LMSW Practice Test

Generally speaking, addicted clients have poor treatment prognosis when A. they also have borderline or antisocial personality disorder. B. they are over 40. C. they are unemployed or homeless. D. they suffer from an anxiety disorder.

*A. they also have borderline or antisocial personality disorder.* Certain personality disorders have poor prognosis, perhaps because the client is unlikely to experience serious anxiety about their behavior.

A social worker is leaving an agency and must terminate many cases. How long prior to leaving should the social worker tell the clients she is leaving the agency? A. About one month before the termination date. B. About two weeks before the termination date. C. When the client seems ready to accept the social worker's departure. D. About three months before the termination date.

*A. About one month before the termination date.* It is generally accepted that one month is enough time for the worker and client to resolve the termination process.

After repeated hospitalization for severe back pain, Harry is provided with prescription painkillers. His family tells his social worker that he has started to obtain duplicate, sometimes forged prescriptions for controlled substance to supplement his regular supply. Harry told his family that the doctor is not giving him enough drugs to control his pain and that he has been forced to "improvise." The social worker might suspect A. Harry has become drug dependent and needs help to control his need for painkillers. B. the doctor needs to be informed and asked to increase Harry's prescription. C. the family should be helped to control Harry's behavior. D. Harry's behavior will probably diminish after that back problem is cured.

*A. Harry has become drug dependent and needs help to control his need for painkillers.* Drug dependence occasionally follows on legally prescribed use of prescription painkillers. Harry's request for increased doses, suggest a medically induced drug dependence for which treatment is needed. Even if the back problem is cured, it is likely the drug dependence will continue.

A young woman with a history of drug abuse appears at a Mental Health Clinic for her fourth visit with a clinical social worker. Though calm and lucid at previous interview, the client is not agitated, anxious, sweating profusely and her hands are shaking. She seems unable to sit still and moves her legs continuously. She occasionally rises and walks aimlessly around the room. The worker might suspect A. a possible drug withdrawal syndrome. B. a pre-psychotic episode. C. intoxication. D. a drug overdose.

*A. a possible drug withdrawal syndrome.* The client exhibits classic symptoms of drug withdrawal. Intoxication is likely to produce either an exhilarated or depressed state, while a drug overdose is likely to immobilize the person or even cause them to enter a comatose state.

In dealing with a client's guilt, the worker would A. accept and understand the client's guilt, allowing him or her to ventilate. B. always relieve the client's guilt. C. help the client see that guilt is very unhealthy and find ways to rid the client of guilt. D. help the client see what he or she has done.

*A. accept and understand the client's guilt, allowing him or her to ventilate.* People feel guilt for many reasons, but in order to deal with guilt, the client needs opportunities to express it to the worker. The methods for helping clients deal with guilt depend on the grounds for the guilt.

To diminish a client's resistance in a treatment relationship the worker would A. acknowledge the client's ambivalence about accepting help in solving his problem. B. increase the client's anxiety about problems to increase his motivation. C. be firm with the client and insist an answer to all questions. D. remind the client of the reason for seeking assistance and stress the importance of cooperation.

*A. acknowledge the client's ambivalence about accepting help in solving his problem.* The way to reduce resistance is to accept the client's feelings, to "go with it" rather than hammer against it, which is likely to strengthen rather than weaken resistance. As a practical matter, premature direct approaches to resistance may also threaten the client sufficiently to terminate a treatment relationship.

When referring a recent legal Latino immigrant client for public assistance, the referring social worker should A. coach the client about what to expect, facilitate the referral by calling the welfare department, and ask the client to call back after filing an application. B. determine eligibility before making a referral and then advocate for the client. C. discourage the client from applying since welfare reform makes it difficult to receive assistance, then refer the client for employment. D. suggest that the client bring a legal assistance lawyer with him.

*A. coach the client about what to expect, facilitate the referral by calling the welfare department, and ask the client to call back after filing an application.* Helping the client obtain services is a similar process for immigrants and for others. If there were language difficulties, the social worker might also have to make additional arrangements.

In comparing models of social work clinical practice, probably the most significant difference is related to A. contracting. B. interpretation. C. clarification. D. confrontation.

*A. contracting.* The contract is theory-based and will be different depending on what is understood as the issue or focus. The other responses are tools for working with clients and are similar in all theory-based practice.

A neighborhood association, concerned about area health and education problems, employs a community worker to explore the problems further and develop new programs. The workers initially establishes relationships with a variety of community representatives and involves residents in preliminary discussions about the problems. As the organization's program develops and membership grows, the worker is likely to be concerned about A. developing leadership. B. developing a formal structure. C. envisioning the results for the members. D. providing support services for organization participants.

*A. developing leadership.* C and D are not normally associated with organizational development. B, developing a formal structure (implying elected officers and a charter), is not always necessary. However, leadership development is the only task that insures continuity and promotes organizational effectiveness.

A worker believes that her supervisor is regularly abusing alcohol and is sometimes incapacitated at work. During one supervisory meeting, the supervisor is clearly intoxicated. Her speech is slurred and she is unable to respond adequately to questions. The odor of alcohol is on her breath. The social worker's best first step is to A. discuss the problem with the supervisor and ask her to seek assistance. B. discuss the supervisor's problem at the next staff unit meeting and urge the supervisor to seek help. C. report the problem to the administration. D. refuse to meet with the supervisor if she appears intoxicated at subsequent meetings.

*A. discuss the problem with the supervisor and ask her to seek assistance.* Section 2.09 of the social work code of ethics states that social workers should first discuss impairments with the colleague and assist them in seeking help. If that fails, then the worker should pursue remedies through established channels within the agency or the profession. The social worker would not be expected to do this if there were reason to fear retribution or if there were any illegal or imminently dangerous activities involved.

The most proximate health consequence for the infant of a drug and alcohol use among pregnant women is often A. higher risk of birth defects, cardiovascular problems, impaired growth and development, prematurity, low birth weight and stillbirth. B. higher risk of raising children who replicate their parent's behavior. C. prosecution of the mother for child abuse. D. increased risk of mental retardation.

*A. higher risk of birth defects, cardiovascular problems, impaired growth and development, prematurity, low birth weight and stillbirth.* The use of alcohol or drugs during pregnancy places the baby at high risk for multiple birth defects, prematurity and low birth weight. These are the most proximate health consequences.

According to Beck, the treatment modality that seems to be *least* used in treating clients diagnosed as schizophrenic is A. individual therapy. B. group therapy. C. milieu therapy. D. community therapy.

*A. individual therapy.* In treating schizophrenia, it is crucial to improve social skills. Treatment involving a group is likely to achieve better results than individual modes.

A supervisor works with a social worker whose learning pattern is that of an experimental-empathetic learner. The worker is intuitive and uses self appraisals quite well. To enhance the worker's learning the supervisor might A. offer repetitive experience with different cases. B. state concrete and specific expectations. C. help the worker conceptualize and critically evaluate the issues. D. make the associations between theory and practice.

*A. offer repetitive experience with different cases.* The key term is experimental. This type of learner is prepared to learn empirically from demonstration-effect-observation. Learning best from observation and testing is quite common and suggests that a supervisor permits some latitude to the supervisee to allow them to test hypotheses.

A social worker doing joint or multiple interviewing will focus on A. the interactions between people and with the therapist. B. the basic personality patterns of each individual. C. the issues to be resolved. D. dividing the interviewing time evenly.

*A. the interactions between people and with the therapist.* Multiple interviewing refers to working with several people at a sessions at the same time. This technique is used in family work, based on the assumption that the relationship system is the focus. Thus, the way people interact with each other is the primary focus.

A young man separates from his wife. He goes back to live with his parents saying that he cannot afford an apartment. He argues with his mothers incessantly and make many demands of her. He gives the impression that he has not separated from her. The social worker would first work with A. the man alone. B. the man and his mother. C. the man and his wife. D. his mother.

*A. the man alone.* Using Mahler's separation-individualization theory, as well as object-relations theory, the worker would discourage the idea that the man needs to stay with his mother or mother-substitution in the form of his wife. Thus, the clinical work should be done with only the man.

A woman is referred to a community mental health agency by the local hospital. She was tested twice for AID. Though the test results were negative, she requested additional tests and continues to ask for more AIDS tests. She ask the social worker to intervene with the hospital on her behalf. The social worker should assess A. the reasons for her concern. B. her current mental health diagnosis. C. how to advocate on her behalf with the hospital. D. her AIDS risk behavior.

*A. the reasons for her concern.* Since the repeated negative results don't seem to resolve the woman's concern, there could be something else that holds the worry in place. The social worker needs to go to the next level of exploration and explore the reasons for her concern.

When treating persons who have had long periods of alcohol dependence and abuse, the worker might reasonably expect that A. there is a high likelihood of cycling between periods of relapse and recovery. B. once treatment has been fully implemented clients will be free of their addiction. C. the client will consistently lie about their alcohol use. D. their friends will be supportive and try to help them refrain from using alcohol.

*A. there is a high likelihood of cycling between periods of relapse and recovery.* The treatment of addictions is not for the faint of heart. Relapses can be expected to occur with some frequency as clients slowly learn that they cannot control their alcohol use and need to abstain completely. While clients may lie, it should not be assumed that this is a universal trait. It is unlikely that long-term chronic alcoholics will have a circle of friends who will support their efforts to stop drinking. The opposite can be expected as old associates encourage the client to rejoin the circle of drinking associates.

The mental health agency learns that a local landlord refuses to rent out apartments to African Americans. The Board decides to take action on behalf of several clients who have been refused housing. The best strategy is to A. use existing anti-discrimination statutes and institutions to force landlords to comply with the law. B. organize a demonstration to protest the landlord's actions. C. sue the landlord for damages. D. publicize the landlord's behavior.

*A. use existing anti-discrimination statutes and institutions to force landlords to comply with the law.* There are many strategies that the agency can pursue, however the most efficient and probably the most effective is to use anti-discriminatory laws and local agencies charged with enforcing them to change behavior. These issues are settled in the law and the landlord will be required to comply.

When a client who is unused to self-reflection first reveals anxiety-provoking feelings and experiences severe anxiety, the social worker might A. use sustaining procedures, allaying the client's anxiety. B. involve the client in further understanding the dynamics of his or her reactions. C. not expect the client to return for another appointment. D. not discuss the unconscious conflicts with the client.

*A. use sustaining procedures, allaying the client's anxiety.* Although it is important to help clients understand the roots of their anxiety, it is important to first help the clients deal with it, so as not to cause an end to therapy. If too much anxiety is provoked, the client may opt not to continue.

The most important consideration in choosing a goal with a client is A. what the client wants. B. what the agency wants. C. what the worker wants. D. what the client's parents want.

*A. what the client wants.* A treatment relationship cannot progress unless the worker and the client agree on the treatment goals.

A psychological, cultural and political orientation to life that both determines and influences how people think, behave, make decisions and understand phenomena is usually called a A. world view. B. culture. C. personal opinion. D. perception.

*A. world view.* This is a definitional question -- a worldview encompasses culture, attitude, beliefs and ideology.

Which of the following statements about Tardive's Dyskinesia is *untrue*? A. It is caused by prolonged use of antipsychotic medication. B. It can always be reversed by discontinuing psychotropic medication. C. It causes involuntary facial, lip and tongue movements. D. It is a late-appearing condition causing gross motor problems involving jerky limb movements and finger motions.

*B. It can always be reversed by discontinuing psychotropic medication.* Unfortunately, Tardive's Dyskinesia, an iatrogenic neurological disorder caused by long-term use of antipsychotic medication, is often not reversible.

The family therapy theorist who would consider the identified patients behavior to manifest a problem in the family system is A. Erikson. B. Minuchin. C. Parad. D. Vinter.

*B. Minuchin.* Of all the theorists listed, only Minuchin is associated with family therapy theory, specifically Structural Family therapy. Erikson developed a psychosocial theory of development.

Hassan, his wife and two daughters aged 11 and 13, moved to the United States from the Sudan seven years ago. Both parents sought and achieved citizenship. The year, prior to a planned brief visit to Khartoum in the Sudan, both daughters ran away from home several times and were returned by the police. When asked by a social worker whether their parents mistreated them, both girls said their parents loved them and took good care of them. After careful inquiry, the social worker learned that the girls did not want to return to the Sudan because the purpose of the visit was to perform clitorectiomies on both girls. What should the social worker do with this information? A. The social worker can and should do nothing. Female circumcision is an accepted cultural practice in North Africa and among many Islamic cultures, and the worker has no warrant to impose her values on the family. B. There is no question that this si

*B. There is no question that this situation fits the criteria of child abuse. The worker should take immediate steps to involve the child protective agency and to prevent the family from performing the surgery.* Clitorectomies are primitive cruel cultural practices that many human rights advocates believe should be banned. The social worker should treat this situation as a child abuse issue and involve the protective agency to protect the children. Immediate action is needed since the family plans to travel to the Sudan.

When treating clients with a borderline condition it is generally recommended that the social worker A. urge the client to accept group treatment, preferably the Gestalt approach. B. allow the client to fell in control of the session. C. focus on the issue of dependency and the client's inability to choose life goals. D. confront the client on his or her use of diminishing defenses.

*B. allow the client to fell in control of the session.* Borderline clients are difficult to treat. They experience chronic feelings of emptiness, impulsivity, and a sense of aloneness that they struggle with. Highly sensitive to criticism, these clients do better in treatment when they feel in control of the treatment environment.

AIDS ACTION best represents an example of A. a self-help organization. B. an advocacy-brokerage program. C. a community development approach. D. a consumer organization.

*B. an advocacy-brokerage program.* AIDS action defends the interests of individuals with HIV/AIDS, agitates for improved services and more research and provides case services. It is an advocacy organization that also brokers services for clients and insures that they find services.

A social worker seeks to develop a relationship and case plan with a 15-year-old Black adolescent who is involved with a violent gang. His family has low expectations of him and focus on "staying out of trouble" as a primary goal. Some relatives have rejected him, telling him he will grow up like his father --- a chronic alcoholic and wanderer. Neighborhood adults have accorded him pariah status and are openly fearful, distrustful and occasionally hostile. He feels that police harass Black teenagers and do not provide protection. His school performance is poor and because of his attitude, teachers have low performance expectations for him. He does not participate in social agency recreational programs and view youth workers as simply another type of authority figure. The gang provides a sense of community and family and offers opportunities to display power and competence. In working with the teenager described above

*B. an ecological systems approach.* An ecological systems approach is one which takes into account the social environment. A central feature of this adolescents life is his membership in the game. Thus, the most effective plan is one which recognizes and respects the centrality of this relationship.

The most common hallucinations in schizophrenia are A. visual. B. auditory. C. tactual. D. olfactory.

*B. auditory.* Although people with schizophrenia do experience visual, tactual and olfactory hallucinations, the one most commonly experienced is auditory, or the perception of voices or sounds that can only be heard by the individual.

In counseling battered women who have been involved in lengthy marriages, the social worker should keep in mind that many battered women A. do not care for the batterer and find it easy to decide to leave. B. believe that they can stop the violence by learning new techniques to control the behavior of their mate. C. trust the confidentiality and protection of the agency. D. do not experience ambivalence toward the batterer or the relationship.

*B. believe that they can stop the violence by learning new techniques to control the behavior of their mate.* Despite the violence, many women are attached to battering husbands and come to believe they are responsible for provoking the behavior. If they believe they are responsible, then they may erroneously assume that it is in their power to stop the violence, if they can change their behavior.

Mrs. K., age 35, has been in treatment for the past three months. She says she feels inferior and worthless when with family and friends. She avoids close personal relationships and fears dependence on others. She feels that most people are more in control and are "happy about their lives." Preoccupied and anxious about her failures and worries about the future, she constantly complains about chest and back pains that keep her awake at night. Medical evaluations are negative. She also experiences sudden mood shifts in which she appreciates her achievements, feels good and sees others as the problem. Mrs. K's condition could be diagnosed as A. overanxious reaction to adulthood. B. borderline personality disorder. C. narcissistic personality disorder. D. reactive depression.

*B. borderline personality disorder.* While there is some anxiety, it is not enduring, not a severe panic anxiety, and not the central characteristic. The poor self-esteem, control or power issue, mood shifts, somaticizing and projections described in the question are all characteristics of a borderline personality. The narcissists (C) consistent self-centeredness is not presented as a trait. Her depression vacillates (D) with times of feeling good which reveals that she is not suffering a reactive depression to a specific event.

A client diagnosed as schizophrenic begins to hallucinate while in treatment. The social worker's primary strategy is to likely involve A. engaging the hallucination to diminish anxiety. B. continuing to provide ego support. C. referring the patient to a psychiatrist for medication. D. offering insight and trying to interpret the client's hallucinations.

*B. continuing to provide ego support.* The treatment of choice for people with schizophrenia is ego supportive work. When a symptom of the illness emerges, it is important to maintain treatment consistency by encouraging the client to draw on their strengths to stay connected to reality. Therefore, it is counterproductive to join with the hallucination (A) or try to interpret it (D). Referring the client to a psychiatrist (C) will encourage the person to feel even more helpless and rejected.

Mrs. Taylor was referred to a social worker after her alcoholic husband was hospitalized following an acute episode. She felt there was no reason to see a social worker as she had consulted with several doctors and read popular books on alcoholism. She feels that her husband sees her as a mother symbol and blames her for all his problems. She offered him a psychology book to read that she thought would help him understand his behavior. Mrs. Taylor found passages from an abnormal psychology book that she thought described her husband. She read sections of the book to Mr. Taylor, especially chapters describing personality disorders, egocentricity and dependency. Mrs. Taylor's major defense mechanisms are A. reaction-formation. B. denial and intellectualization. C. obsessions and compulsions. D. compensation and displacement.

*B. denial and intellectualization.* Reaction-formation (A) involves adoption of the opposite characteristics to those most hated or feared. It is possible that she is so angry at her husband that she wants to deny her anger, thus becoming overly conciliatory toward him. However, use of books and denying her feelings supports intellectualization and denial. Obsessions (C) would involve more preoccupation with one particular thought and compulsions would be expressed in repetitive behaviors. Compensation and displacement (D) would involve refocusing in another direction, such as anger at someone else or flirting with other men as compensation for feeling less than a woman with her husband.

A single man, aged thirty, comes to an outpatient medical clinic for a physical checkup to decide whether he can work. He has a shattered index finger on his left hand because of an injury. The surgeon recommends an operation on the damaged finger and refers him to social services for help in planning for the operation. The social worker's first step in dealing with the patient is to A. refer the patient to the psychiatrist for evaluation of his readiness for surgery. B. establish a relationship with the patient to find out what surgery means to him. C. investigate community resources about helping the patient with his surgical plan. D. help the patient handle his anxiety about the operation by describing his procedure.

*B. establish a relationship with the patient to find out what surgery means to him.* In any social work intervention, the first step is to establish a relationship with the client and find out how the client is experiencing the situation.

When a client is especially receptive a a social worker's interventions and highly positive results seem to occur in a brief period, the client may be A. seeking approval by being particularly accommodating. B. experiencing an acute state of crisis. C. in an anxiety-free state of equilibrium. D. particularly fortunate to be working with a skilled worker.

*B. experiencing an acute state of crisis.* Social workers and other mental health professionals have noted that clients in crisis tend to respond rapidly to treatment. This is attributed, in part, to crisis dynamics which often tend to peak rapidly, but then diminish as the situation changes or the client's coping skills start to engage.

A patient who was readmitted to a psychiatric hospital complains to the social worker that his previous and current doctors rarely understood him or responded to his feelings. In such a situation, the social worker should A. explore the client's reasons for this feeling and offer to discuss them immediately with the doctor. B. explore the client's reasons for this feeling and help the client discuss them with his doctor. C. acknowledge that this is a common problem to minimize his hostility. D. tell the doctor about the patient's complaint so that the doctor can handle this with the patient directly.

*B. explore the client's reasons for this feeling and help the client discuss them with his doctor. * The social worker's task is to focus on the client's experience and help him to use his own abilities to take action on his own behalf.

A child welfare worker observes red marks and welts on a 4-year-old Asian child's stomach and thighs. The child has recently been ill. The family are recent emigres and they seem stable and loving. The child seems well-cared for. There are no previous referrals for child protection. The worker should first A. refer the family for a child protective investigation. B. explore the possibility of a culturally specific practice that might have lead to the symptoms described. C. recommend ongoing supportive services. D. Do nothing.

*B. explore the possibility of a culturally specific practice that might have lead to the symptoms described.* An immediate referral to child protection would seem excessive since there are no indications other than the marks at this time. Thought child abuse may be a factor, there are culturally specific practices that can produce the welts described. Some Asian groups, for example, believe that rubbing coins on the body of the sick person cures the disease. Answer C is premature, and of course, doing nothing is a poor choice if there is a vulnerable child involved.

On several occasions a social worker observes that a co-worker in the agency seems to be under the influence of either drugs or alcohol. On one occasion the worker smelled alcohol. The co-worker is seeing clients. The social worker should A. talk to the administrator. B. first speak to the colleague about obtaining assistance. C. first speak to the supervisor. D. do nothing in anticipation that the worker's problems will be observed by the administrator.

*B. first speak to the colleague about obtaining assistance.* The new NASW Code of Ethics suggests that workers first try and correct problems with the colleague before discussing problems with management. The worker, however, would not attempt a direct discussion if he or she felt threatened or believed the worker might retaliate.

The Jones family is composed of a mother, her live-in boyfriend, and seven children. The family receives financial assistance through Temporary Assistance for Needy Families (TANF). Mrs. Jones is depressed and complains of losing control of the children. There is continuous fighting among them. According to Minuchin's model of family treatment, the most helpful intervention would be A. sibling play therapy with each child to encourage them to verbalize their feelings. B. first working with the family's neutral subgroupings, then changing the subgroupings and actually manipulating them in relation to the whole family group. C. working with Mrs. Jones and her boyfriend. D. working with the adolescent subgrouping giving Mrs. Jones the most problems.

*B. first working with the family's neutral subgroupings, then changing the subgroupings and actually manipulating them in relation to the whole family group.* Sal Minuchin, a structural family therapist, believed that child therapy could not be practiced outside of the context of the family. Thus, an approach using the Minuchin model would require that at least initially, the practitioner will intervene with the whole family. None of the other choices includes the entire family as the focus on intervention.

Mr. and Mrs. Beech continuously argue and bicker, though they agree in one area: Mr. Beech's beginning career as a college teacher. Both are pleased with his choice of the profession, the salary and the university that hired Mr. Beech. Mr. Beech is on the verge of an emotional collapse, however, due to his fears of starting a career and the stress involved in completing his dissertation and his work as an instructor. Mrs. Meech demands constant attention and interferes with his work. The social worker's primary focus in treatment would be to A. modify the attitudes that created the marital crisis. B. give support to Mr. Beech and help him work through the stresses involved in pursuing his academic career. C. examine and interpret the underlying causes of their marital conflict. D. help Mrs. Beech minimize her destructive attacks on her husband.

*B. give support to Mr. Beech and help him work through the stresses involved in pursuing his academic career.* The key is the phrase "on the verge." In this case, the worker should pay attention to the most critical issue first, and that is Mr. Beech's precarious psychological state. The remaining issues can be addressed when he is more stable.

Rose, a crack cocaine and alcohol user, appears at the HMO clinic complaining of frequent stomach pains. Rather than getting the painkillers she wants, she is surprised to learn that she is at least nine weeks pregnant. In addressing Rose's pregnancy, the social worker interviewing her should first seek to A. refer Rose for psychiatric care. B. help Rose understand the health consequences of drugs and alcohol on her body and the developing fetus. C. discuss the pregnancy with Rose's family and ask for their help in forcing her to stop using drugs and alcohol, at least during her pregnancy. D. arrange admission to a half-way house.

*B. help Rose understand the health consequences of drugs and alcohol on her body and the developing fetus.* The question stem does not indicate the degree to which Rsoe is using drugs. However, there is no indication of a serious addiction. The best answer in this case is to discuss the health implications of substance use on mother and child. Other steps might be necessary depending on the response on subsequent evaluation.

An infant showing drug withdrawal symptoms at birth is read for foster care placement following medical treatment and court action. To prepare the prospective foster parents, the social worker should A. not mention the infant's drug background so as not to precipitate feelings of bias. B. inform them of the infant's drug background, treatments provided and answer any questions about the medical issues the child may present. C. inform them that the baby may have some medical problems and give them instructions about how to proceed. D. inform them of biological mother's drug addiction and that they should not worry about any potential medical problems.

*B. inform them of the infant's drug background, treatments provided and answer any questions about the medical issues the child may present.* This is both an ethical and a practice question. The foster parents have a right to full disclosure of the infant's condition. Moreover, in order for them to properly care for the child they need to have complete information. Holding back or minimizing is an ethical breach and is poor practice.

Empirical research on diagnostic patterns has historically demonstrated that Black clients with the same symptom presentation as Whites will often be diagnosed A. less severely. B. more severely. C. the same. D. irrelevant.

*B. more severely.* Research findings repeatedly show that Black clients with similar symptoms are diagnosed with more severe mental illnesses than Whites.

Using the technique of "modifying the environment" helps to diminish A. superego anxiety. B. objective anxiety. C. instinct anxiety. D. anticipatory anxiety.

*B. objective anxiety.* The other types of anxieties are all thought of as products of the client's internal conflicts. Objective anxiety is a response to external situations.

The Family Court refers Mr. and Mrs. Williams to a community service agency. During the initial interviews they are angry, have poor reality testing, and have difficulty restraining themselves from acting out. Their projections are easily accessible, but Mr. Williams exhibits disorganized thinking. the most appropriate recommendation of the social worker would be to A. see the couple conjointly, but on a short-term basis. B. refer them to a psychiatric clinic for possible medication and long-term therapy. C. see the couple individually for short-term treatment. D. provide no psychotherapeutic interventions since it might exacerbate the decompenstation.

*B. refer them to a psychiatric clinic for possible medication and long-term therapy.* The combination of anger, poor reality testing, and acting out behavior suggests a more intensive therapeutic approach in mental health or psychiatric setting. The "service" agency would not seem to be a proper treatment venue for couples with serious emotional difficulties. Short-term family treatment and short-term individual treatment would not seem appropriate. Doing nothing is not an appropriate option.

After working with a 15-year-old girl with a substance abuse problem for several weeks, the child welfare social worker learns that the client is pregnant. She is unable to control her drug use, has left a rehabilitation program and does not wish to return and seems unconcerned with the potential serious health effects on her unborn child. The social worker's best strategy is A. suggest that the client reenter the drug rehabilitation program. B. seek to place her in a residential setting for the duration of her pregnancy, even if a court order is required. C. notify the client that she can be compelled to stop her drug abuse. D. discuss the problem with her obstetrician.

*B. seek to place her in a residential setting for the duration of her pregnancy, even if a court order is required.* The client's lack of concern, immaturity, uncontrolled drug use and failure to adequately care for herself during pregnancy require a dramatic solution. The worker should find a setting where her drug use can be controlled, at least while she is pregnant. A residential facility is likely to be the best setting, even if it requires a court order or a child abuse petition.

Supportive therapy would *not* be used if the client is A. diagnosed as psychotic B. seeking self-awareness C. able to solve problems not adversely affected by the unconscious. D. diagnosed as a schizophrenic.

*B. seeking self-awareness* Supportive therapy encourages clients to use their strengths. The search for self-awareness promotes anxiety and explores aspects of the self. A strong ego is required. People with psychotic symptoms are struggling with weakened egos and need help improving their functioning. They do not need further threats to ego integrity.

A social worker at a suicide hotline receives a call at 2:00 am from someone who says he is depressed and is contemplating suicide. The social worker should A. keep talking to him on the telephone until a specific arrangement can be made with a therapist later in the morning. B. send a crisis worker immediately or convince him to go to the hospital emergency room. C. tell him no none is available and to call back in a few hours. D. tell him to go to a mental health agency in the morning.

*B. send a crisis worker immediately or convince him to go to the hospital emergency room.* When there is reason to believe someone is in danger of hurting themselves or others, social workers are required to act. Hotline services are designed to provide immediate responses to crisis situations. Therefore, the social worker's task is to intervene in the most direct way possible.

Latin Americans tend to accept help from experts who A. sound knowledgeable and work for local institutions. B. speak Spanish, are knowledgeable about the area of concern and have a positive reputation within the community. C. are Anglo and seem confident about the problem and its possible solutions. D. have a reputation for knowledge about a subject and are also a relative or friend of the person in need.

*B. speak Spanish, are knowledgeable about the area of concern and have a positive reputation within the community.* The ability to speak the language and personal reputation are important features of credibility in close ethnic communities.

Jane, a 14-year-old girl diagnosed with diabetes, reports to her clinical social worker that she and her boyfriend experiment with drugs. Jane is unsure about the names of the drugs she has taken at parties, but she does state that she is concerned about the possible side effects. The social worker's best option is to A. minimize Jane's concerns, but suggest that she not try any more drugs. B. support Jane's apprehension, suggest a referral for drug education and a discussion with her physician. C. discuss Jane's drug use with her parents and ask them to discuss the dangers with her. D. suggest that Jane get more information about the drugs she has taken.

*B. support Jane's apprehension, suggest a referral for drug education and a discussion with her physician.* Drug use by someone with a diabetic condition can be extremely dangerous. Jane should be helped to resist taking any unknown drugs and she should receive a full explanation of the interactive effects of narcotics and diabetes. Her physician should also be involved to reinforce the discussion.

An infant is assessed as low-functioning. The family's social worker should help the family understand that A. the major causes of mental retardation are found in the parent's genetic characteristics, not in their behavior. B. they can be helped to meet the child's needs and that community services are available to them. C. the child should probably be paced in a specialized facility. D. the parent's should consider specialized foster care.

*B. they can be helped to meet the child's needs and that community services are available to them.* B is the only concept that starts from a "strengths" perspective, emphasizing the possible and assuring that the family will be able to manage this crisis and make a reasonable adjustment. The other alternatives are negative and warranted by the description of the child's condition.

In the initial phase of treatment, the primary social work task is to A. establish a warm relationship with the client. B. understand by the client is seeking help. C. engage the client in treatment. D. gather information for a psychosocial diagnosis.

*B. understand by the client is seeking help.* The first task is always to understand why the client has sought assistance. During that process a warm relationship (A) can be established, the client can be helped to engage in treatment (C) and information for a psychosocial diagnosis (D) may be obtained.

A 33-year-old lawyer is convinced his promotion was refused because two senior associates dislike him. He was told he needs further experience, but that the firm would like to consider him for promotion in six months. He tells his social worker that he knows they turned him down because he is too aggressive and that they will deny his promotion again. The social worker's best response is: A. "Yes, you are probably too aggressive for them." B. "How could you believe something for which you have no evidence?" C. "You may be right, but they offered to reconsider you." D. "That is the way law firms are."

*C. "You may be right, but they offered to reconsider you."* This response is respectful of the client's perception of himself and it also allows for some hope in the form of reminding himself of a reality (-- but they offered to reconsider you). The first response suggests there is something wrong with the client and does not allow for hope; the second response is disrespectful of his perception; and the fourth response places the issue outside of the client and does not allow for a client-focused discussion.

In working with a client who exhibits a narcissistic personality disorder, the social worker frequently becomes 1) the object of the client's wishes to be mirrored; 2) an object of the client's anger; 3) idealized by the client to fulfill functions that have remained unfulfilled by the client's parental figure; 4) angry because of the client's distorted projections. A. 1 and 4 B. 1, 2, and 3 C. 1 and 3 D. 4 only

*C. 1 and 3* Self-psychology theory holds that normal development involves having one's goodness and uniqueness mirrored back by the parents and feeling a sense of trust and safety in the presence of perfect parents. Narcissistic personality disorders originate from problems in this area of development. The transference will be in the form of seeking mirroring from, or idealizing the worker.

A 38-year-old client with a history of chronic alcoholism develops short-term memory loss. He compensates by inventing stories. He seems confused and disoriented. The most likely diagnosis is A. psychogenic amnesia. B. Alzheimer's Disease. C. Korsakoff's Syndrome. D. Tardive's Dyskinesia.

*C. Korsakoff's Syndrome.* Korsakoff's syndrome is a neurological condition caused by chronic alcoholism. Tardive's dyskinesia is a possible side effect of the long-term use of psychotropic medication. Psychogenic amnesia is loss of memory as a result of psychological trauma. Alzheimer's disease is a progressive medical condition that affects people of advanced age.

A common psychiatric diagnosis found among South East Asian clients, particularly Cambodians is A. Psychosis. B. Major Depressive Disorder. C. Post Traumatic Stress Disorder. D. Phobias.

*C. Post Traumatic Stress Disorder.* PTSD is more prevalent among Cambodians because of their experience during the murderous regime and the Khmer Rouge. Millions of Cambodians died and no one escaped the horror of this period.

Joan tells her social worker that when her husband Mike comes home from work after having a few drinks, he is often verbally and physically aggressive with her and their children. Mike's drinking has increased and he is clearly using alcohol regularly. He has been arrested twice for driving while intoxicated. Joan is obviously fearful and asks the social worker for assistance. What should the social worker do *first*? A. Ask Mike to come in for treatment and work with him around his alcohol problem. B. Suggest family treatment to encourage Mike to seek help. C. Work with Joan to help her protect herself and the children, either through the child protective agency, a shelter or through a court order of protection. D. Suggest a medical examination for Joan and the children.

*C. Work with Joan to help her protect herself and the children, either through the child protective agency, a shelter or through a court order of protection.* The first priority in this type of situation is to insure the safety of Joan and the children. Mike's problem with alcohol is secondary to the potential for abuse that he presents. Moreover, in this scenario, the primary client is Joan.

A client diagnosed with a character disorder begins to realize certain behaviors are no longer acceptable. The client then becomes depressed, experiences loss of appetite and has trouble sleeping. The social worker would see these symptoms as A. an exacerbation of the client's problem. B. the result of the worker's misinterpretation of the client's psychodynamic functioning. C. an indication of progress. D. the client becoming aware that the worker is not interested in offering treatment.

*C. an indication of progress.* According to Ego Psychology and drive theory, depression following the identification of unacceptable aspects of the self is a normal part of the work and represents grief and self-punishment.

A young, married woman is admitted to a city hospital in acute cardiac decompensation. While there she writes a letter to the medical social worker in the voluntary hospital where she was previously treated and asks for a transfer to that facility. The work er receiving the letter should A. notify the patient that this is not the worker's function. B. ignore the letter, since the patient is in treatment. C. contact the social worker in the city hospital and ask him or her to see the patient. D. arrange for a transfer, as per her written request.

*C. contact the social worker in the city hospital and ask him or her to see the patient.* The client's request reflects an attachment to her previous social worker. However, she needs to be in a medical facility at this time. Her former social worker should contact the social worker in the current facility. This is a response which is caring and respects the history of the relationship between the client and the former social worker. The current social worker would let the client know that her previous worker called. This could allow the client to feel that there was a connection between her previous facility and her current one. Such a connection can feel holding and safe to clients.

A client who is unable to tolerate frustration had a tendency to discharge tension by action is said to A. act-in. B. act-out. C. decompensate. D. sublimate.

*C. decompensate.* This is a simple definitional question. Decompensation involves psychologically losing touch with reality and a weakening ego function. Sublimation is a high-level defense where raw id impulses are transformed into socially acceptable activities.

One goal in treating a person diagnosed with a character or personality disorder is to A. increase the client's dependence on the worker. B. help him or her ventilate their feelings. C. make the ego-syntonic trait ego-alien. D. provide some concrete services.

*C. make the ego-syntonic trait ego-alien.* A defining aspect of a personality or character disorder is the client's inability to understand how their behavior causes problems for them. Therefore, the clinicians' major task is to help the client see that the current way to doing things is not in their best interest.

As the social worker develops an understanding of the basic behavior of the client, he should A. continue to observe the client, keeping this knowledge in mind. B. share this information with the client. C. direct the client toward awareness without interpretation. D. gauge when the client is ready to both share and contribute to understanding his own behavior and this discuss it.

*C. direct the client toward awareness without interpretation.* The goal of clinical work is to promote insight so the client may change behavior. Answer A suggests that the worker should keep the information to himself, which has no clinical impact. It is important that the worker do the least intrusive intervention first, and encourage the client to discover the insight themselves. Therefore it is not useful for the worker to inform the client of the clinician's observations (C). Answer D states that the worker influences the conversation in ways that encourage the client to discover.

Because of an unexpected upsurge of migrant workers during the summer the director of a small social agency must cancel August vacations. He expects that the decision will be met with resistance and dissent. To engage staff effectively he should A. send a memorandum to the staff describing the change and the reason. B. hold a general staff meeting where the issue is noted as an item. C. discuss the issue with subordinates and allow for questions, alternate possibilities and objections. D. discourage dissent within the informal structure by asking the supervisors and informal leaders to meet with the director.

*C. discuss the issue with subordinates and allow for questions, alternate possibilities and objections.* Any policy that affects people's lives and is simply dictated without opportunity for discussion is likely to stir opposition. Opening the issue for discussion creates opportunities for change and provides staff with a sense of participation. Even if the outcome is the same, staff will feel they had an opportunity to represent their interests and to offer alternatives.

A criterion that is not a measure of a client's motivation is A. the level of discomfort. B. The level of hope. C. ego strength. D. ability to see himself/herself as able to change.

*C. ego strength.* Motivation for change stems from thoughts or feelings. Discomfort and hope (A and B) are feelings, and the ability to envision change (D) is a thought.

Mrs. Taylor was referred to a social worker after her alcoholic husband was hospitalized following an acute episode. She felt there was no reason to see a social worker as she had consulted with several doctors and read popular books on alcoholism. She feels that her husband sees her as a mother symbol and blames her for all his problems. She offered him a psychology book to read that she thought would help him understand his behavior. Mrs. Taylor found passages from an abnormal psychology book that she thought described her husband. She read sections of the book to Mr. Taylor, especially chapters describing personality disorders, egocentricity and dependency. Initially, treatment with Mrs. Taylor would involve A. telling her that her approach has merit and suggests sensitivity to her husband. B. reflecting that her approach is overly intellectualized and futile. C. exploring her feelings about her personal and fami

*C. exploring her feelings about her personal and family situation.* The first step is to offer the client an opportunity to talk about her feelings. Only when there is evidence of resistance is it useful to respond. According to theories about working with family members of people with compulsive behaviors, it is important to begin to challenge the idea that it is their job to save the addicted person. Therefore, the worker should focus on the family member's own feelings and encourage them to feel that their experience is important.

A family seeks counseling help after the accidental death of one of their two children. The social worker's genuine concern and "over involvement" with the family is noticed by the social worker's supervisor. The supervisor should A. commend the social worker for being so dedicated to his work. B. arrange for an immediate transfer of social work services for this family to a more experienced social worker. C. involve the social worker in assessing the effect his subjective reactions may have on the quality of his work and on his clients. D. thoroughly explore the social worker's inner conflicts regarding the nature of this tragedy and suggest the necessity for an immediate resolution.

*C. involve the social worker in assessing the effect his subjective reactions may have on the quality of his work and on his clients. * The social worker has genuine concern for the family and this is an important and useful factor in treatment. Rather than remove a concerned worker from a case, the supervisor is using this opportunity to augment the worker's skills by including the worker in the process of learning. The supervisor's technique is one which utilizes the worker's ego strengths. Answer A ignores the problem, answer B is an overreactions and answer D seems to shift the supervisory relationship into the clinical sphere.

On an unconscious level, according to the theory underlying Ego Psychology, a client seeks help for motives that differ from those on the conscious level. These unconscious motives include A. an overpowering desire to receive mothering. B. reassuring unconscious concerns. C. keeping unconscious desires from consciousness. D. fear of intimacy.

*C. keeping unconscious desires from consciousness.* Ego psychology holds that the unconscious is in conflict around the expression of primitive or taboo wishes. There are many theories that have a different understanding. This is the most general answer.

A community social worker begins work in a neighborhood with a homogeneous, mainly white, working class population. The worker finds that three is little organized effort to improve the schools or any other local institutions. There is, however, a community consensus around the school system's major problems. These problems include ineffective leadership from the school board, a weak, vacillating superintendent and a lack of resources. The most appropriate model to use in considering strategies would be A. social goals. B. social planning. C. locality development. D. social action.

*C. locality development.* In this question the community is described as fundamentally inactive and unaware of the roles it might take in repairing local institutions. The first steps the social worker should take involve raising consciousness about the possibility of change. As the process proceeds, the worker can start developing the community institutions that are required to initiate and regulate change. These activities fit within the definition of locality.

A factor that contributes to the development of a "group-think" mentality within a policy-making committee is A. apathy. B. hostility. C. competition. D. amicability.

*D. amicability.* Group think suggests unquestioning unanimity and lack of critical thought. Groups that have achieved a high level of personal connection tend to overvalue relationships and can diminish the work functions of the group.

A board function that is inappropriate, except in rare instances is A. fund-raising. B. policy formulation. C. monitoring day to day activities. D. establishing new organizational goals.

*C. monitoring day to day activities.* Board functions can vary but it is highly unusual for a Board to intrude on the domains of the executive director. Day-to-day program operations are a clear boundary that Boards should observe. The creation of board policy directions, planning, fund-raising, and future directions are clearly within the parameters of Board responsibility.

A client at a mental health clinic who has been diagnosed HIV positive and now has AIDS has stopped working. As the illness progresses, he is uncharacteristically depressed and apathetic. He has memory lapses, has difficulty concentrating, appears confused and withdraws socially from friends and family. At the most recent interview the social worker noticed that he walked with a slight shuffle. The social worker might attribute these changes to A. growing depression associated with the client's life situation. B. diminished mental and physical capacity engendered by the client's growing physical weakness. C. physical and mental symptoms associated with the physiological effects of HIV. D. a consequence of being shunned by his friends and family.

*C. physical and mental symptoms associated with the physiological effects of HIV.* While all the responses are, to some extent factors in the treatment of HIV positive clients, approximately 50% of AIDS patients experience some form of neurological impairment. The particular clusters of symptoms noted in the stem of the question suggest HIV encephalopathy. the most vivid clue is the changed walk, in combinated with emotional symptoms.

A school social worker sees Susie, a 15-year-old, for academic and behavioral problems. She is easily distracted, overwhelmed by her studies, extremely negative to self and others, mistrustful and critical and resentful of family members. She is strongly resistant to treatment. The social worker is most likely to recommend A. long-term treatment. B. group therapy. C. short-term trial treatment. D. psychoanalysis.

*C. short-term trial treatment.* The only possible activity is to seek to engage the girl in a brief program that might help overcome her resistance to treatment. None of the other choice are realistic alternatives until her resistance to treatment is reduced.

Fred, age 35, is participating in his third family counseling session with his wife, Norma. Her major complaint concerns Fred's drinking. Fred feels his drinking habits are within normal limits. He has a responsible job that requires considerable travel and is home several evenings and on weekends. He wants to relax and feels that drinking 8 to 10 beers after working all day isn't unreasonable. Fred says that he rarely has more than two drinks daily at business lunches, and perhaps one more with his colleagues after work. In working with this couple, the worker should A. help Norma adjust to Fred's habits as his drinking is not excessive. B. suggest that Fred take Norma out more often to soften the tension between them. C. suggest that Fred confront his excessive drinking as it seriously affects his health, work and family life. D. ignore the drinking as the problem is Norma's lack of acceptance.

*C. suggest that Fred confront his excessive drinking as it seriously affects his health, work and family life.* Fred's drinking is excessive. He is consuming the equivalent of 10 shots of whiskey daily and is in denial about his abuse of alcohol. Whether in a family or individual treatment, his alcohol abuse is a major presenting problem.

A major difference between clinical social work and psychiatry is A. the use of verbal techniques. B. the use of nonverbal techniques. C. the ability to prescribe medications. D. a focus on intrapsychic issue.

*C. the ability to prescribe medications.* Clinical social work has much in common with Psychiatry. The primary defining difference between the two is that the Psychiatrist can prescribe medication. In recent years, psychiatry has placed an increasing emphasis on the use of medications. Both professions, however, emphasize social functioning and sue similar technique.

An elementary school teacher has placed a disruptive child away from all activities for a predetermined, though short, period. This is an example of a A. positive reinforcement. B. negative reinforcement. C. time-out strategy. D. vicarious reinforcement.

*C. time-out strategy.* Positive reinforcement involves offering a reward for the desired behavior. Negative reinforcement involves removal or cessation of a pleasant stimulus, or application of an unpleasant stimulus when the negative behavior is displayed. Time-out simply removes the person from the activity and provides time to calm down.

The contemporary focus of treatment in schizophrenia in patients who have families available to them is A. the etiology of the condition, particularly with regard to family relationships. B. an understanding of the intrapsychic state of the individual. C. to focus on helping families respond to the patient and to help the family and the client use available community resources. D. the relationship among siblings.

*C. to focus on helping families respond to the patient and to help the family and the client use available community resources.* With the advent of deinstitutionalization, there is a corresponding emphasis on community-based care. Family work with schizophrenic clients focuses on maintaining clients in the family. This often involves maximizing use of community support programs.

A client complains that if the social worker really cared about him like his mother does, then the social worker would not charge him for treatment. This is an example of A. counter-transference reaction. B. sublimation reaction. C. transference reaction. D. subjective reaction.

*C. transference reaction.* Counter-transference (A) applies to the worker's reactions, while transference applies to the client. Sublimation involves transforming primitive id impulses to socially acceptable behavior and feelings. Objective criticism has to do with the client's ability to see the worker more or less for who he is and not as a parent substitute.

In order to encourage reluctant patients from third world countries to adopt Western health methods and reject unhelpful traditional medical practices, a social worker should first A. take a tour of the health facility with the patient. B. arrange for the client to be seen in the home first. C. try to convince the oldest family member. D. try to convince the youngest family member.

*C. try to convince the oldest family member.* A marked characteristic of traditional societies is a hierarchical family structure and respect for the elderly. If an elderly family member can be convinced that modern scientific medicine is effective, it is likely that other family members will be easier to convince.

Assertive casework is a technique in which A. the worker encourages the client to be more assertive n his interpersonal relationships. B. the worker is insistent that the client answers all questions to see how he or she functions under stress. C. within a very short time limit, the caseworker asks probing questions and provides direct interventions. D. the worker allows the client to tell the story in piecemeal fashion, allowing time to develop a relationship and increase his or her strength.

*C. within a very short time limit, the caseworker asks probing questions and provides direct interventions.* This is a brief treatment modality. It's based on assumptions that clients have a certain strength level and that there is only a limited time available to complete tasks.

As treatment progresses with Ira, a computer programmer who abuses cocaine and alcohol, the social worker realizes that he is highly unmotivated, but unable to fully stop. Which cognitive behavioral-approach might the social worker use to help him? A. Emphasize insight-based therapy to help Ira understand the underlying psychodynamic processes that promote his addiction. B. Suggest that Ira participate in a partial hospitalization program. C. Suggest that Ira participate in a family treatment program. D. Find out which situations seem to be associated with substance use and help Ira learn to avoid these.

*D. Find out which situations seem to be associated with substance use and help Ira learn to avoid these.* Psychodynamic psychotherapy, family treatment and partial hospitalization are not cognitive behavioral treatments. Helping clients identify and stay away from situations that foster drug abuse is a standard treatment strategy for working with substance abusing clients.

In assessing risk factors for alcohol dependence among adolescents, the social worker would be most interested in A. the youth's involvement with friends who engage in deviant behavior. B. the youth's school performance and social relationships. C. the youth's developmental age. D. a biological family history of alcohol abuse.

*D. a biological family history of alcohol abuse.* The answer to this question reflects repeated research results showing that a predisposition toward alcohol abuse in the children of families with a history of alcohol abuse. None of the other answers are definitively associated with alcohol abuse.

A DSM-IV diagnosis of substance abuse disorder does *not* include A. repeated episodes of substance intoxication. B. substance related relationship difficulties at work or within the family. C. legal difficulties related to substance abuse. D. a period of at least two years of involvement.

*D. a period of at least two years of involvement.* This is a fact question that is asked in the negative. The DSM-IV criteria requires that the consequences of a substance abuse disorder occur during a *one* year period.

In reacting to a client's presentation of material in a psychotherapeutic or clinical situation, the social worker should primarily A. deal solely with the concrete data presented. B. expand the date by interpreting on a deeper level. C. reflect back to the client using the same language and words where possible. D. abstract the basic theme of the communication and reflect it in a broader perspective.

*D. abstract the basic theme of the communication and reflect it in a broader perspective.* The clinical social worker should reflect themes that the client expresses and offer a way for the client to consider these from many perspectives. Simply responding to concrete material (A) doesn't help the client generalize to other aspects of life. Restating the client's words (C) doesn't add anything. It is important to enable the client to move to deeper levels (B) by themselves. If this is done by the worker, the client may feel criticized or exposed.

When treating an impulsive and problematic child, the worker's most important task is to A. provide a positive antidote to the child's negative experiences. B. provide the child with painful experiences so that a weak ego can be strengthened with each new mastery of pain. C. provide a warm, protective environment in which the child can freely express himself or herself. D. accept impulsive statements and actions and help the child find constructive way to express them.

*D. accept impulsive statements and actions and help the child find constructive way to express them.* Children are often referred to treatment because of difficulty managing impulses. By accepting the child's impulses, the worker is indication to the child that s/he is acceptable. By helping the child learn other ways to express self, the worker is teaching the child that there is a difference between feelings (impulses) which are acceptable and some behaviors which are unacceptable. In this process, the child may well experience a positive antidote to prior negative experiences (A) and the child may feel protected (C).

In working with a client over time, a social worker should communicate an attitude of A. concern about the client's moral responsibility for his behavior. B. openness, affection and permissiveness. C. accepting the client unconditionally. D. acceptance for the client with positive though conditional regard.

*D. acceptance for the client with positive though conditional regard.* Although social workers are obligated to place high priority on ethical and moral behavior, it is not useful to preach morality (A). A social worker cannot express acceptance of immoral or illegal acts (B). Social workers should support behaviors that do not damage the client and intervene if a client is self-destructive or assaultive.

In establishing a working alliance with the client, the social worker should A. establish the conditions for proceeding. B. subtly try to encourage a positive relationship. C. consider clinical objectives and get the client to agree to them. D. allow for the client's ideas and goals, understanding that conditions change as clinical work proceeds.

*D. allow for the client's ideas and goals, understanding that conditions change as clinical work proceeds.* It is the only answer that allows for client input in the process.

An intake worker in an adolescent shelter is assigned a 14-year-old girl who has run away from her family. She does not wish them to know her whereabouts. When asked about her reasons for leaving home, she says that she has problems with her father, but does not volunteers any additional information. The worker would first A. notify the parents that she is at the shelter and request that they come in for a family interview. B. interview the parents. C. tell her that when she is ready to talk, a social worker is available. D. allow her to discuss taboo subjects.

*D. allow her to discuss taboo subjects.* A child who leaves home and presents at a shelter may have many reasons. However, a teenage girl who reveals "a problem with her father" may be unwilling to discuss embarrassing or threatening facts such as sexual exploitation. In this case, the worker would not initially contact the family, nor react with a neutral response. An attempt would be made to help the child express her concerns by letting her know she is protected, and that the worker will not be shocked by the situation.

A therapy patient with a history of drug abuse seems euphoric, excessively restless and far more talkative than usual. He speaks rapidly, relating many ideas quickly and without explaining their relationship to each other. He seems suspicious of everything the social worker says and relates a grandiose scheme for marketing a new product that he says he can develop. The social worker might suspect A. a psychotic episode. B. alcohol intoxication. C. dissociation. D. amphetamine intoxication.

*D. amphetamine intoxication.* The behaviors described are among the signs of amphetamine use and are similar to those of cocaine. Grandiosity, euphoria and high energy are often accompany amphetamine use. Other behaviors include hyper vigilance, impaired judgement, heightened sensitivity and changes in sociability. The symptoms usually disappear within 24 hours.

A social worker has begun work with a new client. In the first session the client tells the worker that she had a bad experience with a previous worker. She felt betrayed because the social worker revealed information to her husband without her knowledge. The worker should first A. reassure the client that she won't reveal anything to anyone unless authorized by the client. B. tell the client that with today's computerized systems, there are no secretes that are secure. C. reassure the client that the other worker probably had the client's best interest in mind. D. ask the client to tell her more about what had happened with the other social worker.

*D. ask the client to tell her more about what had happened with the other social worker.* Only by exploring the client's prior experience can the worker understand what happened. The other answers are glib and are biased on the worker's wish to reassure rather than explore. If the client, for example, experienced homicidal thoughts about her husband, it would have been the worker's responsibility to inform him. Answer A and B do not help the client to feel safe and secure; answer C may cut off discussion with the client about previous experiences in therapy. It may also be true.

One psychological mechanism that tends to obstruct identification and treatment of alcoholism is A. projection. B. sublimation. C. magical thinking. D. denial.

*D. denial.* Alcoholics and their families are often enmeshed in a web of denial that makes alcoholics dependent individuals difficult to identify and treat. Until the individual and the family acknowledge the drinking problem, little can be done to help the client.

Marie and Tony are about to be married. They see a social worker to resolve relationship and communication problems that concern Marie more than Tony. After several sessions, the social worker comes to the conclusion that Tony has an unacknowledged alcohol problem. After coming to this understanding, the social worker should A. meet with Tony privately, confront him with the problem and offer him a referral for treatment. B. meet with Mary privately and form an alliance to address Tony's drinking. C. say nothing about the alcohol problem since this was not the reason they came into treatment. D. encourage discussion of Tony's alcohol problem at the first appropriate moment during a joint counseling session.

*D. encourage discussion of Tony's alcohol problem at the first appropriate moment during a joint counseling session.* This is a treatment question that frequently arises. Though the agreement between the clinician and the couple is to work on communication issues, one partner's alcoholism is a serious impediment to the marital relationship that is likely to grow worse over time. The clinician should permit the issue to come to the surface and then seek to motivate the client to seek help.

A withdrawn child in a residential treatment setting had progressed somewhat with a play therapy approach, but now seems disinterested. The social worker should A. processed with the treatment plan as though nothing has changed. B. transfer the case to a more experienced worker. C. seek a psychiatric evaluation. D. evaluate the treatment situation in supervision.

*D. evaluate the treatment situation in supervision.* The social worker has seen some progress with the child, however, there has been a change in the direction of treatment and the child is no longer responding. Answers A and B are unrealistic - continuing a strategy that is not working is inappropriate. There is no indication that a more more experienced worker is needed. Answer C would seem unnecessary --the child has not regressed and the condition has not worsened. The "best" answer is D. It is the minimal and least intrusive response and may lead to a rethinking of the worker's strategy.

The diagnostic criterion for substance abuse does *not* include A. a pattern of pathological use. B. impairment in social and/or occupational functioning due to such use. C. duration of disturbance of at least one month. D. guilt concerning excessive use.

*D. guilt concerning excessive use.* While guilt over the alcohol or drug may use may be present, it is not essential for the diagnosis. The remaining three responses must be present for a DSM-IV diagnosis.

Michael finds it easy to give up alcohol, and he's done it hundreds of times in the last twenty years. Finally fed up by Michael's alcoholism, Barbara, his wife, has told him she will obtain a divorce unless he stops drinking completely. She wants him to move out of the house until he's totally sober for three months, then she'll consider taking him back. The family social work counselor should A. urge Barbara to soften her stance and give Michael a chance to shed his dependence of alcohol while at home since a separation will add to the stress and inhibit Michaels' recovery. B. point out to Michael that if he is sincere he can convince Barbara to relent. C. support Barbara's firmness as this may help Michael to fully confront the damage he is doing to himself and his family, and motivate him to change. D. help Michael confront the situation that he now faces and assist him in finding the treatment resources that he

*D. help Michael confront the situation that he now faces and assist him in finding the treatment resources that he needs.* Barbara's firm stance may actually help Michael and the worker would not interfere in her decision. Since this is a family treatment situation, the best response for the worker is to help Michael as he addresses his denial. The worker would also assist him in sorting out how he can keep his family together and in finding the programs and service he needs.

In the beginning phases of establishing a professional relationship with a client, a social worker must convey a sense that the social worker's predominant feeling is A. a neutral attitude. B. a sense of objective observation. C. healthy skepticism. D. positive acceptance.

*D. positive acceptance.* Social work philosophy stresses a belief in individual worth, as well as the curative value of a positive relationship. Social workers are obligated to advocate on behalf of clients. A neutral, objective or skeptical stance does not communicate the regard essential for a social work relationship.

A social worker in a community agency is treating a married woman. She complain that her husband is a compulsive gambler. He owes money to bookies and has received physical threats. Her discussions always emphasize her husband's behavior. The social worker would A. call Gamblers' Anonymous. B. ask that the husband come in to see the social worker. C. refer the wife to a credit agency as a community resource. D. seek to help the woman understand that she is the client and the primary person to be treated.

*D. seek to help the woman understand that she is the client and the primary person to be treated.* Of all the choices, this is the best one since it recognizes that the woman is the client, not the husband. There may be reasons that the woman has difficulty focusing on herself, but the worker must always be clear about who the client it. The best place to start is with the person in the office.

Credit unions, peer tutoring programs, and locally sponsored nonprofit housing corporations are an example of A. consensus strategies. B. community action programs. C. social action efforts D. self-help programs.

*D. self-help programs.* This is a definitional question. Self-help programs are designed to provide services to people who have similar concerns and problems.

The difference between "acute stress disorder" and "post-traumatic stress disorder" in DSM-IV is A. the length of time following trauma and length of time symptoms are experienced. B. the degree of trauma. C. that more somaticizing accompanies accompanies acute stress disorder. D. that PTSD has more flashback symptoms and occurs over a period of at least one month.

*D. that PTSD has more flashback symptoms and occurs over a period of at least one month.* This is a definitional question and reflects DSM criteria.

The client's transference reactions usually relate to A. the client's tendency to observe his feeling in other people. B. the tendency of present events to color past memories. C. the client's ability to transfer learned experiences form one situation to another. D. the tendency to distort present perceptions due to transferred inferences from past, primary experiences.

*D. the tendency to distort present perceptions due to transferred inferences from past, primary experiences.* Answer A would seem similar to projection, while B is overly general. C is not responsive to the question. A transference reaction occurs when *a client develops beliefs about the therapist based on their experience with a significant authority figure in the client's past.* Transference reactions are often encouraged in insight-based therapies.

The most important contraindication for marital therapy is A. the fragility of one marital partner's defense. B. paranoid reactions by a marital partner. C. one partner's acting out behavior, e.g., infidelity, noncompliance with agreements. D. the therapist's inability to prevent a marital partner from using sessions for aggressive, hostile and destructive purposes against his or her mate.

*D. the therapist's inability to prevent a marital partner from using sessions for aggressive, hostile and destructive purposes against his or her mate.* It is well understood in couples work that when there is a threat of, or actual violence against one person by a partner, the therapy will be ineffective and will continue to place one person in a dangerous situation.

One disadvantage of self-help programs is that A. the participants are never fully equipped to offer the services they claim to provide. B. community groups involved in self-help rarely acquire the necessary financial resources. C. their scope is too limited to be of true service to the community. D. they rarely influence the larger institutional system.

*D. they rarely influence the larger institutional system.* Self-help groups rarely develop effective action programs. The reasons are rooted in the service orientation that energizes them. Providing services is labor intensive and occupies the energies of members, leaving little room or energy for altering priorities.