Correct answer: Consider if you want to make financial exceptions or provide appropriate referrals The best answer is to consider if you want to make a financial exception for your client. However, you are not obligated to do this, and if you can't do so, you need to provide referrals. You do not necessarily NEED to offer a sliding scale rate (although you should be mindful of client abandonment). You would not automatically terminate treatment (because you would first consider if you will make financial accommodations). We don't have enough information to determine whether it's appropriate to step down a client's care. Doing this prematurely can be dangerous for the client.
A client living within a residential treatment facility states that they need a more comfortable bed to support their scoliosis. The client cites that they are also in very bad back pain and would like to talk about making better accommodations for this discomfort. As a counselor, how should you next proceed?
Correct answer: Coordinate with your care team to review possible accommodations As a next step, it's a good idea to talk about the potential options with your care team. The client has already shared what accommodation they need (and you need to see if this is possible). You may request that they meet with their doctor to see if any physical injuries or acute care concerns need to be ruled out. We don't have enough information to determine whether they should be transferred elsewhere.
What is the BEST definition of "continuity of care" as it pertains to substance use treatment?
Correct answer: Coordination of care as clients transition and move across different support systems This is the best definition of continuity of care. Because substance use disorder treatment tends to be chronic and long-term, clients need support as they move through different supports/resources. This stands regardless of whether relapse happens or stabilization is achieved. Coordination of care among multiple healthcare providers treating a client generally refers to a treatment team or wraparound care.
Another counselor approaches you stating that they are building their practice and that they will offer you $50 in exchange for any client referral that you give them. Based on this information, how should you ethically proceed with this request?
Correct answer: Deny it, as you should not engage in fee splitting. Counselors should not engage in fee-splitting, which refers to receiving commissions or monetary referrals based on clients. This can be exploitative, but the ethical consideration falls under fee-splitting. Documentation or client consent does not apply in this case.
All of the following represent appropriate screening questions to determine a client's risk for suicide EXCEPT?
Correct answer: Do you ever threaten suicide to get my attention? This is not considered an appropriate screening question and instead insinuates the client may be doing something wrong by talking about their suicidal thoughts/feelings. The other questions (Do you ever wish you weren't alive?, Does it ever seem like your life isn't worth living?, and Do you have a plan to end your life?) are all appropriate screening questions.
What is technically considered 'heavy drinking' for men in the United States?
Correct answer: Drinking more than 5 drinks in one period on 5+ days in the past 30 days. According to SAMHSA, drinking more than 5 drinks in one period of 5+ days in the past 30 days is considered heavy drinking (4+ drinks for women). However, it is important to note that drinking can ebb and flow over the lifespan, and any pattern of binge drinking should be taken seriously.
All of the following represent appropriate interventions to use during the precontemplation stage of change, EXCEPT:
Correct answer: Educating the client about cravings and how to cope with them safely The precontemplation stage is characterized by themes of denial, in which the client does not acknowledge having a problem and is not considering making changes. Therefore, you would not talk about coping with cravings because the client has not expressed wanting or needing alternative strategies for coping with cravings. However, you would certainly explore the risks and benefits of ongoing substance use, assess for discrepancies in a client's stories/realities of substance use, and provide psychoeducation using qualified, objective information from trusted sources like the DSM-5.
Your client tells you that they're worried they won't have any friends if they stop drinking, stating that the majority of their social connections are built on partying, going to clubs and bars, and tailgating at sports events. How might you BEST intervene with this client?
Correct answer: Empathize with their fear and explore their feelings deeper As a counselor, it's important to validate your client's feelings and reaffirm their internal experiences. Therefore, jumping to ask them to list all the consequences somewhat invalidates their emotions. And while it is possible to build authentic sober relationships, you don't want to disregard your client's fears at the present moment.
A client with a significant history of severe alcohol use has come to treatment reporting that they would like to learn how to drink alcohol in moderation. They state that the idea of "never drinking" seems impossible. Given this information, how should the counselor BEST move forward?
Correct answer: Encourage the client to consider temporarily experimenting with abstinence As a first step, it's important to raise the idea of temporarily experimenting with abstinence without the pressure of it being a "never drinking" situation. Some clients may be adamant about a harm-reduction approach, and if that's the case, it may be beneficial to engage in moderation experiments (which often start with a month or so of abstinence) followed by moderating use. Psychoeducation is always helpful, but you wouldn't necessarily have the client sign anything indicating that they learned about these benefits, unless it's an agreed-upon treatment goal. We don't have enough evidence to suggest that this client is in the precontemplative stage of change, which denies having a problem.
What is the first step in conducting a comprehensive, biopsychosocial assessment with a new client?
Correct answer: Engaging the client and building rapport. Building rapport is always the first (and often the most important) step in any assessment process. This includes validation, empathy, and compassion for clients, which then lends to a more open, honest assessment. From there, you would assess for the right diagnoses, establish the client's strengths and supports, and then determine the appropriate level of care.
Margie is a client who continues to call her counselor, Fiona, after work hours. Margie is often in a perceived state of crisis and states that she feels reassured by Fiona's calming words. Fiona is finding herself increasingly resentful of the extra effort she needs to put into Margie's treatment. Given this situation, Fiona should NEXT proceed by:
Correct answer: Establishing boundaries for what constitutes an emergency and apologizing to Margie for any misunderstanding that she allowed in the past Fiona should quickly reestablish boundaries and apologize for any potential rupture in the counseling relationship. It is not enough to just remind Margie to call in true emergencies, as she likely perceives these instances as true emergencies. At this point, continuing to take her calls may exacerbate resentment, and this is not necessarily a case of abandonment. As a precautionary measure, Fiona should also seek supervision and/or consultation about this case.
A client tells you that they are committed to remaining abstinent from alcohol and benzodiazepines. However, they report that they do not have a problem with cannabis and do not intend to quit using it. They are using cannabis daily to 'manage symptoms of anxiety and other drug-related cravings.' You have some concerns that their cannabis use is impacting their ability to get and hold a job. Given this information, how should you proceed next?
Correct answer: Exploring their fears or thoughts about what it means to quit cannabis. All the answers MIGHT be used, but this is first course of action. You'd want more information about what the client thinks quitting cannabis might mean for them. Knowing these thoughts/fears can help you decide the next interventions (i.e. suggesting abstinence for a designated period if time, honoring their autonomy, and providing more psychoeducation). You want to avoid getting into power differentials with clients and instead understand their viewpoints better.
All of the following represent significant risk factors of suicidal ideation EXCEPT:
Correct answer: Having direct access to firearms. Firearms certainly pose a risk to someone who indicates having suicidal thoughts, but they are not inherently a risk factor (even though people are more likely to die from using firearms than other means). Having a past history of suicidal ideation or attempts, having co-occurring disorders, or having a family history of suicidal thoughts/behavior all represent significant risk factors. When talking about someone's firearms, it's important to understand the value/reason for having them, rather than assuming someone wants to use them to harm themselves.
Steve is working with Carol, who arrives to session severely under the influence of both alcohol and narcotics. She also appears to be in a state of acute psychosis. Steve is concerned about Carol's imminent safety given her history of overdoses. He recommends a higher level of care, which she refuses. How should Steve proceed?
Correct answer: He should contact local police and emergency medical services. At this point, Carol is in serious danger, and it's important for Steve to break confidentiality to keep her safe. It might be beneficial to contact her emergency contact, but there's no guarantee that someone is available. We have no evidence that Carol has driven to session, and contacting local authorities is the first step here.
During the "taking action" phase of treatment, a counselor is MOST likely to:
Correct answer: Help clients change their unwanted behavior and reduce or stop substance use At this stage, helping clients change unwanted behavior and reduce/stop substance use most aligns with "taking action". Matching treatment interventions to the client's current level of motivation happens before, during individualized goal-setting and treatment planning. Doing what's necessary to maintain and solidify positive recovery gains occurs during the reducing recurrence or relapse phase. Engaging in a therapeutic relationship and assessing goals is the first phase, which is known as assessment.
All of the following represent areas of assessment within the biological sphere of a biopsychosocial assessment EXCEPT:
Correct answer: History of trauma. Biological behavior refers to concrete medical results (i.e. positive drug tests, impaired cognition, alcohol on the breath, presence of withdrawal symptoms, acute injuries). A history of trauma falls under the psychological part of the biopsychosocial assessment.
A client in inpatient treatment for co-occurring mental health and substance use disorders tells you that they plan on leaving treatment because they are afraid of getting fired from their job and they can't afford to lose their income. They ask asks for your help to find outpatient services that will work with their schedule. You do not believe this client is ready to transition out of their current level of care. Given this information, how should you proceed?
Correct answer: Honestly present your concerns about them leaving treatment and start obtaining referrals for local outpatient services. At this point, it would be appropriate for you to be direct and honest about your concerns. You should support their autonomy, but you should also present your feelings. We don't know if they don't think they are ready to leave treatment, so having them write down 10 consequences somewhat invalidates their current needs.
You are a counselor working in an outpatient setting with Gloria, a young woman referred to treatment for cocaine use and alcohol use disorders. You believe Gloria would strongly benefit from attending 12-Step support groups. She tells you that she has no interest in joining or speaking to a group, but that she's open to counseling and attending church to aid her recovery. How should you proceed?
Correct answer: Honor Gloria's autonomy and explore her resistance to your suggestion. This is the best suggestion. You should not continue encouraging (or forcing) someone to do something they do not feel ready to do. However, it would certainly be appropriate to explore Gloria's resistance. You MIGHT ask if she's willing to try the program for a set period of time, but you'd first want to understand her reasons for not wanting to go.
All of the following criteria are considered when diagnosing substance use disorder EXCEPT:
Correct answer: How frequently someone uses substances. Although the frequency is generally part of a basic assessment, it is not a diagnostic criterion for a substance use disorder. While some people use substances daily (or more often), others use them in a more binge pattern. However, the other answers (using more of a substance than intended, being unable to stop or cut down on substance use, and spending more time getting or recovering from substance use) are all DSM-5 criteria to consider when diagnosing.
Many counselors teach H.A.L.T to their clients as a way to avoid escalating stress. What does H.A.L.T stand for?
Correct answer: Hungry, angry, lonely, tired. Hungry, angry, lonely, tired is the long-form of H.A.L.T, and this is commonly taught in substance use settings, as any of these triggers can induce cravings. The others (hot, livid, arrogant) may also be noteworthy triggers to conside
You are a counselor working in a drug and alcohol treatment facility that typically treats patients for 3-6 months. Your new client, Gail, informs you that she doesn't plan on staying in treatment longer than one month, as that's all she's allowed to take off from work. She has a severe methamphetamine addiction and a history of relapsing just after treatment. How would you BEST plan for Gail's treatment after your initial intake together?
Correct answer: Initially focus on short-term goals and then reestablish the course of treatment as it gets closer to 30 days. As a counselor, you want to focus on meeting the client where they are. So, you should focus on short-term goals first and then reestablish as needed. You should not automatically challenge Gail's resistance or ask her if she wants to extend treatment — although you might do this later in your course of work.
All of the following represent potential protective factors against developing substance use problems EXCEPT:
Correct answer: Intelligence Intelligence is generally not considered a protective factor or risk factor for substance use. A protective factor refers to characteristics that coincide with lower likelihood of problem outcomes (i.e. abusing substances). Positive self-image, high themes of self-control, and social competence (getting along well with others) are considered protective factors in substance use treatment and in reducing the risk of developing substance problems in the first place.
All of the following are true about assessing for suicidal ideation, EXCEPT:
Correct answer: It is important to have guns removed from the home. Sometimes, it is helpful to have guns removed from the home, but guns can be an important part of the patient's or family's identity/values, so this is not the automatic response, particularly if the client denies ideation. However, screening should be done at the beginning of treatment as well as throughout treatment. Since people use guns more than any other method to complete suicide, it's important to ask if they're present in the home.
When is it considered appropriate for a counselor to engage in a sexual relationship with a former client?
Correct answer: It is never considered appropriate It is never considered appropriate to engage in sexual behavior with current or former clients. This supersedes any 'year rules' (i.e. two years passing). A client's recovery or ability to consent to sexual behavior does not change this ethical consideration. Counselors are in a position of authority within the counseling relationship, and a sexual relationship can undermine and exploit that power.
Why is the assessment phase generally considered the most significant phase of treatment?
Correct answer: It sets the stage for just about everything that follows it and often determines whether a client stays in treatment. The assessment phase is the first phase of treatment in which you gather all background and current data about a client's presenting issue, and it absolutely sets a tone for what happens afterward. This can "make or break" treatment. Treatment planning happens after the assessment, during the goal-setting phase. Concretizing what a client is doing occurs during the "taking action" or "action" phase.
One of the main limitations of disulfiram (Antabuse) is:
Correct answer: It's easy for clients to forget or stop taking it once they entertain the idea of drinking. Because disulfiram is taken orally, it requires clients to adhere to the treatment protocol. They can quickly stop taking it as soon as they want. Disulfiram can be taken 24 hours after consuming the last drink (not 1-2 weeks), and people can safely drink roughly 24 hours (not 12) after discontinuing use.
A client comes to you stating they have been depressed for most of the past month with limited energy, poor concentration, very little to no appetite, and passive suicidal thoughts. They are continuing to drink to cope with their 'sadness.' They state that they shouldn't be 'so sad and that life is going pretty well on paper.' Based on these criteria, this client likely meets the criteria for:
Correct answer: Major Depressive Disorder The client likely meets criteria for major depressive disorder, which is marked by experiencing 5+ depressive symptoms over a 2-week period. Bipolar disorder would include the presence of a manic or hypomanic episode, which we don't have evidence supporting. Persistent depressive disorder symptoms occur for at least 2 years (which is not the case here).
During the intake process, a client tells you that alcohol abstinence is not their primary goal. They instead want to work on their depression and anxiety and see if that decreases their desire to drink. This mindset is based on a friend of theirs who had success with this approach. That said, your client also reports drinking 1-2 bottles of wine per night and has had two DUIs in the past three years. How should you best plan their treatment given this information?
Correct answer: Make a treatment plan that focuses on reducing depression, anxiety, and moderating/abstaining from alcohol. It's important to make a comprehensive treatment plan that focuses on all problematic areas. It is highly likely that this client has an alcohol use disorder and needs support with this, even if it isn't their main focus right now. You would work on reducing triggers/managing cravings together, which would likely help with abstaining from alcohol. Unless the client is completely unwilling to work on her alcohol use, you would not just defer to an individual therapist.
You are a counselor working with a client, Bradley, who has been smoking cigarettes since age 11. Bradley is coming into treatment for alcohol, opioid, and stimulant use disorders. Bradley acknowledges that they also smoke 1-2 packs of cigarettes a day and would like help quitting "at some point." Given this information, how should you proceed?
Correct answer: Making a treatment plan that focuses on reducing/quitting all substances, including nicotine. Although many clients struggle with nicotine use, treatment centers, and counselors often overlook this problem to focus on other drug-related issues. However, if a client shares the desire to quit nicotine, their treatment plan should reflect this goal. You might assess how serious Bradley is about these intentions, but they have already expressed that they want help quitting. You might provide them with some psychoeducation about the risks of such dramatic change all at the same time, but you shouldn't deter a client from wanting to make proactive decisions for their mental and physical health.
Which of the following strategies is generally NOT appropriate when counseling someone who is currently in a manic episode?
Correct answer: Matching the client's tone and pace within the session If a client is in a manic episode, you would not want to meet them at their current level of intensity. You'd want to slow down and maintain a calming, grounding presence. This can help maintain a sense of safety. You would definitely want to emphasize maintaining medication adherence. You would also want to consider assessing for suicidal ideation, as clients are at heightened risk for suicide during this time.
Max is a counselor working with a new client, Frank. Frank was referred to Max by a therapist colleague. The therapist is working with Frank on their trauma and co-occurring bipolar disorder. In your first session, Frank tells you, "Feel free to tell my therapist anything about my treatment. I trust them completely." How should Max best coordinate treatment given Frank's comment?
Correct answer: Max should ensure that they have a signed release of information to talk with Frank's therapist. Max should first make sure that they have a signed release of information (which is intended to coordinate treatment between providers) to talk to Frank's therapist. Verbal permission is not sufficient enough. From there, Max would use their professional discretion to decide what to share with Frank's therapist. Max should then also let Frank know what they will be generally sharing as part of regular treatment updates.
Morgan is a new counselor working in an inpatient setting, facilitating groups and running individual counseling sessions. She recognizes having countertransference toward one of her female clients. She feels protective over her, as if she's a younger sister or friend. Morgan sometimes extends session times with her and has even given her small gifts on occasion. What is the MOST important concern to consider within this counseling dynamic?
Correct answer: Morgan is blurring professional boundaries, which can ultimately harm the client's well-being. This is an example of a counselor blurring professional boundaries, which can be challenging for a client and can cause them harm. This is not the same as a dual relationship (i.e., Morgan acting in a different role for the client). What Morgan is doing is a form of giving a client special privileges, but the privileges fall under the umbrella of blurred boundaries, which create an inherently complicated power differential between counselor and client.
What is the main concern associated with treating a substance use disorder first, when other co-occurring problems exist?
Correct answer: Most clients can't make stable recovery gains without effectively addressing other mental health issues Generally speaking, it's recommended that treatment efforts are comprehensive and focus on all problems together (rather than prioritizing just the substance use first). This is because many people can't sustain their recovery efforts if they don't address their mental health. Many clients can maintain abstinence long enough to work on their mental health, and many can stop using substances even if they have underlying mental health issues. But "stable" recovery refers to a long-term, healthy recovery, and that tends to entail addressing other co-occurring problems.
When a client is acutely intoxicated, all of the following need to be considered during the counseling intake process, EXCEPT:
Correct answer: Obtaining informed consent for treatment When there is evidence of acute intoxication, it's not appropriate to engage in clinical tasks — the client can't coherently consent to treatment at that time. You would, however, make every effort you could to ensure their safety is protected. This may include asking to hold their car keys, arranging for safe rides home, or calling 911.
All of the following represent key elements of culture EXCEPT:
Correct answer: People People isn't considered a key element of culture (although cultures are made of groups of people). But the people are essentially defined by different parts, including symbols (how people express themselves), beliefs (how they think), and practices (how they behave).
A client comes to treatment for his alcohol use disorder. He recently received his second DUI and lost his job as a result. He states that his wife is "fed up with his drinking". He believes he can learn to moderate his drinking, although he also indicates several failed attempts to do so. He says he got caught driving at the wrong times and would like to "find a middle ground" about his drinking with his wife. Based on this information, this client is MOST likely in which stage of change?
Correct answer: Precontemplation This client is most likely in the precontemplation stage, a stage characterized by denial about the severity of their substance use. These clients don't readily come to treatment unless they are either mandated by the court or encouraged by a loved one. If this client were in preparation stage, he'd be "prepared" to make a change towards his alcohol use. If he were in the action stage, he'd be committed to specific goals and taking steps to achieve them. If he were in the contemplation stage, he'd start to experience thoughts/ambivalence toward stopping/reducing drinking, which isn't the case with this client.
When a client arrives at an intake session in a state of distress, what is the FIRST goal the counselor should consider working toward?
Correct answer: Protecting the individual's safety and working to stabilize the most acute symptoms Protecting safety and focusing on the crisis are the most important areas of focus. There may not be a treatment team in place at this time, and you may not have time to collaborate. If the client is intoxicated, you may not be able to obtain informed consent, and protecting the individual's safety would include consent if applicable. We don't have evidence that being in a state of distress equals being intoxicated.
Laura is interested in working with an EMDR specialist due to complex trauma. Given this information, how should her counselor, Tristan, BEST respond by the end of that session?
Correct answer: Provide referrals for EMDR specialists Counselors can and should provide referrals to other providers when appropriate and requested. Exploring the desire to work on trauma or work with a specialist (and learning more about a specific modality) would also be appropriate, but you definitely want to provide that referral.
A journalist reaches out to a counselor asking him to provide his "expert opinion" about a celebrity's "erratic drug use". How should the counselor proceed?
Correct answer: Refuse to provide any professional opinion or diagnosis Counselors should not make public opinions/diagnoses/statements, as it can be misleading to the public. Informed consent doesn't apply here, as the celebrity is not the counselor's client (and we're not speaking about their treatment). Simply stating that "opinions should not be interpreted as facts" is not strong enough.
What are the main functions of the brain stem?
Correct answer: The brain stem is responsible for controlling basic life functions, including heart rate and breathing. The cerebral cortex controls critical thinking, problem-solving, and decision-making. The limbic system regulates the ability to experience pleasure, and it also regulates the perception of positive and negative emotions.
What BEST describes the concept of "reciprocal relapse" as it pertains to substance use disorders?
Correct answer: Relapse into one problem (substance use) precipitates relapse into another problem (mental health issue) Reciprocal relapse refers to relapsing in one domain causing a relapse in another (e.g., someone starts drinking again, which worsens their anxiety or depression). Or, someone feels better sober, so they stop taking their depression medication, which causes their mood to worsen, which triggers a relapse. Relapsing in one area rarely resolves a problem in another area (although it may seem to temporarily). Avoiding relapse in one problem may improve symptoms of another problem, but that's not the case with reciprocal relapse. Relapsing in two problems doesn't always happen at the same time.
From a treatment planning perspective, all of the following statements are true about relapses EXCEPT:
Correct answer: Relapses start once the person begins abusing substances again. Relapse refers to both mindset and behavior. For this reason, the process of relapse occurs before the person starts using again (using is seen as the final symptom and not the beginning one). It is true that relapses are a common part of the recovery process, but they don't necessarily mean that treatment has failed. It's also true that relapses generally happen after someone has withdrawn from their established recovery support and routine (hence relapse being more of a mindset than just a set of actions).
The mechanism of death that's caused by an overdose on opioids is:
Correct answer: Respiratory arrest Respiratory arrest refers to the absence of breathing, which can happen from respiratory distress or failure. This is what death by opioid overdose is caused by. Pupillary constriction refers to having small or constricted pupils, which is a side effect of using opioids. A grand mal seizure is caused by a loss of consciousness, but it is not inherently fatal.
Relapse in the stages of change model can best be defined as:
Correct answer: Returning to previous substance use habits and regressing from one stage of change to an earlier one Relapse refers to abusing alcohol/drugs in old, familiar ways and regressing to earlier stages of change (e.g., contemplation to precontemplation), which can maintain the continued using. Relapse doesn't inherently mean the individual loses the desire or incentive to be in recovery.
Sasha is a counselor sitting in session with a client, Heather, while they make a phone call to their mother. Heather tells her mother, "Sasha is such an amazing therapist! She's so helpful, and I just really appreciate all her guidance." How should Sasha proceed next?
Correct answer: Sasha should clarify her role as a counselor to both Heather and her mother. Counselors should never claim directly or indirectly professional qualifications that they don't possess. Therefore, Sasha should be explicit in her role as a counselor (and not as a therapist). Telling her she's flattered is not appropriate, nor is asking Heather if she's "confused" (as this may come across as condescending or playful). It may be appropriate to validate Heather's feelings (particularly if Heather DOES view her as a therapist figure), but it's most important ethically to clarify her role first.
Two months into addiction treatment, a client tells his counselor, Jasmine, that he is also working with another counselor, Max. He tells Jasmine that he prefers her more compassionate, open-minded approach to recovery, while he likes Max for his highly-direct attitude about recovery. He states that he genuinely gets 'a full treatment experience' by working with both counselors. Based on this information, how should Jasmine proceed NEXT?
Correct answer: She needs to tell her client that she can't provide him with professional services while he's working with another counselor. Counselors need to refrain from offering counseling services when they have knowledge that the client is working with another counselor UNLESS they are specifically focusing on different topics. Based on this information, both counselors are focused on addiction recovery. The client should ultimately decide who they want to continue treatment with, but Jasmine wouldn't outright say, "You have to pick which one you want to work with" without giving education about not being able to provide such professional services when there is another provider in the picture. Coordinating care may be beneficial if they are treating separate issues (which isn't the case here). An ROI may be helpful later on if the client decides to terminate with Max and continue with Jasmine.
Paranoid delusions, volatile behavior, and hallucinations represent extreme reactions that MOST likely coincide with actively using which type of drug?
Correct answer: Stimulants Stimulants, which include cocaine, methamphetamine, and prescription amphetamines, may result in toxic psychosis, which includes delusions, hallucinations, and, at times, violence. These symptoms are generally not present with opioids, but they may be present during acute withdrawal from benzodiazepines and alcohol (although the effects are very temporary).
A counselor in recovery from alcohol use disorder begins drinking again on the weekends. After a few months, she is drinking every night after work. She does attend AA meetings and her sponsor is aware of the issue. She has also been going back to therapy. However, despite these efforts, she has not been able to cut down successfully on her drinking. Based on this information, how should this counselor proceed?
Correct answer: Take a leave of absence from work until she can stabilize herself back into recovery Ethically, counselors need to recognize the impact of impairment on professional performance and seek treatment if they are struggling. Based on this counselor's presenting issues, she should take a leave of absence from work until achieving a sense of stabilization (which may take longer than 30 days — there isn't a set time limit for this). She should consider talking to her boss and care team about what's going on and may seek a higher level of care, but taking a leave of absence is a first priority.
Your client, Robert, reveals that he's been drinking throughout the course of your treatment together, even though you were under the impression that he had been entirely abstinent. He acknowledges tremendous shame and states he was afraid of your reaction to his lying. How should you proceed NEXT?
Correct answer: Thank Robert for his honesty and explore what it felt like to lie to you Empathy is one of the most important traits a counselor can possess, so it's important to empathize with your client, validate their honesty, and explore how their decisions affect your relationship together. Even if you do have concerns about his lying behavior, you wouldn't want to respond in a way that might trigger more shame. You also might discuss what prompted Robert to be honest now, but this would be after thanking him for his honesty.
What is the MAIN risk of a counselor encouraging abstinence when a client doesn't believe they have a problem with their substance use?
Correct answer: The client and counselor may not build a strong rapport, as the client may feel invalidated or controlled. Of all the risks, lack of rapport makes it very hard for a client to trust or feel supported by their counselor. This doesn't mean a client necessarily wants to prove a counselor wrong. It's true that the client and counselor may not agree on treatment goals, but this has less to do with values and far more to do with a counselor not being attuned to what a client needs at that moment (or recognizing their stage of change). This is considered a risk to acting within a client's best interest.
When making decisions about treatment procedures or referrals, what is the MOST important consideration a counselor should keep in mind?
Correct answer: The client's welfare The client's welfare should always be held to the highest standard when making treatment decisions. This may have to do with the client's recovery, although it's not inherently the case. Sometimes their welfare contradicts their preferences, especially in early stages, although they may go hand-in-hand at times.
Which of the following is TRUE about recording a client's counseling session for training purposes?
Correct answer: The counselor needs to obtain written consent Counselors need to obtain written consent to record sessions — verbal is not enough, and it doesn't matter whether the client is a minor or adult. They should also document this in their notes. HIPAA guidelines do not necessarily apply here, as HIPAA refers to how communication is shared with third-party payers, like insurance companies.
A counselor tells a client, "alcohol is pure poison, and everyone really should avoid drinking." What are the ethical concerns with this statement?
Correct answer: The statement is not empirically factual, although the counselor is acting as if it is. Counselors should not make bold and presumptuous claims without having sufficient data to back them. This is not an example of discrimination (which would be treating someone differently based on their sex, religion, race, etc.). It is also not necessarily an issue of scope of competence, which refers to the skills and tasks a counselor can provide.
Hector has agreed to meet with Brian, a young adult for free counseling after he has recently lost his job and health insurance. What is the most important ethical consideration Hector needs to keep in mind?
Correct answer: There are no ethical considerations based on this information alone. Counselors can offer free counseling depending on their specific roles/settings. This can be time-limited or indefinite. If it is time-limited, Hector would need to share this with Brian (although we don't have enough information to justify doing this first). This is not an example of fee-splitting (receiving bonuses or referrals for sending clients to other providers). Brian does not need to sign an ROI for this, although he will need to sign for it in his informed consent paperwork.
All of the following statements are true about MDMA, EXCEPT:
Correct answer: There are numerous case studies of people dying solely from the direct use of MDMA. Deaths from MDMA tend to be from dehydration and poor ventilation, which can cause hyperthermia and/or heart attacks, especially if high amounts of alcohol are also consumed. MDMA has similar properties to methamphetamine (a stimulant) and mescaline (a hallucinogen). Daily, compulsive use of MDMA is rare — it's far more likely for people to take this drug during specific times (at a club, rave, or party). There is evidence that MDMA is neurotoxic, meaning it adversely impacts brain function.
Which of the following is considered a benefit to psychoeducational classes in substance use treatment?
Correct answer: They help increase client awareness of specific problems. Psychoeducational groups are meant to be factual and instruction-based, which increases client awareness of specific problems. They are not a replacement for case management or individual support. Process groups strengthen connections, whereas psychoeducational groups follow more of a lecture-based format.
In all of the following cases, you would maintain a client's confidentiality EXCEPT:
Correct answer: They indicate a babysitter hitting their child As a mandated reporter, you are responsible for reporting child abuse (past or present). Passive suicidal ideation does not warrant breaching confidentiality (until there is an established plan and intent). Relapse is also not grounds for breaching confidentiality. Physical abuse among adults is not reportable (unless children are regularly witnessing it or getting involved or the adult is a dependent adult).
Tim is a counselor working with Ryan, who has struggled with chronic relapse over the past decade. Tim relates considerably to Ryan's story. He recommends that Ryan attend AA meetings every single day, just as he did. When Ryan says he'd like to also work with a psychiatrist, Tim says, "That's the easy way out. I tried it, and medication doesn't fix the problem. You need to really dig in and turn yourself over to God." What ethical concern is MOST present in this situation?
Correct answer: Tim appears to be losing objectivity with Ryan's treatment. Of all the issues present, Tim is losing objectivity and integrity in his work. He's acting as if he knows the best answer for Ryan based on his own lived experience, which doesn't serve in the best interest of the client. Giving direct advice can sometimes be appropriate, as can self-disclosure (although Tim may be misusing both these counseling interventions).
All of the following represent key principles of drug addiction treatment EXCEPT:
Correct answer: Treatment, in rare exceptions, may include medications Many clients benefit from medication for various reasons (cravings, mental health needs, smoking cessation, etc.). This is not necessarily an exception to treatment. It is true that treatment should be easily and readily accessible, that even mandated treatment can be highly effective, and that, if ongoing drug use is occurring, it should be monitored closely.
How long can THC be detected in urine?
Correct answer: Up to 40 days Research shows that THC can be detected in urine for up to 40 days. THC is distributed quickly into fat tissues throughout the body, but it is slowly eliminated and then excreted from the fat cells. Individual factors, such as age, height, weight, and medical history may slightly impact how long any drug, including THC, is detected in tests.
What refers to a rupture within a counseling relationship?
Correct answer: When a client feels unsafe based on something a counselor does Ruptures refer to feeling unsafe within a counseling relationship, and this speaks to when a counselor does something (often without realizing it) that upsets, hurts, or worries a client. When counselors feel unsafe, this is often a countertransference reaction, although it can become a rupture if the client experiences it too. When a counselor is not able to provide the right services for a client, a referral can be made, and this is generally not a rupture.
In which of the following situations would it be MOST appropriate to provide a client with psychoeducation?
Correct answer: When you want to normalize the symptoms of post-acute withdrawal syndrome. Normalizing symptoms can open a great bridge for psychoeducation (educating clients about specific and relevant mental health topics). Because post-acute withdrawal syndrome (PAWS) can be difficult in the early stages of recovery, talking about the symptoms (depression, anxiety, lethargy, irritability) is often helpful for clients. Raising awareness, validating, and building rapport are all important therapeutic skills that often focus on strengthening the relationship and providing empathy for a client's experiences.
Before speaking to a family member about a client's treatment, the counselor needs to legally consider which of the following as a first step?
Correct answer: Whether they have an appropriate release of information First and foremost, confidentiality is a legal consideration for all counselors. A release of information refers to written documentation that allows you to talk about your client's treatment with other individuals. You need this release before making any other decisions. You should consider whether family will be supportive and how the client feels about coordinating care, but these do not fall under legal considerations.
A client shares the desire to taper off their methadone treatment. They have been taking methadone for nine months and say they want to see if they "can do recovery without it". The counselor should consider all of the following points, EXCEPT:
Correct answer: Which medication is more effective than methadone This is not a matter of knowing which medication is more effective than another, as it comes down to individual brain chemistry and unique differences in a client's history/presenting issues. The counselor should certainly assess the motivation behind the desire to stop taking methadone as well as their social support and coping mechanisms, as these may all need to be considered during the tapering process.
You work in a large agency under several counseling directors. A client tells you that another counselor in your agency is regularly buying gifts for clients, driving them to and from AA meetings, and texting them on the weekends. How should you proceed given this information?
Correct answer: Write down this report and notify your boss about the situation. At this point, it's appropriate to escalate the situation to your director, as counselors should address the unethical conduct of colleagues. You would not necessarily need to talk to your colleague directly (although you might). You would not be the one responsible for sourcing clients to write down testimonies (this often comes from a boss or HR). This is not a matter of confidentiality, as confidentiality applies to clients specifically.
Your client, Drew, arrives to your session with red eyes and seems somewhat incoherent. Drew's speaking patterns feel more tangential than normal. You have had some concerns about them relapsing over the past week. Drew hasn't been attending groups and you know they fired their sponsor a few weeks ago. Drew states that they are just tired and haven't been sleeping well. How should you next proceed?
Correct answer: You should ask Drew directly if they have used any drugs in the past week. Counselors, at times, need to be very direct with their concern for their clients. Lying can be a common theme in all phases of substance use treatment. However, you would not tell a client that you think they are lying to you (this can be damaging for rapport). You should, instead, outright ask if they have used any drugs. They may still lie, and at that point, you might assess whether it's appropriate to ask them to take a urine test. This likely doesn't have to do with sleep, as you already have concerns about relapsing.
Your client Logan reports that their wife, Valerie, continues to threaten to leave them over all the problems they have caused in their marriage due to reckless drinking. You have spoken to Valerie on the phone a few times. Valerie presents as relatively hostile, both with you and Logan, and states that they're tired of giving second chances. Logan tells you that Valerie means everything to them and that they'd give anything to save their marriage. Given this information, how should you best proceed with counseling Logan?
Correct answer: You should assess whether Valerie is receptive to couples therapy. This is the best decision here, as the marriage seems to be a source of stress for Logan, and couples therapy can be extremely valuable for strengthening communication and reaffirming trust/commitment. You should also assess whether Logan is receptive to individual therapy, but issues within the marriage seem to be taking precedence at the moment. You would probably assess how Valerie's thoughts and feelings impact Logan's recovery, but you'd want to see if Valerie is open to working on the marriage with Logan. You already know that Logan wants to stay married, which rules out assessing whether they want to stay married.
A client calls you in the middle of the night stating that they are heavily intoxicated and that they feel incredibly depressed. They express tremendous remorse about their decision to drink and start crying inconsolably. They are at home alone and state they're just going to keep drinking until they can't feel anything at all. This client has a history of alcohol poisoning and has overdosed twice in the past year. How should you proceed next?
Correct answer: You should call 911 as this is a life-threatening situation. This is the best answer, given the client's past history and their current status as being completely intoxicated. At this point, they are already showing some potential signs of suicidal/dangerous behavior, and they are not in the right state of mind to speak to you coherently. You would, therefore, not maintain confidentiality, as this client is at imminent risk of harming themselves. You might ask if they have a supportive loved one who can be there for them, but you should still call 911.
You are working with Rachel, a young adult in residential treatment for opioid-use disorder. Her mother wants to know more about whether Rachel plans to break up with her boyfriend. Rachel has signed a release of information for you to talk with her parents, but the relationship continues to be a highly sensitive topic for her. She has acknowledged she doesn't want you to talk about it with anyone else. Given this information, how should you BEST proceed with her mother when she asks?
Correct answer: You should maintain Rachel's confidentiality preferences and avoid sharing information about the relationship. Rachel has already told you she doesn't want you talking about the relationship with anyone else, so you should maintain her confidentiality, regardless of whether she has signed an ROI. At this point, it's not about your personal discretion. Even telling her mother that the relationship is a 'highly sensitive topic' provides more detail than is probably necessary. You might ask Rachel what is appropriate to share, but when it comes to the mother, you should avoid sharing information unless given new information that indicates otherwise.
A client comes to you asking if you'd support her son's school fundraiser. She says a ticket is only $5 and that she'd really appreciate your donation. As her counselor, how should you proceed NEXT?
Correct answer: You should not donate to the fundraiser and explain that it's generally not appropriate to give money to clients. Counselors should avoid entering multiple/dual relationships with clients in which they have different roles with them. Giving money can be a subtle example of this, even if the amount is small. You might consider donating anonymously, but you should first proceed by telling your client that it's not generally appropriate to donate to their causes (regardless of rapport).
During an intake, a new client tells you that they are Catholic and an avid member of the church. You grew up Catholic and no longer identify with this religion and have some residual trauma as a result. How should you proceed with this client?
Correct answer: You should seek consultation and/or supervision and avoid discriminating against a client based on their religion Counselors should avoid discriminating against clients based on religion, race, age, gender, disability, and sexual orientation. If you can't stay objective (and this is generally hard to decide from just an intake), it MAY be appropriate to refer this client to another counselor (but this is not necessarily the case). It is probably not appropriate to disclose your own religious history and doing so would likely adversely impact the relationship.
