Mock exam #1, 2 & 3 and mock exam 1 & 2

24. During a session with a 16-year-old, a therapist learns that the client has been having strong suicidal ideation for the last week. The client has a tentative plan and access to means. What should the therapist do to manage the legal and ethical obligations in this case? A. Initiate an involuntary hospitalization. B. Inform the client that her parents must be informed. C. Provide the client with the number for a suicide prevention hotline. D. Explore the events leading up to the client's suicidal feelings.

B. Inform the client that her parents must be informed. Rationale: The best place to start is B. When treating a minor with suicidal risk, the parents should be included in the discussion unless there is potential harm to the client if they know. If the client refused B, then A would be the next step. C and D are possible interventions at some point.

59. During an initial session, a client tells the therapist that she is currently seeing another therapist. She expresses angry feelings toward the other therapist and would like to get another perspective on her problems. What action should the therapist take? A. Contract a set number of sessions with the client before sending her back to her current therapist. B. Inform the client that she needs to terminate her ongoing therapy before the therapist can provide treatment. C. See the client until she makes up her mind which therapist she wants to have for therapy. D. Request a release to discuss the client's case with the other therapist.

B. Inform the client that she needs to terminate her ongoing therapy before the therapist can provide treatment.

29. Two therapists are co-facilitating a social skills group for children with ADHD. During one of the sessions one of the children shows a scar on his back that his step dad inflicted because the child would not stay in his room after bedtime. After the group the therapists should FIRST: A. Both file a child abuse report. B. Call the child's mother and schedule a session. C. Determine which therapist will file a report. D. Assess the child for recent abuse.

C. Determine which therapist will file a report.

31. A client mentions she has been having a difficult time with anxiety and depression since she began a lawsuit against the company that fired her. She discussed feeling anxious about how they will treat her as a witness in the trial and who else they may end up wanting to bring into the court for the case. The therapist was subpoenaed by the client's opposing lawyer. The therapist should legally respond by: A. Asserting privilege. B. Consulting with a lawyer regarding the subpoena. C. Turning over the client's record and whatever else is required within the subpoena. D. Maintaining confidentiality.

A. Asserting privilege. Rationale: The best answer is A. There is no option of informing the client, so the best thing to do would be to assert privilege.

70. You are treating a 28-year-old client with Borderline Personality Disorder and a history of previous suicide attempts. During one session, she tells you that she frequently argues with her boyfriend, and during the arguments she often threatens to commit suicide to punish him for disagreeing with her. You ask her if she has a plan to kill herself, and she just laughs and refuses to answer your question. You should: A. Continue trying to assess the client for suicide risk, even though she refused to answer your question. B. Review your "no suicide" contract with the client and ask her to sign it. C. Discuss the possibility of voluntary hospitalization with the client. D. Continue treating the client according to the treatment plan, and reassess for suicide risk at a later time.

A. Continue trying to assess the client for suicide risk, even though she refused to answer your question. Rationale: Answer A is the best option. The client has a history of suicide attempts and has indicated potential risk. Although the client is being evasive, the therapist should continue to assess and manage the risk to determine if other interventions would be necessary. If the therapist determined a high risk, then C could be considered. Asking client to sign "no suicide" contract could be part of assessment, but is not sufficient on its own. Answer D does not address the immediate risk.

48. A client seeks therapy for anxiety after a car accident. She also decides to sue the driver of the other car who was at fault claiming that the accident has left her too anxious to drive. The therapist receives a subpoena for the client's records. The therapist should: A. Not accept the subpoena unless directed to do so by the client or the court. B. Accept the subpoena and give up the records since this situation represents an exception to privilege. C. Accept the subpoena and advise the client that the records will have to be surrendered because she has entered her emotional condition into a legal proceeding. D. Accept the subpoena, maintain confidentiality, and assert privilege if the client so directs.

D. Accept the subpoena, maintain confidentiality, and assert privilege if the client so directs.

23. A Mandarin-speaking client meets with a therapist at a mental health clinic after witnessing a shooting in the community. The client and his brother, who accompanies him, have limited proficiency in English. The therapist does not speak Mandarin, but knows a receptionist who is a native speaker. The therapist's MOST appropriate action is to: A. Approach the receptionist and ask her to translate. B. Attempt to conduct the interview without assistance. C. Refer the client to a different therapist. D. Obtain a professional translator before proceeding.

D. Obtain a professional translator before proceeding.

8. A 14-year-old is brought to therapy by her mother following her parents' divorce. The mother shares the custody agreement which states that both parents must consent for mental health treatment. When the therapist contacts the father, he refuses to comply stating, "her mother always thinks our daughter is depressed but she's not." How should the therapist proceed: A. Refuse treatment because the father won't consent. B. Obtain consent from mother. C. Obtain consent from mother and daughter. D. Obtain consent from daughter.

D. Obtain consent from daughter.

29. A 54-year-old woman seeks therapy for 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 whiny baby." What should the therapist do NEXT? A. Refer client to a psychiatrist for medication evaluation. B. File an elder abuse report. C. Determine who is caring for her mother when client is gone all day. D. Refer client to respite care services.

C. Determine who is caring for her mother when client is gone all day. Rationale: There is not enough to file an elder abuse report because there may be someone else caring for the mother while she is out. C is the best answer because it furthers the assessment. Answers A and D could be done at some point.

A therapist has been treating an 8-year-old with Attention-Deficit Hyperactivity Disorder (ADHD) for two months. The focus of treatment has been on reducing his impulsive behavior. One day, he shows up to his therapy appointment with a black eye. He shares that his 17-year-old brother beat him up because he used his computer without asking. How should the therapist proceed? A. Call the parents and discuss the situation. B. Discuss the importance of respecting others' belongings. C. File a child abuse report. D. Explore the client's feelings about the incident.

C. File a child abuse report.

14. A 13-year-old client with anxiety returns to therapy after a month at summer camp in Nevada. The client reports that his camp counselor exposed himself to the kids in his cabin and fondled the client at night. The client does not want his parents to know about the incident because he is ashamed that he "let it happen" and knows his parents will be angry with him. How should the therapist legally handle his disclosure? A. Assure him that his parents will understand and need to be told. B. File a report with Nevada Child Protective Services. C. File a report with California Child Protective Services. D. Obtain a release to contact the camp and inform them of allegations.

C. File a report with California Child Protective Services. Rationale: A child abuse report must be filed because child abuse occurred and it must be filed in California because that is where the therapist is licensed to practice so C is the correct answer.

32. During a group session with teen moms, one client shares that she's been fighting with her boyfriend since he took their 4-month-old out in the car without a car seat. She complains, "He just does what he wants with the baby and tells me I worry too much." The therapist should NEXT: A. Obtain more details about the boyfriend's treatment of baby. B. Inform the group that a child abuse report must be filed. C. File a report with child protective services immediately after group. D. Refer boyfriend to a parenting class for teen dads.

C. File a report with child protective services immediately after group.

A therapist has been working with a 34-year-old woman, who is in treatment for anxiety management. She informs the therapist that she has to go to Colorado on a work trip for 2 weeks. She has asked the therapist whether it would be possible to use Skype and maintain a regular session schedule. Legally the therapist should? A. Encourage the client to use her anxiety management skills and wait to resume sessions after she comes back. B. Inform the client that it is illegal to work with clients who reside in a different state if the therapist is not licensed in that state. C. Obtain a written informed consent and agree to meet the client on Skype during regular session time. D. Obtain informed consent specific to tele-therapy and document it in the client's file.

D. Obtain informed consent specific to tele-therapy and document it in the client's file.

23. A therapist is treating a 13-year-old girl. In the middle of the third session she shyly discloses that she is 5 weeks pregnant. She states that she is scared to tell her mother for fear of punishment. She shares that she and her boyfriend, who is also 13, want to keep the baby. The therapist should: A. maintain confidentiality and provide support to the client. B. make a child protective services report and contact the client's parents. C. make a child protective services report and refer the client to an M.D. D. maintain confidentiality and refer the client to health clinic.

D. maintain confidentiality and refer the client to health clinic.

14. In which of the following situations should involuntary hospitalization be considered? A. A person indicates a plan and intent to cause self-harm. B. A person demonstrates failure to provide shelter. C. A person refuses medical treatment. D. A person states intent to kill his boss.

A. A person indicates a plan and intent to cause self-harm. - A person who STATES intent on killing their boss is not enough, but a person who indicates a plan to harm themselves should have the therapist consider involuntary hospitalization

61. An agency has a policy that therapists cannot accept gifts of high monetary value. A Thai client that has been in therapy for eight months with a therapist gives the therapist a small crocheted blanket, the therapist should: A. Accept the gift graciously. B. Inquire about the value of the gift. C. Accept the gift on behalf of the agency. D. Inform client that she can't accept gift.

A. Accept the gift graciously.

53. A therapist works for a local mental health agency that provides therapeutic services to inmates. The therapist receives a subpoena for one of her clients who is currently serving time for physically assaulting a man who was subsequently hospitalized. What are the therapist's legal obligations in this case? A. Assert privilege on behalf of the client. B. Provide records since inmates are wards of the court and do not hold privilege. C. Consult with a lawyer to determine what legal obligations the therapist has to release records. D. Provide records since committing a crime is an exception to privilege.

A. Assert privilege on behalf of the client. Rationale: Answer A is correct. Psychotherapist-patient privilege still exists when someone is incarcerated. There is no option to contact client, so the next best answer is to assert privilege.

26. A therapist is treating a mother who is going through a contentious divorce. She came to session one day very upset and reports that the husband, who has visitation rights every weekend but does not have legal custody, has taken their children to another state without her permission. The therapist should: A. File a child abuse report for abduction. B. Encourage mother to consult with her lawyer. C. Call the police. D. Determine whether the children are safe.

B. Encourage mother to consult with her lawyer. - With abduction is not a mandated report, recommend a lawyer

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

A. Discuss the request with client. Rationale: A is the best answer before moving forward with a decision about how to respond to the parents request. The boy has a right to confidentiality even though parents consented for treatment. The therapist has the right to refuse the request if it could be damaging to the client to release the records. D might be a good response but only after discussing the request with the client.

38. A new client shares that he is also a therapist. He discloses that he recently had an affair with a client, but ended it because he knew it was wrong. He indicates feelings of guilt and remorse. How should the therapist proceed considering the legal and ethical issues in the case? A. Explore his feelings of guilt and remorse. B. Provide him with the brochure "Professional Therapy Never Includes Sex." C. Encourage him to file a report with the BBS. D. Find out if this has happened with other clients.

A. Explore his feelings of guilt and remorse. Rationale: A is the best answer, there is no obligation to report this or investigate it. At this point your primary concern is to provide therapy to your client regarding this issue. B is done when a client has revealed they had inappropriate relations with a therapist when they were their client.

48. A client seeks therapy for depression and discloses that she engages in non-suicidal cutting and has a history of sexual abuse as a child. The therapist has no experience in this area and feels uncomfortable working with the client. How should the therapist proceed? A. Find a therapist skilled in the area to whom the client can be referred. B. Seek training in the area of self harm and early trauma. C. Help the client decrease the urges to cut. D. Find an experienced therapist who would be willing to provide supervision.

A. Find a therapist skilled in the area to whom the client can be referred. Rationale: In this scenario, the therapist has not yet engaged in therapy with this client, therefore A is the best answer in order to best meet the specific needs of this client.

75. A therapist has been treating a 32-year-old woman with severe anxiety for two months. During a session the client shares that she has heard of EMDR from a friend who said that she found it very helpful. The client asks the therapist if he can provide EMDR as part of her treatment. The therapist has no training in EMDR, but agrees to incorporate it into her treatment. The therapist's action is: A. Illegal and unethical. B. Legal but unethical. C . Legal and ethical as long as he obtains proper training and supervision. D. Legal and ethical as long as he informs client of his limited training.

A. Illegal and unethical. Rationale: The best answer is A. Although therapists often can and do practice outside their scope of competence as they build their skills, it would be both illegal and unethical to falsely claim an ability to offer specialized treatment without any training or supervision. Answer C is wrong because EMDR requires considerable training prior to providing it as an actual treatment. The therapist should disclose his lack of training in EMDR and refer the client to a therapist trained in EMDR.

38. A therapist accepts insurance in private practice. The insurance company sends notice to the therapist requesting copies of five client files for an audit. This is a typical practice of the insurance company. What legal obligation does the therapist have in this situation? A. Make sure each file has an authorization and submit the files. B. Inform the panel that this violates confidentiality. C. Request written authorization for each file and inform clients about information released. D. Provide copies of the requested files.

A. Make sure each file has an authorization and submit the files. You do not need to inform clients of info being released, make sure you have authorization and then you can submit the files.

68. A 16-year-old is referred to a community agency for support. The client just learned she is pregnant and is confused, upset and doesn't think she wants to have the baby. The therapist has strong views against abortion and doesn't think the client should have an abortion. The therapist's MOST appropriate action is to: A. Seek consultation to discuss the matter. B. Refer the client to prenatal services. C. Encourage her to bring in father of baby to discuss the matter. D. Explore client's feelings about abortion.

A. Seek consultation to discuss the matter.

47. A former client is arrested for stealing clothes from a department store. The prosecuting attorney subpoenas the records. The client asks the therapist to assert privilege. In which of the following instances would the therapist most likely be required to comply with the subpoena? A. The client's defense is that she has the diagnosis of kleptomania. B. The client's attorney requested the records. C. The client's attorney has advised releasing the records. D. The judge has quashed the subpoena.

A. The client's defense is that she has the diagnosis of kleptomania.

70. A recently licensed therapist took one course on emotionally focused therapy during his internship. Now that he is licensed he advertises himself as having an "expertise in emotionally focused couples therapy." The therapist's actions are considered: A. illegal and unethical. B. legal and ethical as he received training as advertised following graduate school. C. unethical as he does not have the required training, education, or experience to be considered a specialist. D ethical only if he explains to clients that he only took one course.

A. illegal and unethical. - It is in the business code not the advertise falsely

33. In which of the following instances is a mandated report required? A. A 14-year-old takes pictures of a 9-year-old in her underwear. B. A 4-year-old was left alone with a 12-year-old and the 4-year-old was harmed. C. A 13-year-old reports having sex with her boyfriend. D. A 19-year-old reports sexual abuse by her coach when she was 13-years-old.

B. A 4-year-old was left alone with a 12-year-old and the 4-year-old was harmed.

35. A client who had previously overcome cancer has been readmitted to the hospital. The cancer has returned and spread. The client tells the therapist that she is at peace with the news and doesn't want to suffer through all the treatments again. The therapist is upset and is concerned that the client isn't thinking clearly. The therapist should FIRST: A. Schedule a meeting with the patient and her extended family. B. Acknowledge the client's right to self determination. C. Determine who has legal power of attorney for her health decisions. D. Obtain a release and speak with client's oncologist.

B. Acknowledge the client's right to self determination.

15. After meeting with a Japanese-American family for several months, the family has experienced improvements in communication and their children's behavior has improved. The parents give the therapist a gift card in appreciation of the good work with the family. Ethically, what should you do? A. Acknowledge the parent's appreciation and accept gift. B. Acknowledge the parent's appreciation and decline gift. C. Determine whether "fee for service" is acceptable in area. D. Explore cultural importance of providing gift.

B. Acknowledge the parent's appreciation and decline gift. Rationale: The reason B is the best answer is because there is no indication of the cash value of the card so the best response would be to decline the card. The other issue here is that, unlike other types of gifts that may have cultural meaning, a gift card is essentially cash. If a client tried to pay you a "bonus" for doing your job, it would be unethical to accept that.

56. A therapist has been seeing a client for over a year for substance abuse issues and depression. The client arrives for his session visibly drunk, slurred speech, and refuses to sit down on the couch for the session. The client continues to yell at the therapist and tell him he doesn't want to have therapy anymore and starts to leave the office with his car keys in his hand. The therapist legally should respond by: A. Close the door and try to talk the client into sitting down and staying in the office until he sobers up. B. Call 911 and have police help him. C. Call his emergency contact person and let them know what is happening with the client. D. Let the client leave.

B. Call 911 and have police help him. Rationale: The therapist has a legal obligation to manage safety. Since the client is presenting a danger to self or others due to emotional/mental state, it would be appropriate to break confidentiality and contact police (B). The client is yelling and demonstrating aggressive behavior, so A could endanger therapist and is not required. Reaching out to the emergency contact (C) would not address the immediate danger the client presents, and allowing the client to leave (D) would be ignoring the need to manage his risk to self and others.

A therapist determines that she must file an elder abuse report for an elderly man who is living in his own home. What is the timeline for such report? A. Call immediately; submit written report within 36 hours. B. Call immediately; submit written report within 2 days. C. Call within 24 hrs; submit written report within 2 days. D. Call within 24 hrs; submit written report within 36 hours.

B. Call immediately; submit written report within 2 days.

72. A therapist has been treating a new client for depression for three months. During her session she reports she is going on vacation for a month. She states that she wants to continue treatment while she is away, and asks to continue treatment through the use of phone sessions. Legally, what is your responsibility? A. Verify that she is staying in California and inform her that you can't treat her if she leaves the state. B. Complete a separate informed consent for teletherapy with her, and agree to provide phone sessions while she is away. C. Refer her to a local therapist near her vacation residence, so she can continue face-to-face therapy uninterrupted. D. Review the potential risks and benefits of tele-therapy with her, and discuss the possibility of continuing therapy through the use of phone sessions.

B. Complete a separate informed consent for teletherapy with her, and agree to provide phone sessions while she is away. Rationale: The best answer is B. Legally, therapists can treat clients who are temporarily traveling, even if out-of-state, but must receive informed consent specific to tele-therapy. If we had an option to contact the state's licensing board to determine regulations regarding teletherapy for out of state clinicians, that would be the best answer, but it is not available to us in this question. It would be illegal to treat a client who is residing in a different state.

54. A therapist works in a group practice with four other therapists. The therapist recently discovered that one of her colleagues is smoking marijuana prior to having sessions with her clients. The therapist confronts her colleague who denies the accusation. What ethical responsibilities does the therapist have in this case? A. Report the colleague's behavior to BBS since the colleague was unresponsive to concerns. B. Consult with other therapists in the practice to determine next steps. C. Execute necessary interventions to prevent future incidents. D. Confront colleague again and request she change behaviors.

B. Consult with other therapists in the practice to determine next steps. Rationale: The best answer is B. The next step we would take is to consult with colleagues to discuss concerns. Reporting the colleague's behavior (A) is inappropriate when other, less punitive, steps can be taken. Answer C is too vague and it is unclear what is meant by "necessary interventions." The therapist has already confronted the colleague, so D does not make sense.

57. A therapist has been seeing a client for a few months when the client has been put under a 72 hour hold with a 5150 by his psychiatrist. The therapist is not sure of the reasonings behind the 5150 and would like to find out more about what is happening with his client. The therapist legally can respond by: Score: 0 of 1 A. Calling the client's mother to find out what happened. B. Contacting the psychiatrist treating the client in the hospital to discuss the reasons the client is there and the treatment the client is receiving. C. Not speaking to anyone since the therapist does not have a release from the client to do so. D. Faxing the client a release form at the hospital so the psychiatrist can be spoken to.

B. Contacting the psychiatrist treating the client in the hospital to discuss the reasons the client is there and the treatment the client is receiving. Rationale: In a crisis situation like this, the therapist should do option B. The psychiatrist would have the responsibility of releasing the information since there is a danger issue with a client and it is important that the care is coordinated in the hospital.

28. A 23-year-old female client with a diagnosis of Bipolar I informs her therapist that her father is petitioning the court to be appointed her conservator. The client does not agree with her father's position and asks the therapist to evaluate her and testify at the court hearing on her behalf. How should the therapist address the legal issue in this case? A. Inform the client that she will appear at the court hearing. B. Explain the request is outside the therapist's scope of practice. C. Agree to testify if the therapist does not believe the client is a danger to self. D. Consult with colleagues to discuss benefits of testifying.

B. Explain the request is outside the therapist's scope of practice. Rationale: It is not within the therapist's scope of practice to provide testing and evaluation for this client, therefore B is the only answer that indicates the therapist's inability to move forward with the request. For a mental health conservatorship, if the person objects to the petition, a psychiatrist or psychologist must testify

37. During an intake assessment with a therapist, a client states that he is angry with his ex-girlfriend who, as he recently found out, cheated on him while they were still together. Upon further exploration, the client reports that he has had serious thoughts about harming her so that she "can't ever hurt me again." To address the legal issues in this case, the therapist should: A. Determine if the client has a history of violence and access to a weapon. B. Explore the nature of his thoughts and determine if he has a plan. C. Warn the ex-girlfriend and notify the police. D. Provide a referral to an anger management group.

B. Explore the nature of his thoughts and determine if he has a plan. Rationale: The therapist needs to assess potential danger to others and that would start with answer B. Answer A should also be done, but after B. If the client had an imminent plan then C would be triggered. Answer D is an option at some point but shouldn't be done first.

74. A newly hired therapist discloses to a colleague that she misrepresented her experience during her interview and she feels overwhelmed by the clients' issues she is expected to treat. When the colleague suggests that she discuss the issue with her supervisor, the therapist says she doesn't want to lose the job. The colleague should: A. Report her to her supervisor. B. Inform her that if she doesn't inform the supervisor, the colleague will. C. Instill hope and normalize the colleague's feelings by stating that everyone feels this way when they begin working with this population. D. Provide her with training information.

B. Inform her that if she doesn't inform the supervisor, the colleague will.

1. A therapist meets with a 25-year-old woman who lives at home with her parents. The client reports feeling extremely depressed, has a history of self-harm, and after a suicide assessment, the therapist determines she is at a high risk of serious self-harm. The client reports she does not have insurance and cannot afford to be hospitalized. How should the therapist address the ethical and legal issues in this case? A. Notify client's parents and refer client for a low fee psychiatric evaluation. B. Initiate a 5150 because the client may need to be hospitalized. C. Explore low fee resources to meet client's financial needs. D. Notify client's parents of her plans and safety plan with client.

B. Initiate a 5150 because the client may need to be hospitalized. Rationale: The therapist "determines this is at a high risk for serious self-harm", this would be the time to initiate a 5150. They may determine she does not need to be hospitalized, but the therapist would have covered the standard of care.

7. A therapist was meeting with a client for several months, when shelter-in-place was instituted. The client requested to continue sessions with the therapist, even during the pandemic. How should the therapist legally and ethically respond to the client's request? A. Obtain a new informed consent specific to telehealth and begin online treatment immediately B. Obtain a new informed consent specific to telehealth and ensure technology platform complies with privacy laws C. Determine appropriateness of telehealth for client and only agree to continue if therapist determines the client is high functioning D. Transition immediately from in-person sessions to telehealth to ensure continuity of care.

B. Obtain a new informed consent specific to telehealth and ensure technology platform complies with privacy laws Rationale: Although this question includes reference to the pandemic and shelter-in-place, it is still testing your knowledge of laws regarding telehealth. Answer B is more comprehensive than answer A. Answer A only addresses informed consent, but does not address privacy concerns. While telehealth is most appropriate for higher functioning clients, if other options are not available, telehealth is better than no access to mental health counseling (answer C). Since the vignette indicates shelter-in-place, that would preclude in-person therapy. Answer D is an acceptable answer, as we would want to continue treatment, but answer B is more comprehensive and therefore a better answer.

50. A therapist meets with a couple for the first time. The couple discloses that the husband is also working with an individual therapist on managing his anger more effectively. The therapist would like to speak with the husband's individual therapist. The therapist should: A. Obtain a written release from the husband to speak with his therapist. B. Obtain a written release from both the husband and wife to speak with the husband's therapist. C. Obtain a written release from the husband if only obtaining information about his treatment. D. Obtain a written release from the husband and wife if planning to work collaboratively with husband's therapist.

B. Obtain a written release from both the husband and wife to speak with the husband's therapist. - If you are a couples therapist you need an ROI from both partners b/c naturally saying couples therapist you are releasing that the partner is in couples therapy.

12. A therapist is referred a woman who was recently discharged from a short-term stay in a mental hospital following a manic episode. The woman is living with her parents and is being seen monthly for medication monitoring by a psychiatrist. Legally, the therapist should: A. Request to meet with client's family to gather additional information. B. Obtain signed consent to speak with client's psychiatrist. C. Ask client to sign a no harm contract. D. Identify treatment goals that the client should focus on.

B. Obtain signed consent to speak with client's psychiatrist. Rationale: B is the best answer in order to provide the best care for this client. At this time, the clinician should consult with the psychiatrist. This provides continuity of care coming out of hospitalization and gives the therapist important information regarding medication. It is also the only "legally required" answer. A and D are possible interventions for later. C is out because there is no indication that the client is intending to harm herself.

6. A 7-year-old child is referred to the school therapist because he is unable to sit still in class. The child exposes a large, red rash on his torso and complains that the lotion his mom puts on it makes it worse. The therapist calls the mother who shares that she doesn't have time to take her son to the doctor and that she had the same thing as a kid and had to learn to be tough. Ethically the therapist should: A. Inform the mother that she must take the child to the medical doctor. B. Process a possible child neglect report with mother. C. Schedule a meeting with mom and child. D. Schedule an appointment at a community health clinic.

B. Process a possible child neglect report with mother. Rationale: A is out because that was already done. There is enough here to file a report for medical neglect, so B is the best answer. If the mother understands that there will be a report made she may change her mind. C and D could be done at some point, but the issue of a possible neglect report is the priority.

65. A therapist is currently involved in a contentious custody battle with her ex-husband and perceives her spouse as hostile and unreasonable. The therapist begins meeting weekly with a peer for consultation to prevent her frustrations from impacting therapy with her clients. A month later, a client who has been in ongoing therapy for symptoms of panic disorder and anxiety begins describing relationship difficulties that are similar to what the therapist is experiencing. Which of the following actions should the therapist take to manage the ethical issues involved in this case? A. Contain the therapist's own feelings and focus discussions on the client's depression to maintain consistency with established treatment goals. B. Provide continued treatment to the client and discuss the case with the colleague to monitor own feelings. C. Utilize limited self-disclosure and reassure the client of the therapist's understanding to enhance therapeutic empathy. D. Refer client to different therapist and seek personal therapy to address the emotional distress caused by the contentious custody battle.

B. Provide continued treatment to the client and discuss the case with the colleague to monitor own feelings. Rationale: The best answer is B. Therapists should seek consultation when they identify issues interfering with treatment. It is clear in this case that the therapist's personal situation is affecting her work with this client, so she should seek consultation. Seeking personal therapy may be an option the therapist pursues, however, referring client out is too extreme, making D incorrect.

59. A therapist is treating a 15-year-old girl. At the onset of therapy, the client signed a release allowing the therapist to speak with her parents. Three months into treatment the client discloses that she is gay and that she has a girlfriend. That week the parents contact the therapist to find out what is happening in treatment. How should the therapist manage the ethical issues in this case? A. Inform the parents that the release is no longer valid. B. Provide parents with general information about treatment. C. Talk with the client about the scope of the release and what should be shared. D. Obtain a new release to disclose the client's sexuality.

B. Provide parents with general information about treatment. Rationale: Since the client has signed a release for the therapist to talk with parents, providing them with general information would be the best option, answer B. There is no indication the release is invalid, so A is incorrect. The scope of the release would have been discussed previously, so C is not necessary. The therapist does not need a new release if client shares additional information over the course of treatment.

52. A 15-year-old girl is sent to the school therapist because she is upset in class. She shares that her 18-year-old brother was high on crystal meth the night before and hit her multiple times. She adds that she is worried about her 2 year-old brother who is home alone with her brother today. How should the therapist legally manage this situation? A. Report the situation to child protective services immediately. B. Report the situation to the police immediately. C. Create a safety plan for after school. D. Contact the client's parents and inform them of situation.

B. Report the situation to the police immediately. Rationale: Usually CPS is the best answer in child abuse questions. However, you can also report to the police as both agencies cross-report child abuse. If given the choice on the exam, you would want to take into account the immediate safety issues. In this case, the young child could be in immediate danger so the police would be the faster response time.

A low-fee client who has been receiving therapy for several months has failed to make payments for the services provided even though the client was made aware of the therapist's fees and payment policy. The therapist is considering discontinuing services to the client. What should the therapist do? A. Terminate services with client and provide at least three referrals. B. Review payment agreement with client and discuss possible termination. C. Terminate services immediately until the account is paid by the client. D. Discuss the possibility of lowering fees once the client takes care of the balance.

B. Review payment agreement with client and discuss possible termination.

57. A recently retired therapist is contacted by a 22-year-old former client. The client submits a written request for the records of the treatment he received from the therapist when he was 14. How should the therapist manage the legal obligations in this case? A. Provide the former client with a copy of his records. B. Review records to ensure nothing would be harmful to the former client. C. Inform the former client that records are no longer available after 7 years. D. Determine the reason the former client wants to access the records.

B. Review records to ensure nothing would be harmful to the former client. Rationale: The correct answer is B. Therapists are required to retain records for 7 years, or 7 years after a minor turns 18, even if they are no longer practicing therapy. The therapist should determine the appropriateness of sharing records (B) prior to honoring the client's request. If the therapist determines the records could be detrimental to the well-being of the client, the request can be denied, otherwise, the therapist must provide records.

20. A family sought therapy after the 36 year-old daughter and her 14 year-old son moved back home with her 66 year-old father and 65-year-old mother. At the start of the eighth session the mother reports that three days ago the daughter relapsed and became violent when they confronted her. What action should the therapist take first? A. Explore each family members' perspective of the incident and how they responded. B. Review the limits of confidentiality with the family members. C. Recommend that the daughter seek alcohol treatment immediately. D. Obtain more details about the nature of the violent episode.

B. Review the limits of confidentiality with the family members. - This is the point where we must review limits of confidentiality before we do anything else. Code of ethics tells us to review the limits confidentially throughout treatment.

A therapist has been meeting with a client who lost her husband a year ago. The client has had trouble maintaining her finances, since her husband was the one who took care of the bills when he was alive. The client is now two months behind in the payment of fees and has no ability to pay soon. Professional ethics allow the therapist to: A. Suggest the client find a more appropriate therapist who can accommodate a lower fee. B. Terminate therapy if it is clear that the client is not a danger to self or others. C. Create a payment plan. D. Terminate therapy only if it the client's wishes to do so.

B. Terminate therapy if it is clear that the client is not a danger to self or others.

60. A therapist saw a couple in therapy for several months and is subsequently contacted by the wife who wants him to testify in court on her behalf about an unrelated matter. In this situation, legally the therapist should: A. Testify only about clinical issues related to the wife. B. Testify only if both husband and wife provide written consent. C. Avoid testifying because it would be a conflict of interest. D. Avoid testifying unless there is a subpoena to do so.

B. Testify only if both husband and wife provide written consent. Rationale: The unit of treatment is the couple, therefore the therapist is legally required to have both the husband and wife provide written consent before testifying in court, answer B. The therapist does not need a subpoena to testify, if client is asking him to do so, making D incorrect. There is no conflict identified, so C is incorrect. And limiting information as noted in A is not sufficient, the therapist needs consent from the treatment unit.

57. A therapist is treating a client who is court-ordered to therapy as a condition of his probation. A month into treatment the probation officer contacts the therapist to find out about the client's compliance with therapy. Which of the following is true: A. The therapist can share the attendance history without a release from the client. B. The therapist must obtain a written release before speaking with the probation officer. C. The therapist does not need a written release because the treatment is court-ordered. D. The client has a right to determine what is shared with the probation officer.

B. The therapist must obtain a written release before speaking with the probation officer.

24. A client is the leader of a criminal street gang. He has been seeing a therapist for several years. One day the client shows up to session desperate for a place to hide some guns that could be used as evidence of a gang killing. He brings the guns to the appointment, asking the therapist to conceal them for him. The therapist denies his request. What are the legal issues present in this situation? A. The therapist must report the client to the police. B. This communication between the therapist and the client is not covered by psychotherapist-patient privilege. C. The therapist must assert privilege if the client's records are ordered by the court. D. The therapist must inform the client that he no longer is covered by psychotherapist-patient confidentiality.

B. This communication between the therapist and the client is not covered by psychotherapist-patient privilege. Rationale: This communication between the client and the therapist is not covered by the psychotherapist-patient privilege, because the client is seeking help to avoid being charged with a crime.

33. A therapist has been seeing a client for over a year. The client is a sales rep for a major hotel company and travels a lot for work, but always makes time for ongoing therapy focused on her depression and anxiety around being single. During the holiday season, the client gave the therapist a card before leaving for a holiday vacation. In the card was a gift certificate for a weekend stay at the same hotel chain in town including meals. The card said, "Happy Holidays, enjoy some relaxation with my free perks." How should the therapist ethically respond: A. Call the client thanking her for the card and gift and ask her the best way to schedule the reservation. B. Wait until the next session to politely decline the gift, discuss the reasons, and process her reaction. C. Call the hotel and ask the monetary value of the gift before reserving the room or not using it. D. Consult with a colleague regarding the issue.

B. Wait until the next session to politely decline the gift, discuss the reasons, and process her reaction. Rationale: This is an extravagant gift, even if the client got it for free. The best answer is B - decline gift and discuss with client. There is no need to consult.

A therapist is treating a client with schizophrenia who has an appointed conservator. The client was in an altercation and subsequently sued by the injured party. The therapist receives a subpoena for the client's records from the client's lawyer. The therapist should: A. assert privilege on behalf of the client. B. contact the client's conservator. C. contact the client. D. consult with a lawyer regarding the subpoena.

B. contact the client's conservator.

12. A therapist should review informed consent with a client: A. prior to the onset of therapy. B. prior to the onset of therapy and over the course of the therapeutic relationship. C. in the early stages of therapy and over the course of the therapeutic relationship. D. prior to the onset of therapy and whenever a client requests clarification regarding a therapist's policies.

B. prior to the onset of therapy and over the course of the therapeutic relationship.

22. A therapist working at a community mental health agency started a group for survivors of domestic violence. While meeting with potential group members, a woman states she is concerned that what she says in the group might be shared with people in her community. How should the therapist respond? A. Ensure client that all information shared in group will remain confidential. B. Acknowledge client's concerns and review importance of group maintaining confidentiality. C. Acknowledge that information shared in group is not protected by confidentiality laws. D. Review limits of confidentiality and obtain written agreement from group members.

C. Acknowledge that information shared in group is not protected by confidentiality laws. - Group members aren't protected by confidentially laws, and are not required by law to follow confidentially laws

21. A married couple meets with a therapist in private practice for an initial session. Afterwards, the wife calls the therapist and states, "I have something I want to talk to you about, but my husband can't find out." The therapist's MOST appropriate response would be to: A. Reassure the wife that what she says will be kept confidential. B. Recommend that both husband and wife meet individually before the next couple's session. C. Advise the wife of the therapist's "no secrets" policy. D. Encourage her to make disclosure at a future couple's session.

C. Advise the wife of the therapist's "no secrets" policy. - You can advise her, and then she can share with you what she wants to share. You can do D. after you tell her about the no secrets policy, once you know if the thing she is gonna tell you falls under the no secrets policy/secrets such as violence or testing HIV+

73. A therapist working in a small agricultural town has been seeing a client for several years when the client reports that he cannot afford to pay for therapy for the next few months because he must make upgrades to his farm. He asks the therapist if, until his financial situation improves, he could offer some of his produce as payment. How should the therapist respond? A. Determine the worth of the produce the client has offered. B. Tell client that it would not be appropriate and refer to a low-cost clinic. C. Agree to barter if it's determined this is the only way the client can attain necessary services. D. Tell the client it would not be appropriate and offer a sliding scale.

C. Agree to barter if it's determined this is the only way the client can attain necessary services. - Small town, ct brings it up, it is the only way the ct can get services so bartering is okay in this situation

41. A therapist has been seeing a gay couple for several months for relationship issues. Between sessions, one of the men calls distraught because he learned he has HIV. "I don't know what to do! Please don't tell my partner." The therapist should: A. Encourage him to tell his partner. B. Inform him, that due to Tarasoff, the therapist must inform his partner. C. Assure him that you will maintain his confidentiality and explore his reasons for not wanting his partner to know. D. Remind him of the "no secrets" policy.

C. Assure him that you will maintain his confidentiality and explore his reasons for not wanting his partner to know.

53. A client with a history of suicide attempts leaves a distraught goodbye message on his therapist's voicemail. The therapist returns the call but the client does not answer. What should the therapist do next? A. Initiate a 5150. B. Call 911. C. Call his emergency contact. D. Contact the client's family.

C. Call his emergency contact. - Right to break confidentially, assumption is that you have an emergency contact

1. A 67-year-old woman meets with a therapist for the first time. She informs the therapist that her husband is physically abusive toward her and she can't take it anymore. She shares her plan to finally stand up to him by taking a knife and showing him what it feels like to be hurt. She states she has never harmed him before. How should the therapist manage the legal obligations in this case? A. Create a safety plan and maintain confidentiality. B. Create a safety plan and report abuse to police. C. Call police to report client's plan and process it with client. D. Call APS and warn her husband of her plan for violence.

C. Call police to report client's plan and process it with client. Rationale: The client has made a serious threat of physical violence toward her husband, so the therapist's duty to protect/duty to report has been triggered. We cannot maintain confidentiality in this case, so A is eliminated. B does not address the imminent danger at all. This leaves C and D. The first part of D is correct, as elder abuse is present, but notifying the husband of her threat is not clinically appropriate. There is a history of physical violence perpetrated by the husband; sharing this information with the husband could inflame the situation and increase the likelihood of violence between the husband and wife. This leaves C as the best available option.

68. Your client is a 35-year old woman that you have seen for two sessions. She came to see you to work through relationship issues with her husband, and at the third session she tells you that he finally has agreed to participate in couple's counseling. Ethically, you should: A. Refer the couple to another therapist, while you continue to treat the wife as an individual. B. Obtain informed consent from the husband, review issues related to confidentiality, and proceed to treat the couple. C. Discuss the potential risks and benefits of changing the unit of treatment, obtain informed consent from the husband, and proceed to treat the couple. D. Continue to treat the wife individually, while simultaneously providing the couple with couples counseling.

C. Discuss the potential risks and benefits of changing the unit of treatment, obtain informed consent from the husband, and proceed to treat the couple. Rationale: Ethically, it is acceptable to change the unit of treatment from an individual to couple or family. However, prior to onset of therapy, the therapist should obtain informed consent from the new unit of treatment. Informed consent should include a discussion regarding potential risks and benefits of changing unit of treatment. It is not necessary to refer out (A) since the wife sought out treatment for relationship issues. While B is not incorrect, discussing the risks and benefits is more important based on the scenario provided. It would not be appropriate to provide individual and couples counseling simultaneously as this would create a conflict (D).

66. You are a therapist working in a facility for mentally disabled adults. During a session, you notice that one of your clients has a bruise on her arm. You ask her how she received it, and she tells you that she bumped her arm on a door while she was walking with assistance into her room. You review her chart and determine that the staff member who was with her followed the correct procedures for providing assistance to a resident while walking. What is your legal obligation in this case? A. Report the injury to Adult Protective Services, because a dependent adult was injured in a care facility. B. Report the injury to law enforcement, because a dependent adult was injured in a care facility. C. Document the incident in your notes, but take no other action because the injury was accidental. D. Document the incident in your notes, and report the injury to your local ombudsman.

C. Document the incident in your notes, but take no other action because the injury was accidental. Rationale: Based on the information provided in the question stem, there is no indication of abuse, thus the therapist should not make a report (A, B, and D). Ethically, the therapist should document the incident and rationale for not reporting and maintain confidentiality, answer C.

46. A Hmong couple are referred to therapy by their children's school. Their 6-year-old daughter has been sick recently and the school is concerned that the parents are not getting adequate health care. The parents share that they immigrated here five years ago. The therapist knows very little about the Hmong culture. Ethically, the therapist should: A. Research Hmong culture. B. Ask the couple to talk about their culture and their immigration story. C. Encourage the couple to tell her about their culture and how it may be impacting the current situation. D. Consult with a therapist who is an expert on the Hmong culture.

C. Encourage the couple to tell her about their culture and how it may be impacting the current situation. Rationale: It is best to get cultural information directly from the couple since they have their own unique experiences within the culture that they are a part of. Therefore, answer C is the best answer. In addition, it builds therapeutic rapport with the clients.

75. A therapist working in a small town has been seeing a client for a few months when the client reports that he lost his job and can no longer afford to pay for therapy. The client offers to provide house repair services for the therapist in exchange for continuing therapy. How should the therapist respond? A. Refer to low-fee mental health clinic. B. Consult with colleagues to determine if bartering is common practice. C. Explain conflict of interest and explore alternative payment arrangements with client. D. Create a written contract for the exchange of services.

C. Explain conflict of interest and explore alternative payment arrangements with client. - You won't want to engage in bartering services where you are hiring the client for services, it is different if it is goods that you are getting such as veggies

17. A therapist has been meeting with a client for four months with the expressed goal of addressing the client's social anxiety. The therapist seeks consultation but the client continues to make no progress. What should the therapist do? A. Begin termination with client. B. Discuss referring client to a different therapist. C. Explore lack of progress directly with client. D. Refer client for psychiatric evaluation.

C. Explore lack of progress directly with client. - Support client's self-determination

69. A 15-year-old client tells her therapist that she has fallen in love with a 17-year old boy she met at a sleepaway camp. She says they miss each other and have been staying in touch by texting every day and talking on the phone. The client adds that they have also been sending naked pictures to each other while they talk on the phone. The client says she is very self-conscious about her body and not sure if she should be sending photos because she doesn't want her boyfriend to think she is fat. She adds that the boyfriend told her it's the only way he'll feel connected to her. The therapist legally should respond by: A. Referring the client out to a therapist that specializes in eating disorders and body image issues for teens. B. Discussing the client's feelings regarding her body and what ways she can improve that view. C. Filing a mandated report to CPS for child abuse. D. Providing psychoeducation to the client regarding sending sexual images and the damage it can do to her image and the relationship.

C. Filing a mandated report to CPS for child abuse. Rationale: This 15 year-old reports discomfort sending naked pictures to her older boyfriend. Sending sexual pictures of minors via internet or text is a mandated report, so C is the best answer.

A client is concerned in session that her obsessive thoughts of suicide might be a result of the antidepressant medication her psychiatrist prescribed. The client agrees to voluntary hospitalization and wants the therapist to call her psychiatrist. The therapist realizes he has no more copies of his release forms in his office. The therapist should: A. Speak to the psychiatrist without written consent because the client's level of suicidal ideation constitutes an emergency. B. Refrain from calling the psychiatrist until the client signs a typed release, as is legally required. C. Have the client write a release in her own handwriting that is signed and dated. D. Wait for the psychiatrist to call once the client has been admitted to the hospital.

C. Have the client write a release in her own handwriting that is signed and dated.

52. A therapist is renting an office from a therapist colleague. The therapist refers a client to the colleague and the client starts to see him for therapy. The colleague wants to lower the rent in appreciation. The therapist should: A. Accept the reduced rent. B. Determine the fair amount for the reduction. C. Inform the colleague that it would be illegal and unethical. D. Inform the colleague that it would be unethical.

C. Inform the colleague that it would be illegal and unethical.

4. A single father's parental rights were terminated due to neglect of his two young children. After a year of the children being in foster care, the foster care therapist receives a call from the father stating that he has changed his behaviors and would like to have custody of his children returned to him. The therapist should: A. Empathize with the father but state that the therapist can't do anything to reinstate parental rights. B. Discuss the request with the judge who terminated parental rights. C. Inform the father to speak with a lawyer regarding his appeal. D. Encourage the father to first re-develop a relationship with his children by setting up weekly home meetings.

C. Inform the father to speak with a lawyer regarding his appeal

47. A bilingual therapist working at a community clinic has met with a client for three sessions. During the fourth session the therapist determines that it is necessary to initiate a 5150 because the client presents as a serious danger to himself. After informing the client of the need to initiate a 5150, he becomes agitated and demands to see the clinic's interpreter, stating the therapist must have misunderstood him. The interpreter meets with the client and reports finding no reason the client should be hospitalized. How should the therapist manage the legal issues in this case? A. Follow the advice of the interpreter and not initiate a 5150. B. Explain the concerns to the interpreter. C. Meet with the client and the interpreter to reassess. D. Initiate a 5150.

C. Meet with the client and the interpreter to reassess. Rationale: C is the best answer. The interpreter is not a trained professional to assess for suicidality. Therefore, the therapist needs to conduct the assessment and the interpreter is there as a means for the therapist to have clarity in communicating with the client. Initiating 5150 is a serious matter, that takes someone's freedom away. So before doing D we need to be certain that there is a good reason for it.

10. According to HIPAA all of the following are true regarding psychotherapy notes EXCEPT: A. Psychotherapy notes should be separate from medical record. B. Psychotherapy notes document the contents of the session. C. Psychotherapy notes are released to third-party payers for billing. D. Psychotherapy notes are generally not accessed by the client.

C. Psychotherapy notes are released to third-party payers for billing. - This aligns with HIPPA

3. A therapist working in a community agency receives a referral for a child with severe PTSD from sexual abuse. The therapist has no training or experience treating children with PTSD from sexual abuse. The therapist should: A. Attend a training on PTSD in children. B. Conduct an initial assessment and make treatment recommendations. C. Refer the child to appropriate services. D. Treat the child after getting consultation.

C. Refer the child to appropriate services. Rationale: C is the best answer for this particular client because it is outside of the scope of competence of the therapist. Neither attending a training nor seeking consultation would be adequate for this type of case, so A and D are out. B is wrong because the therapist would need training in how to assess and what to recommend.

35. A client is moving and requests a copy of her records. If the therapist is a HIPAA covered entity he must: A. Obtain a signed waiver of privilege. B. Inform the client of any possible negative outcomes of releasing records. C. Release only the medical record. D. Release both the medical record and the psychotherapy notes.

C. Release only the medical record. Rationale: C is protocol when the therapist is HIPAA compliant.

32. An 84-year-old client calls her therapist because she cannot make it to the session. She has been financially and physically dependent upon her daughter who moved out unexpectedly last week. Which of the following actions must the therapist take to assist the client? A. Determine alternative support person(s). B. Refer the client to a social services support agency. C. Report possible elder abuse to the appropriate authorities. D. Offer to see the client in her home.

C. Report possible elder abuse to the appropriate authorities. Rationale: This qualifies as abandonment and would require a report so C is the best answer. A, B, and D are all things that could be done at some point but C must be done.

40. A mother of an 11-year-old boy was arrested and subsequently ordered to enter a 90-day detox facility for drug and alcohol abuse. The son was sent to live with a foster family temporarily when the mother went into a detox facility. The child has been court-ordered to attend therapy. From whom should the therapist obtain consent for his treatment? A. Mother B. Judge C. Social worker assigned to case D. Foster parents

C. Social worker assigned to case Mom is in detox, judge no, social workers or the lawyer get informed consent. If lawyer was on there pick the lawyer

11. A therapist runs into a former client at the mall a year after their treatment ended. The client asks the therapist out to dinner and a movie and the therapist accepts. The therapist's actions are: A. Acceptable because the former client initiated the relationship. B. Acceptable because the therapy was terminated at least 1 year ago. C. Unethical but legal. D. Unethical and illegal.

C. Unethical but legal. - Illegal would be sexual contact, but its not indicated in the question.

A therapist is required to follow HIPAA in order to: A. ensure compliance with informed consent. B. effectively manage privileged information. C. establish privacy standards related to electronic storage and transmission of patient information. D. provide clients with reasonable access to their records

C. establish privacy standards related to electronic storage and transmission of patient information.

26. A therapist is treating a 24-year-old gay male client whose partner is physically and emotionally abusive. The therapist has reviewed a safety plan with the client and explored his options. The client is adamant that his partner won't do it again and wants to keep trying at the relationship. The therapist has serious doubts about the client's safety and thinks the client should end the relationship. The therapist should: A. Encourage the client to consider dating other people. B. Express concerns the therapist has about the client's safety. C. Provide the client with a referral to a domestic violence shelter. D. Acknowledge the client's hope that the partner will change.

D. Acknowledge the client's hope that the partner will change. - Therapist has this opinion, you want to honor self-determination. You already made a safety plan and it includes going to a shelter. D. supports client's self-determination, accepts the client's feelings and doesn't push them to do an agenda

63. A 43-year-old man with depression and anxiety is referred to therapy by his doctor. The client shares that his wife is extremely jealous and occasionally physically attacks him when she gets really angry. He states that he loves her and doesn't want to end the marriage because they have a child but he's tired of living in fear. The therapist should FIRST: A. Develop a safety plan with the client. B. File a child abuse report. C. Discuss the options of couples therapy. D. Assess for child abuse.

D. Assess for child abuse.

42. A therapist meets with an 80-year-old man and his son. The son would like the father to move out of his home and into an assisted living facility. The son states that his father lives alone, has fallen twice, and he is concerned for his safety. The father disagrees and would like to stay in his home. The son wants the therapist to convince the father that moving would be in his best interest. How should the therapist ethically manage the issues presented? A. Discuss the importance of self-determination with the son and his father and provide a referral for home assistance services. B. Explore the risks of the father staying in his home and his fears of assisted living. C. Discuss the pros and cons of assisted living facilities. D. Assess for potential self-neglect and discuss expectations of treatment.

D. Assess for potential self-neglect and discuss expectations of treatment. Rationale: D is the best answer. You would want to assess for self-neglect right away as that is a key part of any decision going forward. Expectations for treatment are also important and this would be important to clarify when there are competing ideas of what need to happen. Answer A seems to push to support the dad's wishes. B states the dad has "fears" of assisted living, which isn't in stem. C does not address potential self-neglect at home.

The mother of a three-year-old boy is referred by her doctor. She is in the last month of a second pregnancy, and is experiencing episodes of depression with poor appetite, crying, withdrawal from parenting, and increasing fear that she will harm her child. The client states that she has a history of major depressive disorder with psychotic features following the birth of her first child. The therapist should first: A. Refer the client for a psychiatric evaluation. B. Report the situation to the child protection agency. C. Initiate a 5150. D. Assess safety of the first child.

D. Assess safety of the first child.

71. A therapist is meeting with a 75-year-old man who is living in a residential facility. He appears confused as he informs the therapist that he is concerned about his living arrangements, as he is now several months behind in payments to the facility. He has a son who is in charge of his finances and does not understand what is happening with his money. What legal responsibility does the therapist have in this case? A. Report fiduciary abuse to APS and process with client. B. Make an immediate report to APS and document in notes. C. Contact law enforcement and the local ombudsman. D. Assess the client's mental status and determine need to report elder abuse.

D. Assess the client's mental status and determine need to report elder abuse. Rationale: The client "appears confused" suggesting the need for a mental status assessment. There is a hint of possible elder abuse here, but it would be good to verify his mental status and and further assess the financial situation. Also, the client, when asked, may state that his son has been dealing with other life issues and that there isn't reason to suspect abuse.

41. A 54-year-old woman, who has been married for 17 years, comes to therapy complaining that her husband has been having an affair for the last several years. She tells the therapist that she and her husband are in couples therapy together with another therapist, and she would like to start individual work with you as well. How should the therapist ethically manage this situation? A. Obtain a release from her and her husband to speak to her couple's therapist to develop a treatment plan. B. Begin therapy with her immediately. C. Tell her that it is not ethical to see two therapists at the same time. D. Begin therapy with her and obtain a signed release from her to speak to the couple's therapist.

D. Begin therapy with her and obtain a signed release from her to speak to the couple's therapist. Rationale: The therapies being sought are different in nature, therefore, it is acceptable to take on this client while she continues to go to couples therapy. It is best practice to include consultation with the other therapist if client is willing to sign a release. D is the best answer. A is wrong because the therapist is treating the woman. The couple's therapist should have them both sign a release.

A therapist is treating a 68 year-old woman following the death of her spouse. The patient has no immediate family and reports having been financially exploited by acquaintances following the spouse's death. In order to address the legal issues in this case, the therapist should: A. Interview the client regarding the specifics of the alleged exploitation. B. Call APS immediately and file a written report of elder abuse within 24 hours. C. Seek legal assistance concerning the financial exploitation. D. Call APS immediately and file a written report of elder abuse within 2 days.

D. Call APS immediately and file a written report of elder abuse within 2 days. Rationale: Financial abuse of an elder is a mandated report so you are picking between B and D. The correct time line for a written report is 2 days so D is the best answer.

68. A school counselor in a high school refers one of his students to the therapist because he is concerned about the student's behavior. His parents report that he has no friends, stays locked in his room most of the time playing video games, and that he is becoming increasingly withdrawn. They say that he is just shy, and they assure you that he doesn't have access to a gun. When the therapist meets him, he stares at the wall and mutters that he needs to "get out of here" or he's going to have to "kill someone at school." How should the therapist legally manage the situation? A. Report the information to the police, because the student made a credible threat to kill someone at school. B. Report the information to the school counselor, because the student made a credible threat to kill someone at school. C. Refer the client to a psychiatrist for a psychiatric assessment, because there isn't enough information to warrant a credible threat. D. Continue assessing the client, to determine if there is a credible threat against an identifiable victim.

D. Continue assessing the client, to determine if there is a credible threat against an identifiable victim. Rationale: The student has made a vague threat that the therapist must further assess before deciding to break confidentiality, answer D. The student's comments are not clear enough to warrant a report to the police or school counselor, making answers A and B wrong. The priority is to assess the potential threat, which would not require psychiatric assessment, answer C.

63. A therapist is treating a child whose parents are getting a divorce. The child's mother asks the therapist to do a custody evaluation. The therapist has a history of conducting custody evaluations for the court. How should the therapist manage the ethical issues in this case? A. Conduct the evaluation because it falls within the therapist's scope of competence and the therapist is familiar with the family. B. Conduct the evaluation and discuss the implications of it with both parents. C. Conduct the evaluation only if both parents agree to it and provide transparency regarding the process. D. Decline to provide the evaluation and provide family with referral for a custody evaluation.

D. Decline to provide the evaluation and provide family with referral for a custody evaluation. Rationale: Therapists should avoid providing both treatment and evaluations with clients. In this case, the most appropriate course of action would be answer D, to decline the service and refer the client to an impartial evaluator. While it is within the therapist's scope of competence, providing this service would be a conflict of interest as the therapist already has a therapeutic relationship with the child.

7. A therapist has been treating a 42 year-old, single man for five months. The client is a successful partner at a prestigious law firm. For the past month, the client has noticed improvements in his mood and his relationships with others. Around the holidays the client leaves the therapist a bottle of wine outside the office as an expression of his gratitude. What action should the therapist take to address the ethical issues in the case? A. Accept the gift graciously during the next session. B. Explain to the client that the therapist is not allowed to accept gifts. C. Assist the client in finding someone else in his life he could give the wine to as an expression of gratitude. D. Determine the estimated value of the wine.

D. Determine the estimated value of the wine. Rationale: D is practicing the standard of care when considering accepting a gift. Consideration of monetary value of the gift is stated in the ethical guidelines and the value of wine can vary greatly.

23. A therapist has been treating a 16-year-old girl for depression and social phobia. The client recently shared that she is being bullied at school by some older girls. The following day her mother calls the therapist and reports that she thinks her daughter took some pills. What should the therapist do NEXT? A. Explain to the mother that the therapist does not have a release to talk about client. B. Ask the mother to put the client on the phone. C. Determine the type and quantity of pills taken. D. Direct the mother to call 911.

D. Direct the mother to call 911. Rationale: Due to the potential medical crisis in this scenario D is the correct answer. All of the other answers do not address the immediate medical attention that may be necessary. C is out of scope of practice to determine effects of medication.

71. A newly married couple seeks therapy for relationships issues. The husband is Caucasian and the wife is Japanese. The husband complains that the wife is "unemotional" and does not tell him how she is feeling. The wife shakes her head and states "I don't understand what he wants from me." How should the therapist incorporate human diversity issues in the treatment plan? A. Explain to the husband that in Japanese culture one does not express emotions. B. Explain to the wife that the husband wants her to be more expressive. C. Discuss how their families of origin expressed emotion. D. Explore how their cultural backgrounds are influencing their relational issues.

D. Explore how their cultural backgrounds are influencing their relational issues.

74. A therapist is treating a 25-year-old woman for anxiety and depression. The woman reports she has thoughts about suicide, but denies having a plan. Two days later, the therapist receives a call from the client's mother who is worried about the safety of her daughter. What legal obligations does the therapist have in this case? A. Explain limits of confidentiality and contact the client safety plan. B. Explore mother's concerns and Initiate involuntary hospitalization. C. Provide mother with emergency information and maintain confidentiality. D. Explore mother's concerns and contact client.

D. Explore mother's concerns and contact client. Rationale: In this case you would want to get information from mother about what is making her concerned for her daughter. When suicide is involved the therapist has a right to break confidentiality for safety reasons. In this case collecting more specific information with mother then contacting the client to further assess her would be the best option to meet the standard of care.

21. A therapist receives a phone call from a former client requesting access to his records. The therapist terminated with the client several months back due to lack of payment and sent the client's information to a collection's agency in an effort to collect the outstanding balance. Ethically, how should the therapist respond to the client's request? A. Inform the client that he will be required to communicate directly with collection agency prior to accessing records. B. Provide client with access to records within 5 business days of request. C. Require client to pay balance prior to allowing access to records. D. Inform client that he can access his records within 5 business days after therapist receives written request.

D. Inform client that he can access his records within 5 business days after therapist receives written request. Rationale: The client has a right to the records in spite of the lack of payment for services. Allowing 5 business days and having a written request is protocol for accessing records, therefore D is the best answer.

66. A 44-year-old client is referred for therapy by his co-worker for complaints of problems in his marriage. The client wants to work on issues that involve only him, but mentions that he was in therapy with his partner a year ago. He wants to obtain the records from the previous therapist, but does not want his partner to know he has sought treatment alone. Which of the following actions should the therapist take in this situation? A. Reassure the client that the records are not necessary because the treatment focus has changed. B. Have the client sign a release to obtain treatment records that pertain to him. C. Contact the previous therapist to request summary records of the client's therapy. D. Inform the client that the couple must each sign a release for previous treatment records.

D. Inform the client that the couple must each sign a release for previous treatment records. Rationales: The therapist would not be able to obtain records from the former therapist unless both the husband and wife sign the release, as they were both part of the treatment unit (D).

56. A 33 year old woman mentions that the home her grandmother has been staying in has not been answering the phone. When she is able to get through on the phone, they do not put her grandmother on the phone. She complains to the therapist that the last time she went to visit her in the home, her grandmother seems gaunt, distraught and had bed sores that weren't there before. The therapist should ethically respond by: A. Discussing with the client the need to call APS and file a report. B. Calling the home during the session with the client to try and assist her with getting on the phone with her grandmother. C. Making a call to a friend who is a therapist at the home and seeing if the friend can check on the client's grandmother. D. Informing the client and discussing with her the feelings around the therapist's need to call the police.

D. Informing the client and discussing with her the feelings around the therapist's need to call the police. Rationale: There is enough to have reasonable suspicion of abuse. In cases where it is at a facility, you need to report to the police. D is the best answer because it includes discussing it with the client.

51. A client is being treated for PTSD. The client is engaged and her fiancé has attended collateral sessions. She tells the therapist that she self-harms when she feels overwhelmed by emotions. The client shows up to a session with deep gashes on her arms and when confronted by the therapist, minimizes their severity. Legally, how should the therapist respond? A. Initiate an evaluation for hospitalization. B. Maintain confidentiality and continue to monitor safety. C. Contact fiancé for collateral session to manage safety. D. Maintain confidentiality and develop safety plan with client.

D. Maintain confidentiality and develop safety plan with client. Rationale: The best answer is D. The level of risk is not severe enough to warrant breaching confidentiality or pursuing hospitalization (A and C). Monitoring safety in answer B, while appropriate, is not sufficient. The client has a history of self-harm so safety planning to prevent/minimize future harm would be the best option, answer D. The client indicates she self-harms when she is overwhelmed by her emotions, but there is nothing to indicate she is currently overwhelmed by emotions. We do not know when she will next be overwhelmed, so safety planning for when that happens is the strongest option.

6. During the sixth session with a 64-year-old man he breaks down in tears while discussing his relationship with his estranged 40-year-old son. He confesses that when his son was younger the client was physically abusive to his son on a number of occasions, especially when the client had been drinking. He says that besides his wife, he's never told this to anyone before. How should the therapist manage the legal obligations in this case? A. Explore client's feelings about disclosure and document the session in his record. B. Inform the client that child abuse is a mandated report and file a report. C. Review the limits of confidentiality and determine whether the client is currently abusing any minors. D. Maintain confidentiality of the reported abuse and document session in his record.

D. Maintain confidentiality of the reported abuse and document session in his record. Rationale: You would not report child abuse if the victim is no longer a minor. There is no indication that the client is currently abusing any children. This leaves you with A and D. D is better because it addresses the legal obligations, where "explore client's feelings" would be a clinical, not legally required, response.

16. In their session, a couple talks about their "bad physical fight" last weekend. The therapist notices bruises and abrasions on the wife's legs. How should the therapist proceed to stop the violence? A. Refer the husband to a batterers' group, identify the triggers to the violence, and work with the couple conjointly. B. Refer the husband to a batterers' group, work with them conjointly to own their individual responsibility, and increase their understanding of the choices. C. Refer each to individual therapy to give them a safe place to explore their feelings and continue couples therapy. D. Refer the husband to a batterers' group and individual therapy and refer the wife to the local women's shelter and individual therapy.

D. Refer the husband to a batterers' group and individual therapy and refer the wife to the local women's shelter and individual therapy.

69. A therapist at a community agency is treating a Latino adolescent client with a history of child abuse. Over the course of therapy, the therapist becomes aware that the client has racist beliefs that clash with the therapist's value system. The therapist should: A. Explore origin of client's racist beliefs and determine whether the client has been a victim of racism. B. Educate the client about the negative effects of racism. C. Seek consultation. D. Respect the client's beliefs and focus on the presenting problem.

D. Respect the client's beliefs and focus on the presenting problem.

63. An unlicensed therapist would like to address ongoing personal relationship issues she believes are impacting her work with male clients. The unlicensed therapist did not like her previous therapist and is considering asking her clinical supervisor to be her therapist. Which of the following actions should the intern take to manage the ethical issue in this case? A. Wait until supervision hours are complete prior to initiating personal therapy. B. Explore the relationship issues with the supervisor as part of supervision. C. Arrange for therapy with the supervisor that is separate from supervision. D. Seek personal therapy from another therapist to avoid a dual relationship.

D. Seek personal therapy from another therapist to avoid a dual relationship. Rationale: Requesting the supervisor provide individual therapy would lead to a dual relationship and should be avoided. The only answer that properly addresses and avoids the dual relationship is answer D. Answers B and C involve dual relationships, so they are wrong. The unlicensed therapist's concerns need immediate attention as they are interfering with work, making A incorrect.

Obtaining informed consent from clients is: A. Legal but not ethical. B. Ethical but not legal. C. Both legal and ethical. D. Neither legal nor ethical.

c. both legal and ethical