LMFT Mock Exam

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

A. Acknowledge the client's frustration with her daughter.

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

A. Conduct a family life chronology; Explore effects of social messages about homosexuality; Assess Marks verbal and non-verbal communication patterns and survival stance.

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

A. Determine when the client's problems first began.

A therapist has been working with a client for four months and has noticed that the client often corrects the therapist when the therapist paraphrases back to him what he heard him say. He seems to be unaware of this pattern. Using a psychodynamic approach how might the therapist address this in a future session? A. Directly tell the client your observation; Ask your client if he felt unheard or misunderstood in his family of origin, Process client's reaction to the intervention. B. Ask the client how he feels when you paraphrase what he is saying; Explore the clients beliefs about the intervention; Ask the client to notice and chart this defense throughout the week. C. Directly tell the client your observation; Ask how he feels in the present moment; Educate your client on defense mechanisms. D. Ask the client if he feels misunderstood by you; Directly tell him your observation; Ask him if he would prefer you didn't paraphrase his ideas in the future.

A. Directly tell the client your observation; Ask your client if he felt unheard or misunderstood in his family of origin, Process client's reaction to the intervention.

Which of the following factors should be included in the assessment of a client from a culture that is different from the therapist's? A. Evaluation of socioeconomic variables, determination of any culturally-related issues, and determination of level of acculturation. B. Evaluation of socioeconomic variables, consultation from traditional healers, and assessment of religious beliefs. C. Evaluation of mental status, determination of any culturally-related issues, and assessment of religious beliefs. D. Evaluation of mental status, determination of any culturally-related issues, and determination of level of acculturation.

A. Evaluation of socioeconomic variables, determination of any culturally-related issues, and determination of level of acculturation.

A 16-year-old client discloses that she is pregnant but plans to have an abortion because she doesn't want to have the baby. She hasn't told her boyfriend or her parents because she is worried they will pressure her to keep the baby. How should the therapist clinically manage this case? A. Explore the pros and cons of her decision and maintain confidentiality. B. Explore the pros and cons of her decision and encourage her to tell her boyfriend because he has a right to know. C. Inform her that because she is a minor, her parents must be informed and encourage her to tell her boyfriend because he has a right to know. D. Explore the client's religious beliefs about abortion and provide psychoeducation about the emotional impact of abortion.

A. Explore the pros and cons of her decision and maintain confidentiality.

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

A. Express appreciation of her struggle to accept that aspect of herself, highlighting the fact that she did eventually choose to leave it.

A 40 year-old female client reports having been depressed for weeks, often tearing-up during the day and having a hard time falling asleep. She used to enjoy riding her bicycle on weekends, but can't get motivated to do so. What questions should the therapist ask when assessing this client? A. Has the client had a change in her weight or appetite? Has she ever had thoughts of disappearing or killing herself? When was the client's last full physical? B. Has the client been in therapy before? Why is the client seeking therapy at this particular time? What do her friends and family think is going on? C. Has the client had a change to her weight or appetite? Has she ever had periods in her life when she had "extra energy" or felt highly productive? Has the client tried getting a new activity if she no longer enjoys riding her bicycle? D. Has the client been in therapy before? Why is the client seeking therapy at this particular time? What hopes does the client have for the outcome of therapy?

A. Has the client had a change in her weight or appetite? Has she ever had thoughts of disappearing or killing herself? When was the client's last full physical?

A 10-year-old girl is brought in to therapy by her parents because she has developed an intense fear of the dark that is interfering with her ability to sleep. At the intake session, the parents inform the therapist that their daughter's fear has progressively worsened, stating, "Initially, she asked for the light on in her room at bedtime. Over the past few months, however, she has become more and more fearful and now is refusing to go into her room at night." The parents tell the therapist that the girl has been staying awake late and eventually falls sleep in their room. The girl is constantly tired and often falls asleep in school. How would a Cognitive Behavioral therapist address the client's fear of the dark in the early stage of treatment? A. Help client and her parents develop a list of the least to most scary aspects of her room. B. Normalize the client's behavior and help implement changes that would make the client feel safer. C. Highlight times when the client was able to successfully sleep in her room and praise her for the behavior. D. Reframe the client's behavior as a way of increasing the attention she receives from her parents.

A. Help client and her parents develop a list of the least to most scary aspects of her room.

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

A. Manage the fees; Explore clients' expectations of therapy; Inform clients of the limits of confidentiality

A therapist with a background in substance abuse treatment sees a new Asian-American client referred because of heavy alcohol use. During the initial assessment the client questions the therapist's credentials and competence. He states that he wants to know because he has tried therapy before and did not find it helpful. He mentions that he has attempted sobriety in the past but always fails to maintain it. How should the therapist proceed during the initial session? A. Provide the client with honest information regarding therapist's credentials; Explore clients expectations of therapy; Ask client about what he would like to see change in his life B. Ask the client why it is important for him to know your credentials; Assess the amount of alcohol the client is using daily; Explore client's expectations of therapy C. Ask how the client feels about seeking help; Assess for suicidality; Refer him to Alcoholics Anonymous D. Explain that the therapist has treated a lot of patients like him; Build rapport with the client; Provide assurance that you will help him maintain sobriety

A. Provide the client with honest information regarding therapist's credentials; Explore clients expectations of therapy; Ask client about what he would like to see change in his life

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

A. Refer to school's special education department for an evaluation; Request a medical evaluation; Obtain a release of information to talk to the client's teacher.

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

A. The 15-year-old client and/or the judge can authorize treatment and she is the holder of privilege.

Tonya, a 64-year-old self-employed real estate agent, is referred to therapy by her neighbor. Tonya has been feeling "depressed and lonely" since her husband left her for another woman six months ago. She shares that the she's been taking pain killers to help her sleep and that most of the time she wishes she just wouldn't wake up. She adds, "Now all I worry about is money and how I'm going to manage by myself. The only thing that gives me satisfaction is planning my revenge on the two of them." Which of the following issues in this case require immediate assessment? A. Tonya's possible suicidality; Tonya's substance use; Possible danger to others B. Severity of Tonya's symptoms; Tonya's level of suicidality; Socioeconomic stressors C. Tonya's social support; Socioeconomic stressors; Tonya's substance use D. Tonya's possible suicidality; Severity of Tonya's symptoms; Tonya's substance use

A. Tonya's possible suicidality; Tonya's substance use; Possible danger to others

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

A. Track the number of calls and confront the client.

In which of the following situations may a therapist provide information without the client's consent? A. When a client files a malpractice suit. B. During a child custody evaluation. C. When a client is dead. D. When a client is unable to provide reliable information.

A. When a client files a malpractice suit.

A client seeks therapy following a miscarriage. She reports feeling sad and guilty about the loss. She is having a difficult time focusing at work and feels disconnected from her husband. What psychological factors should the therapist assess when formulating the initial treatment plan? A. Her husband's reaction to the miscarriage. B. How she has coped with difficulties in the past. C. The strength of social support network. D. Her history of miscarriages.

B. How she has coped with difficulties in the past.

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

B. Ask the couple how their relationship would change if the drinking stopped.

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

B. Assess for suicidal ideation; Provide psychoeducation on grief process; Identify coping strategies and social support.

A 29-year-old client reports having a history of relationship difficulties. He is currently in a new relationship and shares that he gets angry when he is not in control of the situation. He adds that he speaks to his mom on a daily basis and she is highly critical of him. What intervention would a Cognitive therapist use in the middle phase of treatment: A. Explore the client's feelings toward the therapist and the history of the client's relationship with his mother. B. Assign homework to identify triggers to his anger. C. Instruct client to limit contact with mother. D. Confront the client's problematic automatic thought patterns.

B. Assign homework to identify triggers to his anger.

A mother brings her 10-year-old daughter, Wanda, to therapy at the request of Wanda's pediatrician. During the last few months a representative from child protective services has been investigating potential abuse allegations that have been made against Wanda's father. The investigator eventually determined that abuse allegations were unfounded and the case has been closed. Since the investigation, the child has been afraid to sleep in her own room, is demanding of her parents, and has nightmares that her dad is being taken. What should be the immediate, short term objective of therapy with this client? A. Reduce the child's display of anxiety and encourage the client to forget the incident because it was unfounded. B. Assist the client to explore her emotions and fears about the incident and identify self-soothing resources available to her. C. Stabilize the client's mood and instruct the parents to set firm limits on child's bedtime behavior. D. Refer the client to a psychiatrist for a medication evaluation and eliminate denial in the client's family.

B. Assist the client to explore her emotions and fears about the incident and identify self-soothing resources available to her.

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

B. Assist the couple in understanding the religious values of their family of origin; Explore whether Darla is using the church to avoid marital issues and intimacy.

A therapist at a community clinic is working with Helene, a 45-year-old woman, who has a history of paranoid delusions and crack cocaine use. She is distrustful of the system and service providers in general. "All they want is more and more information about me. Nobody cares about helping me, they are just trying to gather information so they can get paid," she states. She has refused medication and substance abuse treatment. What initial clinical strategies should the therapist use in this case? A. Refer the client to substance abuse treatment; Require that the client attend at least 3 Narcotics Anonymous meetings a week; Assign the client to attend group therapy B. Attempt to establish a trusting relationship to engage the client in treatment; Maintain unconditional positive regard; Explore the pros and cons of her drug use C. Assist the client in seeing a psychiatrist to treat her mental health problems; Assign the client to attend group therapy; Direct the client to write a good-bye letter to cocaine D. Provide psychoeducation on the relationship of drug abuse and her mental health; Maintain unconditional positive regard; Assist her in coming to an acceptance of her chemical use

B. Attempt to establish a trusting relationship to engage the client in treatment; Maintain unconditional positive regard; Explore the pros and cons of her drug use

A 30 year-old man, a recent immigrant from the Middle East, comes to therapy for the treatment of anxiety. He states that, despite his excellent English, his anxiety causes him to freeze when interviewing for employment. As a result he finds himself stuttering and forgetting words. What interventions would a Solution-Focused therapist include in the middle phase of treatment? A. Compliment client's command of the English language; utilize scaling questions regarding positive change since the beginning of treatment; deepen the inquiry into client's successes in his country of origin. B. Compliment times client has managed his anxiety successfully; utilize scaling questions regarding positive change since the beginning of treatment; deepen the inquiry into client's evolving vision for positive outcomes in his future. C. Address cultural conflicts the client has encountered; utilize scaling questions regarding positive change since the beginning of treatment; deepen the inquiry into client's successes in his country of origin. D. Address cultural conflicts the client has encountered; utilize scaling questions regarding positive change since the beginning of treatment; deepen the inquiry into client's evolving vision for positive outcomes in his future.

B. Compliment times client has managed his anxiety successfully; utilize scaling questions regarding positive change since the beginning of treatment; deepen the inquiry into client's evolving vision for positive outcomes in his future.

At a community mental health agency, a new therapist replaces another therapist who resigned with short notice due to a family emergency. Within a few weeks, the new therapist has met with all the clients. While in an agency waiting room, a therapist colleague hears the new therapist say to a client that it was "unprofessional and harmful" for the prior therapist to leave the agency so suddenly. The colleague should first: A. Discuss the incident with a supervisor. B. Confront the new therapist. C. Make a note of this incident and monitor the new therapist. D. Consult with other colleagues in the agency about the situation.

B. Confront the new therapist.

A polyamorous couple comes to therapy for the first time. They share the fact that both members of the couple are in a relationship with other people and issues of jealousy and sexual safety are coming up for them causing conflict. They state that they have been referred by one of the partner's psychiatrists. The psychiatrist told them that therapist has tremendous experience in working with polyamorous couples. In actuality, the therapist has treated mostly monogamous couples and has only attended seminars on how to work with polyamorous couples. What ethical responsibilities does the therapist have in this case? A. Upon the completion of the session contact the referring psychiatrist and provide correct information regarding both the experience and the training the therapist has. B. Contact the referring psychiatrist in order to provide correct information and process the couple's reaction after telling them the actual status of therapist's experience. C. Inform the couple that the information regarding the therapist expertise is incorrect and inquire about the impact of such correction. D. Tell the couple that even though the therapist has seen mostly monogamous couples the seminars the therapist attended have been very helpful in helping understand a polyamorous dynamic.

B. Contact the referring psychiatrist in order to provide correct information and process the couple's reaction after telling them the actual status of therapist's experience.

A therapist is hired as a supervisor at a residential treatment facility. During a supervision session with one of the team members, the supervisee complains about another team member's treatment of him. How should the supervisor address the concern? A. Tell the supervisee that the supervisor will watch out for the problem. B. Encourage the supervisee to confront the team member. C. Document the concern in the supervision notes. D. Address the concerns to the team member in the next supervision.

B. Encourage the supervisee to confront the team member.

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

B. Health status and ability to provide basic care.

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

B. Issues related to family transition and individual life stages.

Dan, a 42-year-old African-American army sergeant, and Anna, a 36-year-old Caucasian, are referred by Anna's physician. The married couple of six years report that they have been arguing constantly for the past month. Anna shares that she has been suffering from insomnia since she had a miscarriage three months ago. Dan says, "I get that she's upset but she just needs to get over it." Anna shares that she's been going to church again, but Dan refuses to join her. Dan adds, "I'm gonna be heading to the front lines again in a couple months. I don't really want to spend any of my free time at church." What human diversity issues should the therapist explore initially in this case? A. Health concerns; Ethnic differences; Religious and spiritual beliefs B. Military culture; Ethnic difference; Religious and spiritual beliefs C. Socioeconomic stressors; Religious and spiritual beliefs; Age difference D. Age difference; Ethic difference; Religious and spiritual beliefs

B. Military culture; Ethnic difference; Religious and spiritual beliefs

Tina, a 49-year-old self-employed Asian American computer programmer, is referred to therapy by a close friend. Tina reports feeling tense and nervous since her 88-year-old father moved in with her. Tearfully, she explains, "In my culture it is unacceptable to have your parents in a nursing home." She adds that he has Alzheimer's and that she gives him extra medication to keep him sedated, otherwise he wanders off when she is on business calls. How should the therapist clinically manage the legal obligations in the case described in the vignette? A. Obtain a release to speak with Tina's father; Refer Tina to support group for children with aging parents; Contact Adult Protective Services to file report of elder abuse/neglect. B. Process the need to file a report with Tina; Contact Adult Protective Services to file report of elder abuse/neglect; Document the incident in the file. C. Obtain a signed release to talk with the father's MD; Further assess for elder abuse/neglect; Process the possible need to file a report with Tina. D. Obtain a signed release to talk with the father's MD; Refer Tina to support group for children with aging parents; Further assess for elder abuse/neglect.

B. Process the need to file a report with Tina; Contact Adult Protective Services to file report of elder abuse/neglect; Document the incident in the file.

A seven-year-old boy is referred to a community mental health center due to aggressive play, poor attention in class and angry outbursts. During the initial session, the mother informs the therapist that she and her son recently moved into a domestic violence shelter to escape his father. She states that her son had seen the father beat her up multiple times. What additional information would most help clarify the initial diagnosis for this child? A. Severity of symptoms B. Onset of symptoms C. Frequency of symptoms D. Family history of mental illness

B. Onset of symptoms

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

B. Reactive Attachment Disorder because of Lucy's behavior in session and history of caregiving disruptions.

A parent in great distress consults a therapist. The parent is unsure how to respond to recently finding her five-year-old touching the body of another child. The parent is disturbed and worried that this is deviant behavior and desires to set up a session with the therapist to discuss concerns. In this initial session the therapist should: A. Discuss the parent's feelings about sexuality; Assess for possible sexual abuse of the child; Refer to a incest survivors group. B. Reassure the parent that this is normal behavior for children this age, Assist the parent in handling distress and worry; Discuss the parent's feelings about sexuality. C. Contact the child's other parent; Assess for child abuse; Call CPS. D. Assess for child abuse; Provide ongoing therapy to the mother to assist her in handling her fears; Refer to a parenting group.

B. Reassure the parent that this is normal behavior for children this age, Assist the parent in handling distress and worry; Discuss the parent's feelings about sexuality

Tony, a 29-year-old male, seeks treatment regarding his social anxiety. In the process of therapy, the client discloses his love for gambling. He vividly describes the smells and noises of the casino, free drinks that flow endlessly, and "the thrill of winning and walking away with a wad of cash in your hands." In addition, the client shares that his social anxiety is almost non existent at the gambling table because the adrenaline rush takes care of it. The therapist had had a problem with gambling in the past, but has been in recovery for the past seven years. After meeting with the client for four months, the therapist is so drawn in by the vivid descriptions the client provides, that the therapist finds himself in a casino almost weekly. The therapist begins to dread upcoming sessions with Tony. Which of the following actions should the therapist take? A. Inform the client that they can continue therapy only if the client begins attending gamblers' anonymous meetings. B. Seek therapy for personal issues of gambling addiction since this issue has the potential to negatively impact the therapeutic relationship. C. Seek immediate consultation to resolve gambling addiction issues before therapist's bad habits negatively impact the therapeutic relationship. D. Share the thrill of gambling that the therapist experiences with the client as way of connecting and validating the client.

B. Seek therapy for personal issues of gambling addiction since this issue has the potential to negatively impact the therapeutic relationship.

A therapist meets with a 35-year-old Japanese American man who is referred by a co-worker. He shares that he needs help because his wife is pressuring him to move his mother into a nursing home. He prefers that she live with them but he doesn't want to argue with his wife who is the breadwinner in the family. How would a Systems therapist further assess this situation? A. Be authoritative and suggest a course of action; Offer to meet with the couple to teach communication skills; Provide the client with referrals to assisted living homes B. Survey client's cultural perspective around this issue; Suggest that the couple come in together to discuss the issue; Explore family roles C. Invite the mother and wife to the next session; Discuss cultural norms and customs; Encourage the mother's self determination process D. Address the client's family dynamics, Teach communication skills, Refer to a support group

B. Survey client's cultural perspective around this issue; Suggest that the couple come in together to discuss the issue; Explore family roles

A therapist is facilitating a group for mandated teenagers who are part of the foster care system. A new member joins the group after it has been going for a few months. What should the therapist address in the initial group session? A. The group rules. B. The expectation of confidentiality. C. The history of the group. D. The goals of the group.

B. The expectation of confidentiality.

Parents bring a 14-year-old to a therapist because the adolescent questions authority, is late for curfew, and no longer desires to attend church with the family. The adolescent states that the parents "treat me like a baby" and that the adolescent wants to go to a "more upbeat" church. Which of the following is the best provisional assessment of the clinical themes present in this case? A. Seeking to identify with peers; Pushing boundaries; Seeking religious freedom. B. Trying to find a personal identity; Differentiation from parents' religious expression; Seeking autonomy. C. Parental role confusion; Oppositional defiant behaviors; Acculturation issues. D. Rejecting values; Fostering new personal values; Seeking autonomy.

B. Trying to find a personal identity; Differentiation from parents' religious expression; Seeking autonomy.

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

B. Understand factors that affect the client's behavior

A. Explore their patterns of interaction when they are dealing with stressful issues and assist the family in identifying supports outside of the immediate family.

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

A therapist sees a family for family therapy. The parents are distraught about their 4-year-olds tantrums. They say they can't agree how to respond and the preschool is threatening to have him kicked out. What is an example of circular questioning that the therapist can ask the parents in this case? A. "When did you two notice this was a problem?" B. "If you each had it your way, how would you like your spouse to respond?" C. "When your son has a tantrum, how do you each respond?" D. "How have each of you been coping with the stress of this?"

C. "When your son has a tantrum, how do you each respond?"

A 22-year-old client with Bipolar is referred by his psychiatrist for therapy. He shares that he is currently living at home with his parents. During the third session he expresses anger that his parents frequently tell him how to manage his life and argue with each other about his treatment. How would a Systems therapist proceed in this case? A. Suggest that the therapist talk with his parents and obtain a release to speak to the parents. B. Explore how he's been dealing with it and encourage him to express his feelings to his parents. C. Acknowledge his anger and offer a family session to address the issues. D. Explore his early relations with his parents to identify patterns to their behavior.

C. Acknowledge his anger and offer a family session to address the issues.

A therapist in private practice is temporarily moving to another city. After considering the risks and benefits that may be experienced by each client, the therapist offers to continue the therapeutic relationship with several clients through teletherapy. Teletherapy would be most appropriate for which of the following? A. Clients in couple's therapy. B. An elderly client who just lost his wife. C. A high-functioning client making substantial progress toward goals. D. A client expressing suicidal ideation.

C. A high-functioning client making substantial progress toward goals.

A 25-year old woman seeks help at a local mental health clinic. She complains of nightmares, agitation, an inability to concentrate, and weight loss. She's worried she will never feel normal again. During the assessment phase, the therapist learns that the client had been recently raped and mugged. The therapist's initial interventions should include: A. Obtaining details of the attack; Assessing potential for self-harm; Referring to an MD. B. Creating a safety plan; Filing a police report; Identifying coping strategies. C. Assessing potential for self-harm; Referring to an MD; Identifying coping strategies. D. Obtaining details of the attack; Referring to an MD; Identifying coping strategies.

C. Assessing potential for self-harm; Referring to an MD; Identifying coping strategies.

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

C. Clarify and define relational "rules" for the marital subsystem including cultural issues.

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

C. Client has a history of setting fires, being hostile and vindictive before age 15.

Tracy, a 38-year-old corporate lawyer, and her 28-year-old wife, Jill, a musician, self-refer for couples therapy. Tracy recently gave birth to a son with special needs. Tracy states, "Jill doesn't understand my stress. I have to bill a certain number of hours or there is no way I am going to make partner." She complains that Jill drinks and smokes pot nightly and doesn't get out of bed all day. I can't trust her with our baby." Jill responds, "You're the one who wanted the baby. Don't blame me for your child care problems while you keep working 15 hours a day." How should the therapist assess and clinically manage potential child abuse based on the case described in the vignette? A. Determine whether the couple can adequately care for the baby; Review parenting skills modeled by their parents; Obtain a release to consult with the pediatrician. B. Evaluate the current child care arrangements; Explore why Tracy can't trust Jill with the baby; Refer them to a support group for parents of children with special needs. C. Evaluate the current child care arrangements; Explore why Tracy can't trust Jill with the baby; Process reactions to a possible child abuse report. D. File a child abuse report based on Jill's neglect of the baby; Obtain a release to consult with the child's pediatrician; Refer couple to a support group for parents of children with special needs.

C. Evaluate the current child care arrangements; Explore why Tracy can't trust Jill with the baby; Process reactions to a possible child abuse report.

A family of four seeks therapy due to recent behavioral problems exhibited by the teenage children. The parents, McKenzie, age 38, and Blake, age 38 recently got married and moved in together. The husband's children are Anna, age 7, and Gia, age 13. The wife's children are Hunter, age 9, and Emma, age 14. The parents report that Gia and Emma are not listening and acting out. They refuse to do their chores, clean their room or help out around the house. Blake and McKenzie are tired of hearing the two girls fight and pick on each other. They both go to the same school and their grades are beginning to decline. How would a Systems therapist proceed with the assessment? A. Determine when the problematic behavior started with the teenagers. B. Obtain a release to speak to the school and the pediatrician about their behavior. C. Explore how each of the family members is adjusting to the new living arrangements and family structure. D. Inquire about discipline methods used by the parents to address the problematic behaviors.

C. Explore how each of the family members is adjusting to the new living arrangements and family structure.

A therapist is working with a family with three children, the youngest of whom, Danny, age 12, is in a wheelchair because of cerebral palsy. The parents describe Danny's withdrawal from outside activities and believe that he is depressed. Danny remarks that his mother hovers over him, and that his siblings dislike him because he has no chores at home. He expresses an interest in staying with his cousin over Christmas break and says he wants more responsibility at home. How should the therapist proceed? A. Support the mother's understandable need to be protective and consult with the family physician regarding Danny's physical capabilities. B. Focus on Danny's need for greater self-esteem and use therapeutic stories to increase his awareness of feelings and ways to cooperate with others. C. Explore stage of life issues and help the family address Danny's expressed desires. D. Normalize Danny's feelings and suggest the family explore outside activities for him.

C. Explore stage of life issues and help the family address Danny's expressed desires.

Derek, age 40, his girlfriend Anna, age 36, and her daughter Jenny, age 16, are referred to therapy by Jenny's school. Anna reports that her daughter screams every morning that she doesn't want to go to school. Jenny glares at her mother and says, "I hate this school and I hate living with Derek. I want to move back to our old apartment." In a stern voice, Derek says, "You're not in charge here. Do not talk to your mother like that." The next day, Jenny calls the therapist and reports that last month, Derek crawled into her bed and fondled her. She shares that she doesn't want her mom to find out. How should the therapist clinically manage the legal issues related to this crisis issue? A. Assure Jenny that you will maintain her confidentiality; Process Jenny's reactions to a possible child abuse report; Offer to facilitate a discussion between Jenny and Anna regarding the report B. Determine whether Derek has done this before; File a child abuse report but do not inform Jenny because it could impact your relationship; Inform Jenny that her mother needs to be informed. C. File a child abuse report; Inform Jenny that a child abuse report must be filed and process her reactions; Offer to facilitate a discussion between Jenny and Anna regarding the report D. File a child abuse report, Encourage Jenny to tell her mother; Explore why Jenny does not want her mom to know about incident

C. File a child abuse report; Inform Jenny that a child abuse report must be filed and process her reactions; Offer to facilitate a discussion between Jenny and Anna regarding the report

A couple is referred to therapy by their MD. During the first appointment the couples shares that at the wife's annual physical exam the doctor noted some suspicious bruises. The wife told the doctor that her husband drinks too much, becomes angry, and hits her and their children. The husband angrily reports that the doctor made a child abuse report and suggested they go to therapy. How should the therapist proceed? A. File a child abuse report; Refer the couple to AA and Alanon; Refer the husband to a batterer's program; Consult with wife's physician B. Refer the couple to AA and Alanon; Refer the couple to domestic violence intervention program; Document that child abuse report has been made; Consult with wife's physician C. File a child abuse report; Refer each person to individual therapy; Provide wife with information on domestic violence resources; Provide husband with referral for substance abuse treatment D. Refer the couple to AA and Alanon; Refer the husband to a batterer's program; Document that child abuse report has been made; Provide wife with information on domestic violence resources

C. File a child abuse report; Refer each person to individual therapy; Provide wife with information on domestic violence resources; Provide husband with referral for substance abuse treatment

A therapist is moving offices. On the evening she is transporting some of her records, her car is broken into and her records are stolen. How should the therapist initially deal with this issue? Score: 0 of 1 A. Determine which client files have been stolen. B. Contact the therapist's clients and inform them of the situation. C. File a police report. D. Consult with a lawyer.

C. File a police report.

Andy, a 24-year-old Caucasian male is referred to counseling by his probation officer. Andy was recently released from prison where he served time for assault. He shares that he has been feeling really bad and has no future. He never finished college and has never held a real job. Andy adds that he is having problems with the manager of the half-way house. "He is on my case all the time, micromanaging and bossing me around like I am a little boy," he says. "I'm not going to put up with his attitude," he adds. How should the therapist move forward in this case? A. Obtain a release to speak to probation officer; Warn the manager of the half-way house about a possible attack; Discuss Andy's fear of failure. B. Explore Andy's feelings of hopelessness; Probe the client's emotional struggles that are camouflaged by his aggression; Obtain a release to speak to his half-way house manager. C. Find out what he means by "I'm not going to put up with his attitude"; Explore Andy's feelings of hopelessness; Obtain a release to speak to his probation officer. D. Discuss Andy's fear of failure; Remind him that there is a Tarasoff duty to warn if he makes a threat; Obtain a release to speak to his probation officer.

C. Find out what he means by "I'm not going to put up with his attitude"; Explore Andy's feelings of hopelessness; Obtain a release to speak to his probation officer.

Jane is a 22-year old student in her senior year of college. As graduation nears, she has had increased anxiety about finding a job and having to take care of herself. She says, "I feel like I've been taken care of by my parents all my life. I don't know how to take care of myself. I'm scared." What interventions would a Gestalt oriented therapist use for this client? A. Have the client reflect on what "being taken care of" means to her; Normalize her experience as appropriate to this phase of her life. B. Have the client reflect on what "being taken care of" means to her; Share with the client the therapist's experiences after graduating from college. C. Have the client put her "scared self" in the empty chair and encourage a dialog with that part; Use body awareness to keep the client's focus on how she is feeling here in the room. D. Have the client put her "scared self" in the empty chair and encourage a dialog with that part; Ask the client to describe her ideal life six months after graduation.

C. Have the client put her "scared self" in the empty chair and encourage a dialog with that part; Use body awareness to keep the client's focus on how she is feeling here in the room.

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

C. Highlight when the parents interact with the children.

A couple seeks treatment for communication issues and on-going conflict. If a therapist was using a cognitive approach, what would be one focus of treatment? A. Identifying how their pasts influence their understanding of each other. B. Exploring how their patterns of engagement stem from their family of origin. C. Identifying their underlying assumptions about each other and their relationship. D. Setting clear boundaries with their extended families.

C. Identifying their underlying assumptions about each other and their relationship.

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

C. Inquire about social supports; get details on alcohol consumption; identify past and current coping strategies

A couple in their early 40s, Eva and Briella, present for treatment due to an ongoing conflict. After several years of unsuccessful pregnancies, Briella was finally able to get pregnant. As a result, they had their only child, a son named Magnus. When the couple got pregnant they decided that Briella would stay at home until the baby turned one. Their son is now almost two and Eva has been getting impatient. "Our savings are running out and Briella doesn't want to go back to work," she states. " I refuse to be the sole provider any more. It is time to put Magnus in daycare." In response Briella tearfully says, "Do you remember everything we had to go through for us to even have him? I want to spend as much time with him as I possibly can. I do not care if we have go in debt. These precious years will never return." What interventions would a Strategic therapist use in the middle stage of therapy? A. State that their situation is hopeless and teach the clients the use of I-statements. B. Point out ways in which the clients control the therapist and each other and collaborate with clients on strengthening the boundaries. C. Instruct the clients to write each other a love letter each time they have and urge to argue about Magnus and request that the clients stop trying to get better. D. Create a new problem for clients to solve and identify dysfunctional communication patterns in their families of origin.

C. Instruct the clients to write each other a love letter each time they have and urge to argue about Magnus and request that the clients stop trying to get better.

Which of the following factors should a therapist routinely consider when assessing for the risk of child abuse? A. Caretaker characteristics, socioeconomic background, and disciplinary style B. Caretaker characteristics, behavioral signs, and parenting style C. Physical symptoms, behavioral signs, and disciplinary style D. Physical symptoms, socioeconomic background, and parenting style

C. Physical symptoms, behavioral signs, and disciplinary style

A 41-year-old female has been in therapy for two years for anxiety attacks and depression. When she first entered therapy she was taking psychotropic medications to help manage her symptoms. As treatment progressed, her psychiatrist slowly reduced her dose and she has now been off the medication for 4 months. She has not had a panic attack in over and year, and even though she can get down or overwhelmed with her work, she is able to implement the tools she learned to regulate her mood and not fall into a depressive state. During recent therapy sessions she frequently laughs and enjoys herself. Which of the following actions should the therapist take? A. Interpret the client's behavior as a flight into good health and assess for suicidal ideation. B. Confront the client regarding avoidance of underlying issues and assist the client in addressing early attachment wounds. C. Recognize the progress made and develop a termination plan with the client. D. Identify precipitating events leading to the new symptom development and help the client develop healthy self-talk as a means of handling anxiety.

C. Recognize the progress made and develop a termination plan with the client.

A 32 year-old single mother of two comes to therapy complaining of depression. She reports difficulty sleeping, performance problems at her work, a contentious relationship with her former husband, and frequent fights with both of her children, Jane, aged 9 and William, aged 5. The therapist has worked with the client for three sessions and in each session the client focuses on a new pressing issue. In the third session her children take center stage and the client asks if the therapist will see her and her children together as a family instead of continuing with individual sessions. What actions would a Client Centered therapist take in response to this request? A. Accept the client's decision as a way to empower her; Begin seeing the family as the new treatment unit. B. Ask the client to draw a diagram representing her family of origin; Suggest that she continue with individual therapy and refer her to another therapist for family sessions. C. Reflect on how the client seems to have many topics that are all very important to her and express empathy for how challenging this is for her; Suggest focusing on individual therapy for a few more sessions. D. Suggest to the client that she is avoiding her own issues by making family relations the focus of treatment; Refer the children to another therapist experienced in working with children of divorce.

C. Reflect on how the client seems to have many topics that are all very important to her and express empathy for how challenging this is for her; Suggest focusing on individual therapy for a few more sessions.

Larry, a 42-year-old stockbroker, came to therapy after his marriage fell apart. He found out that his partner was cheating on him over the period of the last 5 years. Larry spent a good amount of time healing his pain and taking a close look at his relational dynamic in hopes of understanding various ways in which he might have contributed to such outcome. Nearing termination, Larry tells the therapist: "I am really grateful for all the work we have done together. And I would love for you to benefit from our relationship as well. I have a tip about the stock market that will have a 20% return on your investment. I am happy to share it with you." How should the therapist respond to the client's offer? A. Refuse the tip as an inappropriate boundary crossing. B. Refuse the tip as an illegal barter for services. C. Refuse the tip as a conflict of interest. D. Refuse the tip as a boundary violation.

C. Refuse the tip as a conflict of interest.

Sheri, age 14, is brought in for therapy by her half-sister Kelly, age 28, who was given legal custody following the death of Sheri's biological parents 7 months ago. Sheri has been getting into trouble at school for cheating on exams, skipping class, and threatening classmates. Kelly caught her sneaking a boy into her room over the weekend and caught her smoking marijuana. Kelly states, "I just don't know what's wrong with her. I'll pay for as many sessions as you need. My toddler keeps me busy enough, I don't have time to deal with this!" Sheri angrily responds, "I wish I would have died in the accident too." What crisis issues are presented in the case described in the vignette? A. Loss of parents; Substance use; Academic problems. B. Academic problems; Sheri's possible suicidality; Family restructure. C. Substance use; Sheri's potential for self-harm; Sheri's at-risk behavior. D. Substance use; Lack of social support; Child neglect.

C. Substance use; Sheri's potential for self-harm; Sheri's at-risk behavior.

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

C. The child may not have reached necessary level of cognitive development.

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

D. Assume a curious stance; Share the observation of this pattern with the client; Inquire about her view on the matter.

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

D. Build trust using eye contact and active listening; Clarify the client's experience; Further explore the relationship dynamics.

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

D. Building on the clients' strengths and competencies.

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

D. Clarify what the client means by "depression."

Kamal, a 14-year-old Iranian-American boy, is referred for therapy by his school counselor. Parents, Emad and Darya, and younger sister Lila, age 9, attend the first session with Kamal. Emad angrily complains that his son's grades have dropped over the past few months and says, "He needs to shape up and stop spending so much time alone in his room." Lila sits quietly close to her mother, nervously playing with her hair and revealing a mark on her cheek. Kamal stares at the floor during the session and appears uncomfortable when answering questions. At the end of the session, as the family exits the office, Darya whispers, "I'm tired of the way my husband treats us, but I don't know what to do." How would a Bowenian therapist incorporate human diversity issues into the initial treatment plan based on the case described in the vignette? A. Explore Emad's and Darya's beliefs about parenting and analyze how Darya's and Emad's relation to their family of origin influenced each partner in their marriage. B. Explore how Darya's and Emad's relation to their family of origin influences each partner in their marriage and analyze the value of education in Iranian culture. C. Discuss how being Iranian-American affects their view of the current situation and encourage Emad to journal in order to decrease emotional reactivity. D. Draw a family tree for both Darya's and Emad's families going back at least two generations and explore Emad's and Darya's beliefs about parenting roles in their family of origins.

D. Draw a family tree for both Darya's and Emad's families going back at least two generations and explore Emad's and Darya's beliefs about parenting roles in their family of origins.

A 15- year-old girl, Jill, is brought to therapy by her parents. They are concerned that she is withdrawing from her usual activities, spending less time with the family and choosing instead to do things on her computer in her room. After six weeks of therapy the client asks that the therapist use the name JD, not Jill, and male-gender pronouns when talking about "him." JD pleads that the therapist not tell his parents about this because they are strictly religious and he has heard them reacting with disgust to items in the news about transgender people. What actions should therapist take in this case? A. Tell the client that his parents must be informed because this change may affect him medically and process his reaction. B. Tell the client that his parents must be informed only if the client is considering any medical changes to support his new gender and explore his discomfort at telling parents. C. Respect the client's request for confidentiality and encourage the client to work toward telling parents. D. Explain client's rights to confidentiality and assess for danger to self.

D. Explain client's rights to confidentiality and assess for danger to self.

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

D. Explore the client's feelings about her husband's views and share concerns about possible domestic violence.

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

D. Explore the role of the cutting and ask about triggers for cutting.

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

D. Express empathy for the parents' concerns; get more details about the specific behaviors that they find concerning; arrange to see the minor client at the next session.

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

D. Follow up with the member individually after the group about the situation.

A 32-year-old woman seeks therapy after the recent death of her infant son. She shares that she has struggled with alcoholism and it has gotten worse since her son passed away. What initial adjunctive resource should the therapist consider initially in this case? A. Alcoholics Anonymous B. Grief Support Group C. MD D. Substance Use Treatment Center

D. Substance Use Treatment Center

A 24-year-old college student has been having headaches, insomnia, and feelings of dread for several weeks. The client reports that he has no insurance and cannot pay for services. How should the therapist proceed in providing the client clinical case management? A. Initiate brief therapy to reduce client's symptoms. B. Take a social history of client to evaluate support systems. C. Refer the client to a physician for evaluation for mental illness medication. D. Network resources with the client to secure treatment.

D. Network resources with the client to secure treatment.

Suzanne, age 13, is brought to therapy by her aunt, JoAnne, age 40, who was given legal custody following the incarceration of Suzanne's mother five months ago. JoAnne states, "I don't know what to do with her. I think she's in a gang. She denies it, but she's been carving tattoos in her arm." She adds that the school called her and reported that she's been missing a lot of school. Suzanne looks out the window and states, "The only people who care about me are my home girls." JoAnne, responds angrily. "I do care about you, that's why we are here. I don't want you to end up like your mother." What legal obligations does the therapist have in the case described in this vignette? A. Obtain a release from Suzanne before speaking to school staff; Determine JoAnne's ability to parent; Assess Suzanne for self-harm. B. Set fee before the onset of therapy; Review confidentiality and inform clients on its limits; Assess and manage Suzanne's suicidal ideation. C. Set fee before the onset of therapy; Communicate limits of confidentiality; Initiate a 5150 if Suzanne reports suicidal ideation. D. Obtain signed informed consent to treat a minor if treating Suzanne individually; Assess and manage Suzanne's risk to self and others; Manage confidentiality if treating Suzanne individually.

D. Obtain signed informed consent to treat a minor if treating Suzanne individually; Assess and manage Suzanne's risk to self and others; Manage confidentiality if treating Suzanne individually.

Ava, a 53-year-old optometrist, comes to her first session looking exhausted. During the biopsychosocial assessment she indicates that she is happy at her job and she has an extensive network of friends and family all around her. Recently she has been losing weight and not sleeping. "I cannot think of anything that might have changed," she notes, "but I cannot seem to fall asleep and even when I can, I wake up in the middle of the night and lie awake for hours." She has been married for 25 years and her husband screams and yells when he gets very angry and has hit her in the past. How should the therapist initially respond to the client's disclosure? A. Assist the client in locating appropriate shelters and contact the police. B. Refer the client to a doctor for a medical evaluation and contact the police. C. Assist the client in developing a safety plan and file a report with an adult protective services agency. D. Refer the client to a doctor for a medical evaluation and assist the client in developing a safety plan.

D. Refer the client to a doctor for a medical evaluation and assist the client in developing a safety plan.

A therapist begins to establish rapport with a 16-year-old client. After a few months of working together, the therapist discovers that every once in a while he still sees his former therapist for support. The therapist should first: A. Tell the client that he can no longer see the other therapist. B. Speak directly to the other therapist. C. Terminate therapeutic relationship. D. Speak directly to the client about the situation.

D. Speak directly to the client about the situation.

Barbara, age 43, and Bill, age 48, seek therapy for marital issues. The couple shares that they had separated but that Bill had moved back in when he agreed to go to therapy and stop drinking. Barbara states, "After he lost his job a year ago he started to drink again. And when he's drunk he loses his temper with the kids and becomes violent." Bill nods and adds, "I was sober for 10 years but losing my job just pushed me over the edge." How should the therapist clinically manage the legal and ethical obligations presented in this vignette? A. Identify Bill's prior history of violence; File a report to child protective services; Refer Bill to Alcoholics Anonymous. B. File a child abuse report; Provide Barbara with a safety plan for the children; Document interventions in their record. C. Assess whether Bill is currently sober; Provide Barbara with a safety plan for the children; Document interventions in their record. D. Review the limits of confidentiality; Process with Barbara and Bill the possible need to make a child abuse report; Further assess for child abuse.

D. Review the limits of confidentiality; Process with Barbara and Bill the possible need to make a child abuse report; Further assess for child abuse

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

D. Stabilize symptoms; Increase social support

Dolly, age 44, and Gonzalo, age 46, are referred to therapy by Dolly's individual therapist. They express a deep commitment to stay together. During the initial session they both continually interrupt the other one and become defensive. Why should the therapist utilize role reversal as part of this couples' course of treatment? A. To reinforce autonomy of the two partners. B. To reinforce the established roles of each partner. C. To increase lighthearted interplay between partners. D. To increase empathy and understanding between partners.

D. To increase empathy and understanding between partners.

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

D. express understanding of the client's position regarding therapy.

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

Identify how the depression has affected Melissa and her family; Help the clients state their preferences regarding future effects of the depression