MFT Clinical questions to review

Question ID #24193: Your client wants to contribute to your blog. She asks you how many people read your blog because "I think talking about my experience will really help other people." What ethical standards would guide your discussion? Select one: A.Dual relationships: If she contributes to your blog, you could have a dual relationship. B.Termination: Tell her that she can only talk about therapy in a public forum after she has terminated. C.Scope of competence: Tell her that you will only respond to her posts if they are within the scope of therapy. D.Boundaries: Tell her that you cannot allow her to post messages to your blog because they would violate the confidentiality of therapy.

A

Which of the following is a general systems intervention when developing a treatment plan for a family? Select one: A.Circular questioning to assess communication. B.Relationship questions to assess communication. C.Problem list to reframe the "IP". D.Deconstruction questions to disrupt boundaries.

A Answer A: Circular questioning is a general systems intervention that is used to assess how each person in a family affects every other person. Answer B: "Relationship questions" are Solution-Focused reframing questions that are designed to locate client strengths, not to assess communication patterns. Answer C: A problem list is not used in reference to reframing an "IP". A problem list is a Cognitive-Behavioral intervention that is used in the early stage to formulate goals and treatment priorities.

Question ID #25769: Peter and Harry Kingery are ages 9 and 10, respectively. One day Harry shows up with a black eye and a broken arm and the family explains that Peter finally got his brother back for all the "beatings" Harry usually gives his younger brother. Harry and Peter agree with this account. They sit on opposite sides of your office while their parents talk to you about how they grew up. Under these circumstances you must: Select one: A.Make a child abuse report. B.Teach the children conflict resolution techniques. C.Conduct separate sessions with the boys to determine their safety. D.Maintain confidentiality since a mutual affray between minors does not constitute child abuse.

A Answer A: If children are being repeatedly beaten and injured by fighting with one another, there would be a strong presumption of child neglect and a mandate to report. Answer D: If children are being repeatedly beaten and injured by fighting with one another, there would be a strong presumption of child neglect. The presence of injuries may indicate that this situation is more than a "mutual affray between minors". Therefore, a report of child abuse must be made.

You are seeing the Gregg siblings: Stacy, age 10, Jeff, age 7, and Terry, age 6. Their parents are divorced and the father has physical custody. Mom, a recovering alcoholic, gets the children every other weekend for visitation. The children draw pictures of a woman and a man watching dirty movies on T.V. and drinking champagne. Jeff's drawing has two children in it; he says they are also watching the dirty movies with the adults. You would: Select one: A.Gather more information while you continue to see the Greggs. B.Report to Child Protective Services because you have a reasonable suspicion of abuse. C.Do nothing, this is art therapy and not very reliable as an indicator of abuse. D.Ask the father in to discuss the children's behaviors before and after visitations with the children's mom.

A Answer A: In this vignette you do not yet have enough information to make a report, but you do want to gather more information to see if this is a reportable situation. Answer B: Artwork, in and of itself, does not give enough specific information for "reasonable suspicion" of child abuse and thus more information would be needed to make a report.

Ralph has been seeing you for individual counseling for one month. You know that he has suicidal ideation, and you have been monitoring it very closely. He is also seeing a psychiatrist for depressive symptoms. He had three deployments to Iraq and is having a very difficult time returning to civilian life and getting a job. What information would most heighten your concern regarding the need for involuntary hospitalization? Select one: A.He has a gun and timetable. He will not commit to a self-care plan. B.He has a plan and timetable. He has no outside methods of support and no family. C.He has a plan. He also has a history of violence and poor impulse control. D.He has been hospitalized for suicidal ideation twice in the past 15 years. He refuses to come to therapy more often or stay on anti-depressants. Feedback

A, Answer A: Having a gun and a time table indicates that Ralph CURRENTLY has a highly lethal method to carry out a suicide. Refusal to make a self-care plan indicates his suicide plan is complete, and he is extremely lethal.

A new client starts off the first session sharing how she feels overwhelmed with her life. She shares that she doesn't like her new job but is uncertainof what career she wants to pursue. She reports feeling like her relationship with her boyfriend is unhealthy and wants to get along better with him.Then she adds that she's been having a lot of conflict with her new roommate and can't decide whether she should move out. When formulating theinitial treatment plan, the therapist should: A. Assist the client to prioritize her treatment goals. B. Determine the most important issue to focus on. C. Assess the client's level of coping. D. Identify her social supports.

A. A more collaborative than B

Sergio comes in to see you upon the recommendation of his doctor. He tells you that his hands get sweaty and he feels nauseous when riding in a car. He was afraid to come to the appointment without his wife. Describe the interventions a Solution-Focused therapist would use in the middle stage of therapy. A.Ask Sergio if there are times when he is not anxious and is able to go out on his own. Ask Sergio what he would notice to be different if he woke up tomorrow and the anxiety was gone. Ask Sergio what Elena would notice about him if his anxiety were gone. Ask Sergio how he is able to manage as well as he does D.Ask the "miracle question" to address Sergio's anxiety. Ask Sergio if there are times when he is not anxious and is able to go out on his own. Ask scaling questions to evaluate the severity of Sergio's anxiety. Ask Sergio how he is able to manage as well as he does

A. Answer A is more explicit and detailed in demonstrating how this intervention would be accomplished. Generally speaking, a more detailed or descriptive answer will merit a higher rating on the test than a similar, less detailed or descriptive answer. A Solution Focused therapist uses exception questions as a central intervention. D: A Solution Focused therapist would use a scaling question to focus on how well the client is doing or to measure a client's improvement, not to measure or evaluate the severity of a problem. This is an example of the Solution Focused "coping question," in which the client's behaviors are framed as solution oriented and highlight strengths, rather than problems and deficits.

You are a Person-Centered therapist treating the Walton family. They have been working on communication and helping the children to improve their confidence and assertiveness skills. The oldest daughter, 12, has joined some after-school clubs and is making new friends. She and her parents start talking about their summer vacation they are planning for June. The youngest daughter, Betty Jo, says, "I'm bored, nobody ever pays attention to me, I want to go home." You would respond by saying: Select one: A."Nobody ever pays attention to you and you want to go home?" B."Would it help if we paid attention to you here and now?" C."I want you all to ignore Betty Jo's request to go home." D."Is it really true that 'nobody' ever pays attention to you?"

A. Answer A: A Person- or Client-centered therapist follows the lead of the client, and reflects back to the client, with empathy and unconditional positive regard, what the client has said. Answer B: This intervention moves past letting the client know that they have been heard and initiates action in a way that a Person-centered therapist would not do.

Question ID #26747: Your client works for a local newspaper arranging advertising space. You place an ad in the same newspaper for an upcoming therapy group. The client turns out to be the person who does the ad layout. Ethically: Select one: A.You have every right to place an ad in this newspaper. B.This is an avoidable dual relationship and you should have advertised in a different newspaper. C.You are required to withdraw the ad. D.You should request that the client decline the job if this happens again.

A. Answer A: A therapist has a right to advertise in the local paper. You did not directly interact with the client, nor did you intend for your client to work on your ad. This is an unavoidable dual relationship.

George and Mary, both 27, come in for help because of their frequent arguing. They have two young children, both of whom have begun getting in trouble at school for fighting and not paying attention in class. Mary is a stay-at-home mom who gave up an early career in biomedicine when she got pregnant with the first child. George fidgets frequently and Mary is increasingly argumentative with him. At one point, you are concerned that they are going to get violent in session. A diagnostic assessment for domestic violence would include all of the following EXCEPT: Select one: A.Asking, "Has either of you ever been injured because of fighting between the two of you?" B.Asking, "How often do you use drugs or alcohol?" C.Asking, "Did you witness domestic violence in your family-of-origin?" D.Observing the couple's non-verbal communication.

A. Answer A: Asking about domestic violence with both parties in the room is not a good assessment technique, as it is unlikely to elicit accurate information. If it does reveal domestic violence, it could trigger further anger by a violent partner who feels betrayed. Answer C: Children who witness domestic violence in their families-of-origin are more likely to participate in domestic violence in their own adult relationships

A professional couple, who moved here from India two years ago, begins therapy with you. You know little about their culture. In your work together you: Select one: A.Ask them to educate you about important differences and to tell you how these relate to their presenting problem. B.Do your own research on upper-class Indians to have a better understanding of your clients. C.Ask them if they feel comfortable working with you since you are unfamiliar with their native culture. D.Recommend an Indian therapist who will better understand their concerns.

A. Answer A: Asking your clients for their perspective, and to educate you, will allow your clients to feel more comfortable and facilitate discussion of diversity issues. Answer B: Researching India's culture may also be useful, but "A" is more appropriate, more immediate and more specific to the clients you have in your office.

Question ID #24534: All of the following would represent a permitted breach of confidentiality without the need for a client release EXCEPT: Select one: A.Filing a child abuse report. B.Ensuring safety for a suicidal client. C.Responding to a CPS caseworker's request for family history following a child abuse report. D.Calling the police to notify authorities that your client is leaving your office intoxicated and driving a motor vehicle.

A. Answer A: Child abuse reporting represents a mandated reporting responsibility for a therapist. Answer B: A therapist has the right to break confidentiality to ensure safety for a suicidal client according to Section 1024 of the Evidence Code. Answer C: A therapist is permitted to respond to a CPS caseworker's follow-up inquiries -without a written request- if the therapist deems it is important to do so. Answer D: Evidence Code 1024 stipulates that if a client is intoxicated on alcohol, opiates, cocaine etc., and is going to drive, fly a plane etc. or operate equipment that may make them danger to society at large, a therapist is permitted to break confidentiality to help avert foreseeable harm.

uestion ID #26887: Dennis, a 47-year-old movie producer, has been in treatment with you for depression for eighteen months. Although he occasionally talks about his depression, you find the conversation invariably turns to his complaints about his wife, the unreasonableness of her demands and behavior, and the conflicts with her in which he is always embroiled. How would you address this issue? Select one: A.Continue to work with Dennis' depression. B.Have Dennis bring in his wife for couple's therapy. C.Turn the therapeutic conversation to less emotionally charged topics. D.Ask Dennis what he is trying to avoid by constantly talking about his wife.

A. Answer A: Continuing to work with Dennis' depression is the most appropriate course of action. Exploring how his relationships impact his emotional health would be an important aspect of understanding and treating his depression. Answer B: Having Dennis bring in his wife for couple's therapy would not be appropriate at this time. Dennis has seen you for individual therapy, and the issues that are arising can continue to be addressed individually. There is nothing in this vignette to indicate the need to include Dennis' wife. Answer D: Asking Dennis what he is trying to avoid by constantly talking about his wife sounds like blaming and may be misguided. Dennis does not necessarily need to be avoiding something because he's focusing on his relationship. The challenges in his relationship may be causing him the most distress at this time.

Pierre, 78, Eliane, 74, a French-Canadian couple were recently passengers on a train that derailed, and in which their granddaughter was killed. Pierre says he has been feeling worthless and has been drinking to be able to sleep. Eliane tells you that she is having nightmares and flashbacks and is afraid to leave the house. What interventions would a Narrative therapist use in the middle stage of therapy to treat the issue of grief and loss? Select one: A.Deconstruct dominant culture ideas about grief and loss. Separate Pierre and Eliane from the problem. Find unique outcomes (e.g., when are they not feeling the weight of grief and loss). B.Map the effects of the problem. Circulate the new story. Separate Pierre and Eliane from the problem. C.Deconstruct dominant culture ideas about grief and loss. Map the effects of the problem. Make Pierre and Eliane the experts in treating the grief and loss.

A. Answer A: Deconstructing their rules and roles could be an effective technique in helping them facilitate the grief process. Separating clients from the problem is typical of middle stage Narrative therapy. Finding unique outcomes would be a Narrative intervention for dealing with grief and loss, and it would be utilized in the middle stage of treatment. Answer B: Mapping is an early stage, not a middle stage, Narrative technique. Circulating the story would be used in the late stage of therapy. Separating clients from the problem is typical of middle stage Narrative therapy. Answer C: Deconstructing their rules and roles could be an effective technique in helping them facilitate the process. Mapping is an early stage, not a middle stage, Narrative technique. Locating client expertise would be a solid middle stage Narrative technique.

A couple comes to see you complaining that they have been fighting a lot. Recently the husband lost his temper and "beat up" his wife. She tells you that this was the first this ever happened and it is probably because they have both lost their jobs and he feels guilty for disappointing the family. She says he wants to be "provider" and looks at him while he nods "yes." They have two children and when you inquire, you find out that the husband has never physically abused the children. The wife tells you that when he was hitting her the other night, the children weren't hurt because they were too scared to come out of hiding for two hours. What is your responsibility in this case? Select one: A.Make a mandated report. B.Legally maintain confidentiality, ethically provide for safety. C.Create a safety plan with the wife. D.Help the couple with their anger.

A. Answer A: Domestic violence becomes child abuse when a child witnesses the abuse and experiences distress. In this case the children remained scared and hidden for two hours, clearly demonstrating a rather high level of distress. Answer B: Maintaining confidentiality would not fulfill your mandate to report child abuse.

Doug is a 17-year-old boy referred to therapy by his probation officer. He recently left a residential treatment center where he spent time after being convicted of molesting a young girl. You learn that a school nurse molested Doug when he was between the ages of 7 and 10 while he was attending a boarding school. How would you clinically manage the issue of confidentiality in this case? A.Explain the limits of confidentiality to Doug. Report child abuse if Doug molests another minor. B.Break confidentiality to report child abuse. Report to CPS if Doug says he wants to molest a 17-year-old girl. C.Give Doug a copy of your informed consent form explaining the limits of confidentiality. Speak to his probation officer as necessary without a release. D.Give Doug a copy of your informed consent form explaining the limits of confidentiality. Provide information to the court as requested.

A. Answer A: Explaining the limits of confidentiality is legal management of the confidentiality issue. Reporting possible child abuse is legal management of the confidentiality issue. Answer D: Giving Doug a copy of the informed consent agreement is a type of managing confidentiality. Information would not be provided to the court, even for court-referred clients, without a release authorization signed by the client or a court order to this effect.

A middle school in a small town has been having problems with students fighting, acting out and other delinquent activities. The community itself has a high rate of substance abuse and domestic violence. What can one say is true about school violence? Select one: A.Externalizing behaviors are directly linked to school violence B.Internalizing behaviors are directly linked to school violence C.Exposure to violent video games is related to increased school violence D.Research has linked the school environment to school violence

A. Answer A: Externalizing behaviors refer to delinquent activities, aggression, and hyperactivity, and are linked to, violent episodes. Answer B: Internalizing behavior has been found in some cases of youth violence although more often it is associated with substance abuse. Because they rarely act out, students with internalizing problems are often overlooked by school personnel. Answer C: Exposure to violent video games is thought to be related to increased school violence, but this relationship has not been definitively proven. Answer D: This is generally true, however this answer leaves so much information out about what KIND of school environment leads to school violence, that it is not the best answer.

Question ID #25524: What is NOT an essential element in the development of a therapeutic alliance? Select one: A.Having experience in several theoretical orientations. Affirming the client's choice to seek therapy at this time. B.Understanding that different cultures affect the therapeutic process. Explaining the role of a family therapist if you are treating a family. C.Using your personal communication style. Collaborating with the client on his/her goals; affirming the client's choice to seek therapy at this time. D.The ability to manage the impact of your statements on the therapy. Collaborating with the client on his/her goals.

A. Answer A: Having experience in several theoretical orientations is not necessary to develop a therapeutic alliance. Practitioners learning different theories can build a strong therapeutic alliance with a client. This risks being patronizing.

Francine is a 16-year-old high-school student who was originally brought in by her mother. At first, she was resistant to therapy, but now seems to be connected the therapist and shares openly. She states she has been using "junk" to help her study. She also says that she is "tired of everyone telling me what to do all of the time," and says her mother nags her constantly. She admits that sometimes she wishes she were dead. The clinician uses a primarily Cognitive-behavioral approach. Which interventions would be MOST effective in the middle stage of treatment? A.Helping Francine identify triggers for relapse and problem solve. B.Helping Francine problem solve and referring her to a 12-step program. C.Developing a self-affirming inner dialogue and helping her set goals for therapy. D.Helping Francine to separate from abusive relationships and identifying automatic self-talk that is causing her to feel depressed.

A. Answer A: Identifying triggers for relapse would more likely be something to work on in the middle stage of treatment if one assumes that some progress on her substance will have been made by this time. Answer B: We can most likely assume that the clinician referred Francine to a 12 step program in the early stage of therapy. Answer D: It is not clear that there are abusive relationships in this case. She says her mother "nags" her but that does not necessarily constitute abuse it good be because her mother is concerned about her.

You have been treating Mikey, age 12, for the last 8 months. He has been dealing with feelings of depression and tells you that he is not doing well in school. you receive a call from an attorney who tells you that she was appointed to represent Mikey in the divorce proceedings. She is requesting a copy of your records. How do you respond in this situation? A.Having determined that the lawyer is the child's counsel, you would release your clinical records to her. Tell Mikey about the lawyer's phone call. Document the lawyer's phone call. B.Assert privilege. Maintain confidentiality. Only release records with Mikey's authorization.Incorrect C.Release records with both parents' authorization. Determine if providing a copy or a summary is best. Tell Mikey about the lawyer's phone call.

A. Answer A: If a child is represented by an attorney, that person has the right to obtain a child's clinical records or to interview the assessing or treating therapist. You would tell your client about the phone call. You would document the lawyer's phone call. Answer B: You have not received a subpoena. You would not necessarily maintain confidentiality. See Answer choice "A". Since the attorney is a representative of the court she would be able to obtain the records with or without Mikey's authorization. Answer C: The authorization of both parents would not be needed as the attorney is acting as a representative of the court. The decision to provide a copy or a summary pertains to when a client asks for his/her own records. You would tell your client about the phone call.

Robert comes to therapy because he has never been able to be successful in relationships with women. "I always seem to mess it up, right when it's starting to go well," he says. In doing a clinical assessment of Robert, what is the most important thing to accomplish in the first session? Select one: A.Instill hope B.Gather information C.Form a deep, connected relationship D.Complete a suicide assessment

A. Answer A: If the client doesn't feel at least a little bit hopeful at the end of the first session, he is unlikely to return for a second session. Answer B: Gathering information is, of course, very important, but as stated above, if the client doesn't feel hopeful that the therapy could make a difference, he is unlikely to return for a second session, no matter how much information you have.

Question ID #26744: A woman whom you've never met previously calls you in distress, telling you that she "had to leave him." She tells you that her husband is at home, drunk, and she is scared to return. She asks to see you immediately. "I don't know what else to do!" What would you do first? Select one: A.Ascertain the whereabouts of the woman and obtain her name and the phone number from where she is calling. B.Assess for domestic violence and provide the caller with referrals for shelters, so the woman doesn't have to return home. C.Contact the police and have them trace the call so they can assist the woman. D.Cancel one of your appointments and instruct the caller to come in to see you to establish a plan of safety.

A. Answer A: Initially, you would want to obtain the name and the phone number/whereabouts of the woman. Upon obtaining this information, you can assess the woman's needs and follow up appropriately, which would likely involve helping her establish a plan for safety. Answer B: While you would want to provide referrals for shelters, the question asks what you would do FIRST. You would want to get information about the caller first, in the event that a higher level of intervention is needed.

Your client has been accused of a violent crime. He has asked you to testify on his behalf, to assert that he may not have been competent at the time of the event. Which of the following is accurate regarding the therapist's actions? Select one: A.The therapist must tell the client that competency evaluation is an exception to privilege. B.The therapist could not guarantee privilege because the client has entered his emotional condition into a proceeding. C.By asserting privilege, the therapist has broken the law pursuant to Evidence Code 1023, which states that there is no privilege in competency hearings. D.The therapist should not testify unless appointed by the court to better protect privilege.

A. Answer A: It is part of the standard of care to inform clients about privilege when their records' confidentiality may be compromised. Answer B: A therapist cannot guarantee privilege under any circumstances. A therapist can only assert privilege. Answer C: The judge would determine the client's privilege. The therapist has not broken the law by asserting privilege. Answer D: A therapist may comply with a client's request, even if not court-appointed. Once a court evaluation has started, privilege will be removed whether the therapist is complying with a client's request or the court's demand.

Question ID #25457: Dr. Caputo receives a phone call regarding psychotherapy for a 15-year-old boy. Dr. Caputo treats a lot of adolescents in his practice, most of them brought in by their parents. He finds that it takes about one session to help them get comfortable, and then they often are more honest and open than adults. In order to treat this client, Dr. Caputo needs some source of authorization. Dr. Caputo may receive authorization from all of the following to treat the 15-year-old EXCEPT: Select one: A.A step-parent if the minor's biological parents or legal guardians are deceased. B.A divorced parent with sole physical and joint legal custody. C.An older sibling who is raising the child and who signs a Caregiver's Authorization Affidavit. D.A foster child's lawyer.

A. Answer A: Step-parents have no legal standing to authorize treatment of a step-child unless they sign a Caregiver's Authorization Affidavit swearing that they are raising the child in the absence of a parent or legal guardian. Answer B: A divorced parent who shares joint legal custody may authorize the treatment of a minor child (unless the custody agreement has language to the contrary)

Question ID #26885: You are a Strategic family therapist, and in your first session with the Piffle family, you explain that if the fighting between Mrs. Piffle and the oldest daughter, Pamela, were to suddenly stop, it might throw the rest of the family into chaos. Therefore, you recommend that Pamela and Mom not change their fighting until the family has had a little more time in therapy. You do this because: Select one: A.You are trying to trick Pamela and Mrs. Piffle into changing by using a "restraining strategy." B.The family's homeostasis depends on Pamela and Mrs. Piffle continuing to fight. C.Changing one part of the system will cause change in the entire system. D.You are trying to create second order change rather than first order change.

A. Answer A: Strategic family therapy uses paradoxical interventions to try to trick families into changing by telling them to do the opposite of what you want to have happen, thus counting on the family's natural tendency to resist and rebel their way out of the symptom. Answer B: The family's homeostasis obviously does depend on Pamela and Mrs. Piffle's conflict, but this is not why the therapist uses a paradoxical intervention.

A family of four is in their second session with you. One of the children always starts the session by talking about her day. Her mother tells you that she likes her new school and she does that because everyday when she gets home, either she or her father ask about how her school day went. Her mother says, "she is not trying to get attention. It just means she is comfortable with you." Which of the following would most likely NOT apply to therapy conducted by a Structural family therapy perspective? Select one: A.A detailed family history. B.Mapping. C.Attention to arrangement of family members, body postures. D.Attention to the family's developmental phases.

A. Answer A: Structural family therapy is oriented to the here-and-now; a detailed family history is not reflective of this approach. Answer D: Attention to the family's developmental phases would be a part of Structural therapy because all family therapy takes into account a family's developmental stage.

The therapist sees a family that has been referred for an evaluation because the youngest child is acting out sexually. What are the best methods to assess for child abuse? Select one: A.The child should be seen for the minimum number of times and by the fewest number of people as is necessary, each parent should be interviewed separately, and the therapist should have a sound knowledge of child development and specialized training in abuse assessment. B.The parents should be interviewed separately from the child, the child should be allowed to explore the playroom while the therapist observes, the child should be asked questions about whether anybody has touched him inappropriately. C.The child should be seen for the minimum number of times and by the fewest number of people as is necessary, the child should be asked to draw a picture, and each parent should be interviewed separately.

A. Answer A: The child should be seen by as few people as possible to avoid creating a situation where he might feel pressured to confabulate. It is vital to interview each parent separately, to get the best picture of what the home life is like. Therapists performing these kinds of evaluations should possess a sound knowledge of child development, family dynamics related to sexual abuse, effects of sexual abuse on the child, and the assessment of children, adolescents and families.

Marcie Green, and their three children, ages 12, 15, and 17, have been in family therapy with you regularly for about 9 months. Joe says that they are getting along much better. Marcie says that the children seem to spend more time at home and are arguing less with each other. They think that things are so much better that they are ready to end treatment. Which of the following is NOT an ethical obligation? Select one: A.Adjust your treatment model if it has not been effective. B.Provide informed consent about the termination process. C.Review whether each member of the treatment unit has reached their goals. D.Recommend individual therapy if there are any regressive symptoms in any individual.

A. Answer A: The client has told you that they have made progress, so the model was effective. Answer B: Providing informed consent is an ongoing obligation that would include discussions about termination.

Question ID #24407: Talia says she's afraid that on the way home from therapy, she's going to stop at a fast-food restaurant, order a meal for four to go, take it home and eat it, and then force herself to vomit. The therapist asks Talia what Bulimia says to get her to go along with its plans for her on the way home from therapy. The question is an example of what technique, from what theoretical orientation? Select one: A.An invitation question; Narrative therapy. B.A paradoxical intervention; Strategic therapy. C.A deconstruction question; Narrative therapy. D.A relationship question; Solution-Focused therapy.

A. Answer A: The invitation question is one in which Narrative therapists use to externalize the problem and to help clients see how the external, alien entity -- Bulimia in this case -- invites the client to participate in it. Answer C: Narrative therapists use deconstruction questions, in which they examine the social context that supports the symptomatic presentation.

Question ID #26857: According to Carl Rogers, which are necessary components for effective therapy? Select one: A.The therapist's internal feelings matching his/her external behavior and empathy. B.Praise and unconditional positive regard. C.Empathy and acceptance of responsibility. D.Active listening and empowering the client.

A. Answer A: The therapist's internal feelings matching his/her external behavior (genuineness) and empathy are central to Client-centered therapy. Unconditional positive regard, empathy, and genuineness are the cornerstones of Carl Roger's Client-Centered Therapy. Answer D: "Empowering" is not a word that Carl Rogers used. It implies a more active and directive form of therapy than he performed. Carl Rogers let the client lead the therapy.

Robbie, age 7, and diagnosed with ADHD, is brought in by his mother, a single parent. Robbie was sexually abused by a former preschool teacher and physically abused by his father. Currently, he is taking Ritalin and two other medications whose names the mother can't quite recall. Robbie is fidgety and complains that he feels bugs crawling under his skin. His mother interrupts him to assure you that the physical abuse has been reported. She adds that she has been concerned because she's noticed that she's drinking a lot and isolating herself. What would be your treatment plan for this mother? Select one: A.Individual therapy with you beginning immediately. B.Refer her to Alcoholics Anonymous because treatment can't begin until she's sober. C.Referral to a group for single parents so she can get the support she needs. D.Recommend a psychiatric evaluation to explore her forgetfulness and isolative behavior.

A. Answer A: This mother is clearly in need of direction, support, and evaluation. This case would require crisis intervention, and your job would be to assess and refer as needed. Answer D: A psychiatric evaluation may be in order, however, you don't have enough information to make this call.

In a session with his family, Mr. Stargel begins to escalate. His voice gets louder, he clenches his fists, he starts to sweat, and his eyes dart wildly. When the therapist begins to talk to Mr. Stargel, he interrupts and says he feels like he is going to explode and kill someone. How should the therapist proceed? Select one: A.Get everyone from the room, leaving Mr. Stargel behind, and call the police. B.Assert control of the session and demand that Mr. Stargel calm down. C.Excuse him or herself to "go to the bathroom" and then call the police. D.Pick up the phone and dial 911.

A. Answer A: When a client becomes dangerous to the therapist and others present in the treatment, the therapist should act to protect the safety of self and others by getting everyone away from the dangerous client and calling the police. Answer B: The therapist tried to intervene unsuccessfully, and as easily provoked as this client has already shown himself to be, it would be dangerous to demand that Mr. Stargel do anything.

Cathy and her 3-year-old son comes to see you. She is desperate for a job. Since moving back with her parents, she has been having trouble sleeping at night, so she rests during the day; however, her son bothers her. What are your possible legal considerations? A.Set the fee at the onset of therapy. Keep clinical records in a locked file cabinet. Consent to treat a minor if Cathy's son participates in the therapy. B.Set the fee at the onset of therapy. Inform Cathy that you are legally obligated to breach confidentiality to report child abuse. Take the necessary steps to ensure safety if Cathy is suicidal. C.Consent to treat a minor if Cathy's son participates in the therapy. The legal issue of privilege. Have Cathy sign an authorization to release information. D.Child abuse reporting requirements. Take the necessary steps to ensure safety if Cathy is suicidal. Have Cathy sign an authorization to release information.

A. Answer A: You are legally obligated to set the fee prior to therapy. You are legally obligated to keep records. You may want to bring Cathy's son in for an assessment, in which case you may need parental consent for treatment. Answer B: See Rationale "A." Informing clients of confidentiality limits is an ethical consideration and is not a legal concern. If a client is suicidal, you are legally obligated to take the necessary steps to ensure safety. However, there is no indication that Cathy is suicidal.

Karen informs you that she and her husband got into an argument resulting in a physical altercation. Karen tells you she's scared to go home today because her husband was drunk and yelling before she came to see you. What is your next step? Select one: A.Maintain confidentiality. B.Contact the police. C.Advise Karen to call the police. D.Provide a referral for AA to Karen's spouse.

A. Answer A: You would maintain confidentiality in a domestic violence situation. There is no mandate to report, and to do so would be breaking confidentiality. You would want to assess and establish a safety plan, including shelters, support system contacts, and steps to remain safe. Answer C: To provide advice to clients is unethical, according to CAMFT Ethical Standard 1.4.

Which of the following is NOT true about Factitious Disorder? Select one: A.Symptoms are involuntarily produced. B.There is a need to assume the patient role. C.There is no external incentive for the behavior. D.Symptoms can be psychological or physical.

A. Factitious Disorder is characterized by the voluntary production of physical or psychological symptoms, the absence of external incentives, and the compulsive psychological need to assume the "patient role."

A Vietnamese man drops off his 15-year-old nephew, Nguyet, at your office for his first appointment. The uncle has cared for him since his parents died five years ago. Nguyet angrily indicates that he doesn't want to be there. Later, Nguyet matter-of-factly tells you that three months ago he participated in a gang drive-by shooting in which two rival gang members were killed. When asked about this event, Nguyet laughs and says Satan told them all to do it. Your FIRST concern in seeing Nguyet would be to: Select one: A.Determine if Nguyet has a weapon. B.Assess for drug use to determine if you need to refer Nguyet to a detoxification program. C.Determine if this is within the scope of MFT or LCSW practice. D.Determine if the uncle has legal custody.

A. First, you need to determine if Nguyet has a weapon. When working with a minor in therapy, the issue of legal custody, scope of practice, as well as a drug and alcohol assessment are all pertinent issues; however, these are eclipsed by the potential danger to you, the therapist.

Question ID #26840: You are supervising an MFT intern. The intern's client requests that the insurance be billed for the session. What is the appropriate way to bill for the client's session? Select one: A.Have the intern complete the insurance forms for the session and have both the intern and the supervisor sign the forms. B.Only have the intern complete and sign the insurance forms since s/he completed the service. C.Only have the supervisor complete and sign the insurance forms since the insurance company won't reimburse for the intern's services. D.Inform the client you cannot bill the insurance because the insurance companies don't reimburse intern-provided services.

A. Intern services can be billed through insurance. As the intern is providing the service, the intern must complete the insurance forms for the session, and both the intern and the supervisor sign the forms. Anything else would be considered fraudulent.

Your client was diagnosed with Major Depressive Disorder a year ago but the main symptoms have abated. She now reports that she feels sad and discouraged, and is afraid that the severe symptoms she had before will make her lose her job. She has been staying in almost every night because she doesn't feel like making the effort to go out, get dressed up and do her hair. Most of her contact with the outside world is through social media. Which DSM-5 diagnosis would be appropriate? Select one: A.Other Specified Depressive Disorder B.Chronic Depressive Disorder C.Major Depressive Disorder, Recurrent D.Unspecified Depressive Disorder

A. Answer A: The client meets the criteria for Other Specified Depressive Disorder because the time frame and the number of symptoms are fewer than required for Major Depressive Disorder but there are identifiable depressive symptoms. Answer D: She would not meet the criteria for Unspecified Depressive Disorder because she meets the criteria for Other Specified Depressive Disorder; she has some symptoms that can be identified, so "Unspecified" would be unnecessarily vague.

You are seeing a family for problems related to the husband's drinking. As you work with them, you obtain information that leads you to suspect that the father is hitting the 10-year-old son, who is described as having a "fresh mouth." His mother tells you in a phone call after the session that his father didn't mean to embarrass him and asks you to keep this phone call private. She tells you that therapy is really helping. You would: Select one: A.Report to Child Protective Services. B.Get further information from the mother. C.Assess the children in the next session. D.Request the school records.

A. The vignette states that you "have reason to suspect". Therefore, as a mandated reporter, if you have "reasonable suspicion" you would report to CPS, not assess further.

Boris and Svetlana bring in Vladimir, age 9. Vladimir's school counselor referred him. For the past 8 months, Boris and Svetlana have been getting phone calls from the school because Vladimir has been acting out by teasing and hitting other kids, Vladimir is wetting his bed and has soiled his pants a couple of times. Boris says, "we shouldn't talk about this because it only makes things worse." Using a Gestalt model of therapy, how would you treat Vladimir's symptoms of Enuresis and Encopresis? Select one: A.Use of puppets to express Vladimir's feelings of shame and/or embarrassment about his Enuresis and Encopresis. Suggest a moisture-sensing system that will awaken Vladimir when he wets his bed. D.Incorporate drawing to elicit any feelings of insecurities and shame toward his bed-wetting and soiling. Arrange for family therapy sessions to discuss family dynamics.

Answer A: Use of puppets is an appropriate Gestalt intervention for children. Although a moisture-sensing behavior-modification intervention may be useful for Enuresis, it is not particularly Gestalt. Answer D: Drawing is a Gestalt intervention in which the therapist brings "here-and-now" practices to aid children in expressing their feelings and thoughts. It is useful to bring awareness to all family issues.

A 43-year-old woman seeks therapy for anxiety and depression following the death of her sister. Over the course of therapy the client discloses thather husband is emotionally abusive and she is sure he is having an affair. After working with a client for three months, the therapist realizes that the client's husband works at the same company as the therapist's husband. How should the therapist proceed in this case? A. Review the importance of boundaries with the client. B. Share the information with the client and discuss the impact. C. Seek consultation for countertransference related to information. D. Refer the client to another therapist due to the boundary issue.

B

A couple from El Salvador, Armando and Sylvia, come to therapy because of sexual problems. They have two children, both girls. The youngest girl has cerebral palsy. Armando desperately wants a son. He is furious because he recently found birth control pills hidden in Sylvia's dresser drawer. Sylvia appears tired, speaking only when a question is directed her way. Sylvia looks down and says, " Nothing I do pleases him." Sylvia's doctor referred them to therapy. How would you develop a clinical assessment of this case? A.Observe the whole family in session. Separate Armando and Sylvia to assess for violence. Obtain religious and cultural background. B.Separate Armando and Sylvia to assess for violence. Obtain religious and cultural background. Do a Beck Depression Inventory with Sylvia. C.Do a Beck Depression Inventory on all parties. Get a release to speak to the school teachers.

B

Bill, a 42-year-old Caucasian, was referred by his AA sponsor. His wife Esmeralda recently moved to her parents' house. Bill lost his job as a truck driver one year ago during an economic downturn and is facing foreclosure of the home they bought four years ago. Bill says calmly, "I'm a failure. I can't remember the last time I felt good about myself. Do you really think you can help?" What interventions would a Narrative therapist use to achieve the goal of elevating Bill's mood in this case? A.Collaborate with Bill on language to externalize Depression. Find an alternative story to Bill's diminished view of himself. Map the effects of Depression on Bill's life. B.Collaborate with Bill on language to externalize Depression. Ask Bill how he came to believe that being swept up in a national economic crisis makes him a failure. Explore with Bill what Depression does to invite him to feel bad about himself.

B A-Finding an alternative story is a goal, not an intervention. Answer B: Externalizing Depression means to personify it as an external entity; it helps clients to separate themselves from identification as "being depressed," as opposed to someone struggling with Depression. Asking Bill, "How he came to believe" is known as "deconstruction," a Narrative intervention that helps people challenge the taken-for-granted assumptions and beliefs about themselves that are socially constructed and imposed. Invitations are an example of the externalizing process. The therapist asks clients to examine how the "problem" seduces them into thinking or feeling the way they do and to question more consciously whether they want to accept or decline the problem's invitation.

Andy, a 42-year-old actor, missed his last session. He called you about an hour before he was supposed to be there and did not reschedule. It has been two weeks since you saw him and are concerned that he might not return for therapy. He had often been late to session and you sensed that he might avoiding it. The Motion Picture Industry Pension and Health Plan pays for a portion of his sessions. How should you go about collecting his missed session fee? Select one: A.Bill Andy for the co-payment. Indicate the cancelled session code with his insurance. B.Charge Andy. Have him contact the insurance company. C.Bill the insurance company with the 50-minute code as usual. Document the amount he owes as part of your record of financial transactions. D.Bill Andy for the co-payment and indicate the 50-minute code. Document the amount he owes as part of your record of financial transactions.

B Answer A: Billing the client for only the co-payment and the insurance for the rest and indicating the broken session code is legal, but not likely to be paid by the insurance company. Most insurance companies will not reimburse for missed sessions. Answer B: Billing the client, and letting him seek reimbursement from the insurance company is correct. This choice puts the responsibility on the client, where it belongs. Billing the client, and letting him seek reimbursement from the insurance company is correct. This choice puts the responsibility on the client, where it belongs.

Warner is a 17-year-old high school dropout who lives at home and works as a pizza delivery driver. He says that his drinking problem has "kind of gotten out of hand lately" and that he's worried that he "could become an alcoholic." He says he asked his parents if he could go to therapy, but that they told him that therapy is a waste of time. He asks if you'll be his therapist and help him "get a handle" on his drinking. How would you proceed? Select one: A.Refer Warner to an outpatient alcohol abuse treatment program. B.Agree to treat Warner and document why you're treating him without parental consent. C.Refer Warner to an inpatient drug abuse treatment program. D.Tell Warner that you cannot treat him without a parent's consent.

B Answer A: Referring Warner to an outpatient alcohol abuse treatment program might be a consideration, but it doesn't address his immediate question, which is if you'll be his therapist. Answer B: LFMTs can treat a minor over age 12 without parental consent for clinical issues if in our professional opinion parental involvement would be ill-advised.

Bill, a 42-year-old white man, referred by his AA sponsor. lost his job one year ago and is facing foreclosure from the home they bought four years ago. Bill says calmly, "I'm a failure. I can't remember the last time I felt good about myself." Esmeralda, his wife, calls you and says, "I'm really worried about Bill. He just bought a gun." How would you assess the crisis issue of suicidality in this case? B.Administer a Beck Depression Inventory. Ask Bill if he has a plan and an intention to carry out his plan. Ask Bill if he has lost pleasure in usual activities. C.Ask Bill if he has any prior suicide attempt. Disclose to Bill that Esmeralda called and asked about the gun. Ask Bill if he has a plan and an intention to carry out his plan. D.Contact Bill after Esmeralda's call and assess for suicidality. Ask Bill if he has a plan and an intention to carry out his plan. Attempt to get Bill to sign a self-care plan.

B Answer A: The Beck Depression Inventory offers a full assessment of depression and includes questions about suicidal ideation and planning. Disclosing the phone call would not manage suicidality. History is only an indirect indicator of the potential for suicide and not as relevant as his current behaviors, ideation or plans. Answer B: The Beck Depression Inventory offers a full assessment of depression and includes questions about suicidal ideation and planning. Asking about suicidal plans and intent is one of the most important questions in assessing for suicide. Asking about anhedonia would provide good information about depression, which can be correlated with depression. Answer C: Asking about his suicidal history is one of the most important questions in assessing for suicide. Disclosing the phone call would not manage suicidality. Asking about suicidal plans and intent is one of the most important questions in assessing for suicide. Answer D: In an imminent crisis or potential crisis, a therapist is expected to be more active, and if the therapist has an opportunity (as the therapist does here) to assess the client directly, that would be the most effective course of action. Asking about suicidal plans and intent is one of the most important questions in assessing for suicide. Getting a self-care plan is management (i.e., an intervention), not an assessment.

Question ID #25258: A new client, Bradley, comes into your office and you discover that he is blind and using a cane. How would you most effectively handle the first session? Select one: A.Not comment on Bradley's lack of vision with the intention of first building the therapeutic alliance. Manage any discomfort or countertransference after the session. B.Ask if the visual impairment was part of the reason he was seeking therapy. Start treatment planning by collaborating on his goals. C.Talk about the blindness only if Bradley identifies this impairment as a problem. Respect client autonomy and meet him "where he is." D.Inquire as to whether Bradley might feel more comfortable with a vision-impaired therapist. Start treatment planning by collaborating on his goals.

B Answer B: A major part of an initial interview is to assess a client's purpose for seeking therapy. Discussing Bradley's blindness would be a part of this assessment. For any client, collaboration on goals could be a first session task. Answer C: Not commenting on Bradley's lack of vision ignores an important part of who Bradley is and suggests that the therapist may be unwilling or unable to acknowledge something that is present in the room. Meeting any client "where he is" to support autonomy is appropriate as a first session task.

Sharon comes in with her son Robbie, age 16. His school referred Robbie because he argues with teachers and is frequently truant. Sharon says that she's "had it" with Robbie, and their "fights have gotten pretty out of control." Tearfully, Sharon says that she and Robbie only have each other. Sharon reports trouble getting up in the morning and that she is tired throughout the day. What hypotheses might you make about this family from a Family Systems therapy perspective? A.Sharon and Robbie are too differentiated and must learn how to be solid selves. Sharon may have recruited Robbie to be her companion in a dysfunctional cross-generational alliance. B.Sharon and Robbie are in an enmeshed or centripetal family dynamic. Robbie's symptomatic behavior may be a result of the family projection process. C.Sharon and Robbie are in an enmeshed or centripetal family dynamic. The boundaries must be strengthened

B Answer B: Enmeshment refers to a loss of autonomy due to the blurring of psychological boundaries. Robbie seems to be reacting to the adolescent drive towards individuation against a system that has apparently been quite interdependent. The family projection process may be a situation in which the parent enlists a child to help with that parent's peer affiliation needs that aren't being met elsewhere. In family systems, the symptom in one person is conceptualized as the result of the family's interactional patterns. Answer C: Enmeshment refers to a loss of autonomy due to the blurring of psychological boundaries. Robbie seems to be reacting to the adolescent drive towards individuation against a system that has apparently been quite interdependent. This statement about "boundaries" is correct but not vignette-specific.

Bob, who recently divorced, discloses that he can no longer live without his ex-wife. He has a history of suicide attempts and has been hospitalized for inpatient care three times. He has been having suicidal thoughts and fantasizes about shooting himself. At his last session, Bob says that his depression has lifted. In working with Bob, what would be your next step? Select one: A.Hospitalize him immediately. B.Have Bob sign a "self-care plan." C.Call the P.E.T., and have them assess to see if he needs to be hospitalized D.Continue your therapeutic work with Bob and explore alternatives to suicide.

B Answer B: Given that Bob has a history of suicidal ideation and has a plan to carry it out, the next logical step would be to get him to sign a "self-care plan." Also, since Bob's mood has started to elevate, he may now have the energy to carry out a suicide plan. Answer C: You may have to call the P.E.T. if Bob refuses to sign a "self-care plan" or if you feel he would need to be hospitalized.

A client undergoing Behavioral therapy for an airplane phobia is showing signs of being ready to terminate. To prepare her for termination, the therapist reviews the method of talking about airplanes, visiting airports and then getting on airplanes for short flights to evaluate her current anxiety symptoms. Which of the following would indicate that she is ready to terminate? Select one: A.She is taking small steps toward her goal. B.Her anxiety symptoms do not appear when she gets on an airplane. C.She can reframe anxiety when symptoms appear. D.She now finds air travel to be a positive reinforcement.

B Answer B: This answer choice describes the behavioral goal of "extinction": Extinction is the absence of a particular symptom/syndrome in a client. In this case, if the symptoms of anxiety that are connected to airplane were extinct, it could be time to terminate therapy. Answer C: This answer choice describes a Solution-Focused intervention, not a Behavioral conceptualization for termination.

When obtaining informed consent, the following items are all ethically required EXCEPT: Select one: A.Information regarding the nature of treatment. B.The name and license designation of the owners(s) of the practice if the therapist is using a fictitious business name. C.The expected length of sessions and treatment. D.That there may be risks associated with therapy, and the nature of those risks.

B Answer B: This is a legal requirement of informed consent. Clients must be informed of the rightful name of the business owner in the event they want to redress any grievances or take legal action. The legally required aspects of informed consent are that the fee must be disclosed before therapy starts and the therapist must disclose the true description of his/her license.

What would be the best tool to use in order to ascertain the feelings and attitudes of a client who has severe emotional problems? Select one: A.MMPI-2 B.The mental status examination C.A thorough multi-generational history D.The records of previous therapy

B The key phrase is "severe emotional problems." An important component of the mental status examination is the assessment of feelings.

A therapist has been working with a 6-year-old boy for one month. The child was brought in by his mother after witnessing his father get hit by a car.The mother reports that the child has been less anxious since starting therapy but continues to have nightmares and doesn't want to go to bed. What intervention should the therapist employ in the middle phase of therapy? A. Provide psyhoedcuation to mother about trauma in children. B. Engage in art therapy with the child encouraging him to draw his dreams. C. Create a bed in the office and instruct the child to practice lying down. D. Teach the child self-soothing techniques to use when he wakes up from a nightmare

B better address client's issue - not wanting to go to sleep, but not being able to go back to sleep

You are seeing a 15-year-old boy who tells you he has begun selling speed to support his own daily habit. He also goes to parties with much older kids and drinks on the weekend. He asks if you are going to tell his parents about his drug use. Ethically, you would: Select one: A.Inform him that because he is under 16, you're required to report the crime. Tell him that he is entitled to sign a release before you speak with his parents. B.Discuss the limits of confidentiality with him and find out if he is in danger of seriously harming himself because of his drug use. Obtain a release authorization signed by him before you speak with his parents. C.Ask him if he thinks you should tell them. Consider the benefits of informing his parents. D.Encourage him to invite his parents in and address the issue of his substance abuse. Maintain confidentiality about any criminal behavior.

B Answer B: A minor has the right to confidentiality in most situations. It is important to assess if his current drug use is potentially lethal or if he is planning on committing suicide. If this is the case, involving his parents would therapeutically be in his best interest. Safety is the first concern; confidentiality would be the second. You would need to get a signature before breaking his confidentiality. Answer C: Exploring what he thought about telling his parents could be an excellent therapeutic intervention, but it does not address the ethical issue of assessing for client safety and confidentiality. You could consider the benefits of informing his parents. Answer D: Inviting him to address the issue with his parents in therapy may be a good intervention, but it does not address the ethical issue of assessing for client safety and confidentiality. You would not maintain confidentiality about "ANY" criminal behavior.

Question ID #25487: An intern is working under a supervisor who uses a Structural approach to family therapy. The intern prefers a more strength-based approach with families that are having trouble. The intern is getting close to completing her hours and is focusing on different techniques to forge a therapeutic alliance. Which of the following interventions would be used to accomplish this early stage goal? Select one: A.Develop the client's holding capacity. B.Accommodate the client's style of speaking. C.Use of Solution talk. D.Ask the client to review goals.

B. Answer A: "Develop the client's holding capacity" is directed at symptom reduction and is a middle stage goal, rather than an early stage intervention. It is not a specific alliance-building technique. Answer B: "Accommodating" is a Structural intervention (and term) that refers to alliance building in the early stage of treatment. Answer C: "Solution talk" is a Solution-focused concept that is used to identify goals and strengths. Although it demonstrates warmth and acceptance, it is not a specific alliance-building technique. Answer D: Asking the client for feedback (i.e., collaborative goal setting) about goals is a Cognitive-Behavioral late stage intervention to evaluate termination readiness. It is not a specific alliance-building technique.

Question ID #23958: A woman is non-orgasmic with her husband. How would you most likely determine if this is due to relationship issues or caused by other issues? Select one: A.She has a diagnosed Sexual Dysfunction. B.She is orgasmic during self-masturbation. C.Her husband refuses to come in for therapy. D.She has a history of ingesting alcohol before having sex.

B. Answer A: A diagnosis of a Sexual Dysfunction would not indicate whether this response is relationship-oriented or based in physiology. Answer B: The fact that this woman is orgasmic during self-masturbation indicates that there probably is no physical cause for her inability to have an orgasm.

Question ID #25587: Jack is a 16-year-old boy who has run away from home after his parents discovered that he had stolen his mother's ATM card and withdrawn $300.00 from his mother's savings account. His parents are frantic because he has been out on the street for two days. He tells you that he doesn't know who to call. He has been smoking marijuana since he was 10-years-old. He tells you that he has never felt happy, and at times has felt suicidal, although he does not feel suicidal now. The LEAST likely referral you would give him is: Select one: A.A free clinic B.A psychiatrist C.A teen line D.Child Protective Services

B. Answer A: A free clinic can offer medical or psychological services Jack might need. His physical condition would remain untreated if a free clinic was unavailable. Answer B: If he is a runaway, it is unlikely he could afford a psychiatrist, or have health care coverage to see a psychiatrist. Answer C: A teen line could be helpful in dealing with his depression and drug use. Answer D: Child Protective Services has numerous referral resources that can help Jack move through this crisis. Also, CPS can investigate the reason he ran away, and provide referrals for his family.

A therapist has just received four clients with a history of violence. When meeting each of these clients, the therapist provides informed consent about the situations in which he would have to break client confidentiality. Only two of them come back for a second appointment. According to California law, which of the following situations would require a Tarasoff report? Select one: A.You are treating a 45-year-old man who has just lost his job. His wife calls you to tell you he is talking about shooting his boss. You know that your client owns a gun. B.Your 75-year-old client tells you that his son hits him every day and that tonight, when the son comes home and before he has a chance to hit him, he's going to shoot his son. C.Your client tells you he wants to get even with his boss. He plans to burn down his warehouse tonight, and isn't worried about getting away with it because no one is around after dark.

B. Answer A: According to Ewing v. Goldstein, "patient communication" includes information obtained from family members other "credible third parties". However, in this instance, talking about shooting the boss isn't the same as a threat or an IMMINENT plan to kill the boss, so there would not be a mandate to report. Answer B: According to California law, a therapist is required to notify the police with 24 hours if a client makes a threat of serious harm to a reasonably identifiable victim. For maximum immunity from liability for breaking confidentiality, a therapist may, but is not legally required, to warn the potential victim. Since the client intends to shoot his son as soon as the son comes home, this would trigger a Tarasoff warning.

Question ID #26878: Eva comes in with her husband, Craig, and their two children, Julie, age 15, and Bobbie, age 13. Bobbie is doing poorly in school and getting into fights with his classmates. On the other hand, Julie is getting good grades and, according to Eva and Craig, is "the perfect child." Eva comments, "Bobbie, why can't you be more like your sister?" Bobbie and Julie constantly fight with each other. As a Narrative therapist, what would your treatment goals include? A.Look for exceptions to the problems; use externalizing language; locate the alternative story. B.Identify factors that maintain the family problems; separate the client from the problem; learn about what this family values. C.Establish trusting and respectful relationships; explore the family's life situation; convey understanding and acceptance. D.Improve communication skills; reduce the fusion in the family; reduce emotional reactivity.

B. Answer A: All of these are Narrative interventions rather than goals. Answer B: All of these are Narrative goals.

Jackie's father used to cheat on her mother when she was a child. She tells you that she could never figure out why her mother didn't know, Eventually, Jackie's parents got a divorce and her mother shared with Jackie that she did know but it was too hurtful to talk about. Jackie now finds that she avoids relationships. She says that with all the internet dating sites around these days, it is impossible to keep people from seeing other people. She believes that "If I'm in a relationship, then my boyfriend will cheat on me." She says it's better to just stay independent and not get to trusting or committed to anyone. According to Cognitive-Behavioral theory, this is an example of: Select one: A.An irrational belief. B.An underlying assumption. C.A cognitive distortion. D.A schema.

B. Answer A: An irrational belief is a term used in Rational Emotive Behavioral Therapy, originated by Albert Ellis. It is similar to Beck's term, "cognitive distortion". Answer B: Jackie's belief that "If I'm in a relationship, then my boyfriend will cheat on me" is an example of an underlying assumption. An underlying assumption is often characterized by an "If --- then ----" statement. Answer C: A cognitive distortion is an unrealistic way of evaluating a situation. An example of a cognitive distortion in this situation might be "all men cheat on their wives and girlfriends." This is an over-generalizing statement that would be a cognitive distortion. Answer D: A schema is a core belief developed during early childhood about one's self, the world, or others. Schemas are found at deeper levels of thought than automatic thoughts, cognitive distortions or underlying assumptions. An example of a core schema in this situation might be: "I'm undesirable."

Keesha complains of dizziness, chest pain and says that she vomits in the morning before going to work. Keesha says she does not like to drive when she's symptomatic. How would a Behavioral therapy treatment plan be used? A.Early: Form therapeutic alliance and obtain a history of the cause of the problem; refer to a medical and a psychiatrist evaluations. Middle: Use breathing exercises, visualization to reduce symptoms of panic; explore Keesha's thoughts and beliefs; refer Keesha to a support group. Late: review gains; anticipate possible future problems and how to deal B.Early: Establish therapeutic relationship; gather information about Keesha's symptoms and what reinforces them. Middle: Teach relaxation training ; use breathing exercises and in-vivo desensitization to reduce symptoms of panic; refer Keesha to a support group. Late: Reinforce Keesha's new skills; create an action plan for future obstacles.

B. Answer A: Behaviorists are not concerned with the causes of a problem. The focus is on what reinforces the problem. Behavioral therapists do not focus on thoughts and beliefs (Cognitive therapists do). Talking about goals and anticipating problems would be a Behavioral late stage intervention. Answer B: Establishing a therapeutic alliance is common to all therapeutic approaches. Teaching relaxation training is a basic Behavioral technique. A referral to a support group is another intervention common to many therapeutic modalities. Behavioral therapists highlight and practice coping skills learned in therapy, and anticipate future obstacles and how to confront them.

Keesha, a 29-year-old African American nurse, is referred to you by her EAP because of harassment by her superviso. Keesha complains of dizziness, chest pain and says that she vomits in the morning before going to work. How would a Behavioral therapy treatment plan be used? A.Early Stage: build rapport and obtain a history of the cause of the problem; refer to a medical doctor and a psychiatrist . Middle Stage: Use breathing exercises, visualization and flooding to reduce symptoms of panic; explore Keesha's thoughts and beliefs; . Late Stage: Talk about met goals ; anticipate possible future problems B.Early Stage: build rapport; gather information about Keesha's symptoms and what reinforces them. Middle Stage: Teach relaxation training; use breathing exercises and in-vivo desensitization to reduce symptoms of panic. Late Stage: Reinforce new skills; create an action plan for future obstacles.

B. Answer A: Behaviorists are not concerned with the causes of a problem. The focus is on what reinforces the problem. Behavioral therapists do not focus on thoughts and beliefs (Cognitive therapists do). Talking about goals and anticipating problems would be a Behavioral late stage intervention. Answer B: Establishing a therapeutic alliance is common to all therapeutic approaches. Teaching relaxation training is a basic Behavioral technique. A referral to a support group is another intervention common to many therapeutic modalities. Behavioral therapists highlight and practice coping skills learned in therapy, and anticipate future obstacles and how to confront them.

: Carl comes in visibly angry and tells you he purchased a gun, which he plans to use tonight. Carl indicates that he's going to "off" his next-door neighbor who "can't control his friggin', yappy dog!! It keeps me up all the time!!" How would you first handle the situation? Select one: A.Contact the PET team for an evaluation of danger to others. B.Maintain a slow, even tone using sentences that are simple and easily understood. C.Initiate a 5150 for "danger to others." D.Talk about effective ways to speak with the neighbor.

B. Answer A: Contacting the PET team may be necessary; however, there is an impending crisis in your office, which needs containment. Answer B: Maintaining a slow, even tone and using simply understood sentences can provide containing structure for Carl, which can dampen his agitation. Answer C: Assessing for 'grave disability' (as in answer "A," by calling the PET team) would come before initiating a 5150. However, there is an impending crisis in your office, which needs containment.

Question ID #25314: A woman is concerned that her 12-month-old baby boy is developmentally delayed. She also has a 4-year-old who just started kindergarten and his teacher tells her that he is advanced for his age. He is already trying to read along with the teacher and has memorized all of the songs they sing in class. There would be a reason for concern if the 1-year-old was unable to do which of the following tasks: Select one: A.Crawl B.Pull himself up to a sitting position C.Stand alone D.Drink from a cup

B. Answer A: Crawling begins at approximately nine months. If the child is now a year old, this would not represent the biggest delay. Answer B: Of the choices given, pulling up to a sitting position is the earliest task since it occurs around six months of age. If the child is now a year old, this would represent the biggest delay. Answer C: Standing alone usually happens between 12 and 18 months. If the child is now a year old, this would not represent a delay. Answer D: The ability to drink from a cup develops between 9 and 12 months. If the child is now a year old, this would not represent the biggest delay.

The Samuel family consists of a father who drinks, a mother who whines about his drinking, a son who consistently stays out with his friends after his curfew, a daughter who gets straight As and is a cheerleader, and a 6-year-old boy who wets his bed several times a week and "goofs off" at the dinner table whenever Mrs. Samuel begins to complain about Mr. Samuel's drinking. The school counselor has referred the older son because he is failing two subjects. In family systems theory, treating the marital system in order to stop the bedwetting would be exemplify: Select one: A.Equifinality. B.Wholeness. C.Negative feedback. D.Homeostasis.

B. Answer A: Equifinality refers to the family's predictable mode of interaction that will lead to a similar process ending, regardless of the content issues discussed. Different beginnings lead to the same ending. Answer B: According to family systems theory, wholeness refers to the interdependence between the parts of a system. Working on spousal problems will change a child's behavior because when the dyad begins to relate differently, the child's role changes. Change in one part of the system affects all other parts.

Frieda has been mandated for therapy because she has been arrested for the third time for driving under the influence, and faces jail time unless she participates in therapy. She is obviously angry, and stares stonily at the floor with her arms folded. The clinician should: Select one: A.Encourage Frieda to talk about her feelings. B.Acknowledge and interpret her silence as evidence that she doesn't want to be there. C.Sit back and wait in silence until Frieda speaks. D.Remind Frieda that if she is going to avoid jail time, she needs to at least try to participate in therapy.

B. Answer A: For this client, simply encouraging her to talk about his feelings is too broad of an invitation and is liable to be met with more silence. Also, Frieda actually is expressing her feelings by remaining silent. Answer C: This would turn the situation into a power struggle. Answer D: This almost has the tone of a threat and is certainly not inviting.

Question ID #25454: Your client returns to therapy a year after termination. He was in treatment for alcohol abuse and was continuing to go to AA when he terminated. He says that he thought he had it under control but when his sponsor moved out of town, things started going downhill and he relapsed. He is still attending AA twice a week and has been asked to be another person's sponsor. As a Narrative therapist, what would be his middle stage goal? Select one: A.The client can become a "community of concern" for another AA member. B.The client has externalized the relapse. C.He understands the relapse as a "unique outcome". D.He can reauthor his map of how the relapse came into his life

B. Answer A: Identifying a "community of concern" for the client (not for another person) would be a late stage goal in planning for termination. The question asked for a middle stage goal. Answer B: A middle stage goal would be to help a client externalize/separate the relapse from himself (i.e., not engage in self-blame or feel victimized). Answer C: The relapse is not a "unique outcome". A "unique outcome" from a Narrative therapy point of view would be the time when he is sober, not the time when he has relapsed. Answer D: This answer choice uses "reauthor" in the wrong context; the client would reauthor his story, not the map, about how the relapse occurred.

A 49-year-old accountant has been attending therapy for the past 6 months for help with severe depression. During the past few sessions, he tells the therapist he has been feeling much better and "more like myself." The therapist has increased the length of time between sessions as part of the preparation for termination. The client comes for the next session, despondent over the sudden death of his dog. Which of the following would be best for the therapist to do? Select one: A.Increase the frequency of sessions to facilitate the grief and loss process.\ B.Ask the client how therapy can be most helpful in dealing with this loss. C.Continue with the longer length of time between sessions to encourage client's independence in dealing with life stressors. D.Increase the frequency of sessions due to the client's history of severe depression.

B. Answer A: Increasing the frequency of sessions may or may not be the best thing to do. Making that decision without involving the client could send a message that the client cannot deal with loss without the therapist's help. Answer B: Involving the client in the decision to modify the treatment plan is the best first step. It empowers the client to make decisions about his own care and creates an opportunity for the therapist to assess for a relapse.

susan, who is 17 years old, is referred to you by her doctor. She was sexually assaulted six weeks ago and is now having trouble concentrating at school and is having nightmares. Her 23-year-old husband, Jeff, is so angry that she "let this happen" that he left her and filed for divorce. She just found out that she is five weeks pregnant. She asks what you think she ought to do. How would you gather additional information to develop a clinical assessment? A.Get a release signed so that you can speak with the OB/GYN that you refer her to. Ask if Susan is experiencing nightmares or diminished ability to concentrate. B.Get a release signed so that you can speak with the OB/GYN that you refer her to. Ask questions about the presence of depressed mood and loss of interest or pleasure. C.Ask if Susan is experiencing flashbacks or exaggerated startle responses. Assess Susan for further PTSD symptoms.

B. Answer A: It would be a good idea to gather information from the OB/GYN. Susan already reports having nightmares and difficulty concentrating. This answer choice does not gather any additional information. Answer B: It would be a good idea to gather information from the OB/GYN. This case presents with a recent trauma, loss of spouse and the symptom of "trouble concentrating." These are all factors that indicate the need to assess for depression. Answer C: Susan was recently sexually assaulted, and she reports having nightmares. It would be important to assess for further PTSD symptoms, but this answer choice is incorrect because it does not respond to the question, which asks for HOW you would assess the clinical issues presented in the vignette (meaning what interventions you would use).

Stewart and his girlfriend Sharon come in to see you with their daughter Shannon, age 6. The teacher of Shannon's class thinks Shannon has Attention Deficit Disorder and would like Shannon to be tested. She says Shannon has difficulty paying attention in class. Her parents think that she may be bored with the classroom material. As an Object Relations family therapist, what would you try to accomplish in the first few sessions? Select one: A.Send Stewart and Sharon to Parent Effectiveness Training. Focus on the family dynamics rather than the diagnosis. B.Form a strong relationship with the family. Conceptualize each of them in terms of autonomy, intimacy, and mastery. C.Give directives to encourage change. Examine the couple's struggle for power. D.Blend into the family to try to understand family myths and dysfunctional communication. Focus on the family dynamics rather than the diagnosis.

B. Answer A: It would be premature to send Stewart and Sharon to Parent Effectiveness Training as you have not yet formed an alliance with them. This is true of a psychodynamic therapist but since the client came in with this concern, you would not want to ignore it. Answer B: Object Relations Family Therapists would form an attachment. Object Relations Family Therapists would conceptualize the client in the areas of autonomy, intimacy, and mastery. Answer C: Using directives is associated with Strategic family therapy. Looking at power struggles is associated with Strategic family therapy. Answer D: Joining, understanding family myths and tracking dysfunctional communication are interventions of Structural family therapy. This is true of a psychodynamic therapist but since the client came in with this concern, you would not want to ignore it.

Frank Griffon, M.A., M.F.T., wants to provide therapy over the Internet. What ethical considerations would guide his ability to do so? Select one: A.Frank can only accept clients who are in California or who are residents of California, since that is where he is licensed. He must explain the limits of confidentiality specific to internet therapy. B.Frank must ensure that he is able to provide therapy over the Internet or telephone. He must provide emergency contacts local to the client's geographical location. C.Therapy over the Internet is not a form of therapy approved by NASW, CAMFT or AAMFT. He would need additional certification and education to make sure telehealth is within his scope of competence.

B. Answer A: Legal, not ethical, standards state that therapists do not provide services by internet or other electronic media to patients located in jurisdictions where the therapist may not lawfully provide such services. Answer B: The ethical obligation is to ensure that Frank's scope of competence includes telehealth. This is an ethical obligation as part of informed consent for telehealth.

The Growden family is in their first session with a Structural family therapist. Mrs. Growden reports that her husband works too much and never helps her with the kids, who are out of control. She tells you that she works too, and it's not fair. Their three children, ages 5, 7, and 9, all sit fidgeting on the couch between Mr. and Mrs. Growden. How would you proceed? Select one: A.Move the children from between their parents. B.Say that you admire how much energy they have. C.Block the interactions between Mr. and Mrs. Growden. D.Fidget in the same way the children are as a way of joining.

B. Answer A: Moving the children from between their parents is an example of restructuring, which would occur in the middle stage of therapy. Note that the vignette stated they are in their first session. Answer B: Saying that you admire how much energy they have is an example of reframing, which would occur in the early stage of therapy. Note that the vignette stated they are in their first session.

Jos, and Tina, are a recently immigrated Honduran couple referred to you by their Catholic priest. They tell you that their 16-year-old son, Ruben, was beaten up at school after he told friends that he is gay. Jos says, "Being gay is against our religious beliefs.." What interventions would a Narrative therapist use to help the family deal with Ruben's homosexuality? A.Circulate a new story about the family's relationship to homosexuality. Map the effects of worry about Ruben's homosexuality on him and the family B.Find times when the family gets along well. Map the effects of worry about Ruben's homosexuality on him and the family. C.Re-author stories the family has about homosexuality. Circulate a new story about the family's relationship to homosexuality. D.Re-author stories the family has about homosexuality. Find times when the family gets along well.

B. Answer A: Narrative therapists don't circulate the new story. They help the family derive its own new narrative, and then help the family to circulate that story. Mapping how the problem impacts the family is one way a Narrative therapist might begin to work. Answer B: Finding times when the "problem isn't a problem" could serve to remind the family of who they are when worry or fear about homosexuality isn't causing problems. Mapping how the problem impacts the family is one way a Narrative therapist might begin to work. Answer C: Re-authoring occurs from the client's impetus, not the therapist's. Narrative therapists don't circulate the new story. They help the family derive its own new narrative, and then help the family to circulate that story. Answer D: Re-authoring occurs from the client's impetus, not the therapist's. Finding times when the "problem isn't a problem" could serve to remind the family of who they are when worry or fear about homosexuality isn't causing problems.

Naava is a 32 year-old college student who is not sure if she is on the "right track" for her life. She has had 5 different majors, and still can't decide on what she wants to study. She lives at home with her parents and works part-time as a barista. She states that she has "never really had a boyfriend." According to Erikson, Naava is stuck in what stage of development? Select one: A.Industry vs inferiority B.Identity vs role confusion C.Intimacy vs isolation D.Initiative vs guilt

B. Answer A: The Industry vs inferiority stage is generally the stage that school age (6 to 11) children struggle with. They are trying to master social and academic skills at this stage. Answer B: Naava seems to be having problems with figuring out her identity who she is. Until she does, she will continue struggling with her career path, and will likely be unable to develop peer and intimate relationships. Answer C: This is a good second answer, as Naava does not seem to be available for intimate relationships, but, given the rest of the picture, this could be because she has not successfully navigated the previous stage of identity vs role confusion. Answer D: This is the preschool stage where the child learns to explore and develops a sense of purpose.

A woman comes to your office referred by her physician. She tells you that her husband refuses to come to therapy, but she wants to work on his anger problem. She also tells you that their 8-year-old son has been acting out at school and getting into fights. As you get a detailed history, she informs you that she has been diagnosed with Major Depressive Disorder. Initially, you would: A.Invite her husband in to discuss his anger problem. Do separate assessments if you determine that couple's therapy is not safe. B.Bring in the son to assess his behavioral issues. Identify her general mood, state of mind and activity level. C.Refer the client to a woman's shelter. Get a release from the psychiatrist who diagnosed her with Major Depressive Disorder D.Tell the woman to encourage her husband to come into therapy for marital counseling. Do separate assessments if you determine that couple's therapy is not safe.

B. Answer A: There may be domestic violence in this home. You want to first assess the safety of the woman and the son. Inviting the husband in to talk about his anger problem may escalate the anger and put you and your client at risk for violent behavior. While you would do separate assessments in domestic violence situations, the first part of this answer suggests conjoint therapy. Answer B: You want to assess the behavior of the son since it involves issues regarding safety. The son may be a victim of abuse himself and he may be acting out the behaviors in his home. You also want to do your own assessment of her diagnosis for your own treatment planning purposes. Answer C: Although you may suspect spousal abuse, you want to initially assess the safety of the child as well as the woman, before making a referral. If you wanted to speak with a third party, you would need a release authorization. Answer D: The question asks what you would do initially, and you want to first gather information from the woman and the son to identify the problem in the family. Additionally, "telling" the client what to do wouldn't be a practical intervention. While you would do separate assessments in domestic violence situations, the first part of this answer suggests conjoint therapy.

A family of five comes to therapy because the "kids are wild" and they have "no control" over them. The school age children frequently act out in school, and the eldest one (10) has recently been suspended. How would Minuchin characterize this family? Select one: A.Minuchin would look at transactional patterns, flexibility, resonance, context and the family development stage. B.Minuchin would say that the family has a weak executive subsystem. C.The entire family is enmeshed and there is evidence of mixed subsystems. D.The family's symptoms are best understood when examined in the context of interactional patterns.

B. Answer A: This answer is a correct answer to a different question, i.e., "How would Minuchin assess this family," i.e., what would he look at to inform himself as to their dysfunctional patterns. Answer B: Minuchin would say that the family has a weak executive subsystem, in other words, that the parents are not in charge of the children. It is unclear who, if anyone, is in charge in this family. Answer C: These may be correct statements, but Answer B. is more direct and to the point of what is happening here. Answer D: This is a true statement, but tells us nothing about this particular family.

Jenny calls you for an appointment and tells you that she is depressed. She comes in with her husband, LioneL. Jenny says that she feels "old" and "ugly" taking care of the children, and she suspects Lionel is having affair. If the intervention of using a genogram does not work, how would a Bowenian therapist proceed? A. Connect present issues with family-of-origin issues. Do systemic work with the couple and their children. Use drawing to help identify their feelings. Have the couple re-enact their arguments in order to promote better communication. B.Have the couple journal and share in session. Ask relationship questions to identify ways for improvement. Use role play to help the couple learn effective communication skills. Educate the couple about the impact of stress on their relationship. C. Use the Family Life Chronology to uncover family history. Use role play to learn effective communication skills.

B. Answer A: This is what a genogram is about, so repeating the same intervention will not work. There is no indication that we need to alter the unit of treatment; you are treating the couple. A Bowenian therapist would focus on enhancing a client's cognitive processes, not on identifying feelings. However, this intervention may help engage the couple and assist them in understanding the difference between feelings and thoughts. Therefore, this is an acceptable alternative intervention. This goes against the Bowenian emphasis on dampening emotional reactivity; therefore, it is not a good alternative intervention for a Bowenian therapist. Answer B: This is an alternative intervention that a Bowenian therapist favors in helping a couple improve their communication without encouraging them to react to one another. This is an intervention from the Solution Focused approach to help the couple develop a clearer vision of the desired solution for their issues. An example of this is to ask Jenny and Lionel what they would notice that's different with each other if there is a miracle that resolves their problems. Since it is strength-based and does not increase emotional reactivity, a Bowenian therapist could consider using this as an alternative intervention. A Bowenian therapist could use role play to practice more differentiated behavior. Teaching communication skills is an essential alternative intervention for Bowenian therapists. A Bowenian therapist acts as a neutral coach to help a couple learn about their relationship and uses psychoeducation to help the couple. Answer C: This is a Satirian intervention that involves doing a timeline detailing the family's history with major life events. This intervention is similar to a genogram and can hardly be regarded as an alternative.

Question ID #24038: A client in Psychodynamic therapy has been talking about ending therapy for two sessions. She started in therapy twice a week and for the past six months, has been coming once a week. She tells you how much she enjoys coming, but thinks it is time to "pull the plug". She got a promotion at work and needs to commit full-time, all week to that job. You offer that she come on the weekends, but she tells you that her weekends will need to be "fun, not deep and anxiety-provoking!". From a Psychodynamic point of view, how might the client's readiness for termination be considered? Select one: A.As an opportunity to also terminate the transference. B.How well the client links termination to early life experiences. C.When the client can raise the subject of ending therapy non-defensively. D.If the client shows no resistance to talking about ending therapy.

B. Answer B: A client's ability to connect early life experiences to the ending of current therapy would be considered by a Psychodynamic therapist when evaluating readiness to terminate therapy.

Question ID #26774: A central and consistent approach unique to treating clients with substance abuse problems is: Select one: A.Being empathic. B.Confronting denial. C.Working through transference issues. D.Behavioral modification.

B. Answer B: A current understanding of working with substance abusers is the pervasiveness of denial.

Al and Peggy Smits come to see you with their 16-year-old daughter, Kristen. They tell you that since Kristen turned 16 and got her license, she has completely changed. She never talks to them, and she is always out with her friends. Kristen says that if they didn't fight all the time, she'd stay home more. According to the Experiential model, you might: Select one: A.Notice unconscious motivations and utilize the empty chair technique. B.Create a safe holding environment and assist family members in recognizing communication discrepancies. C.Do a family life chronology and help the family to externalize problems. D.Detriangulate Kristen from the family rules and roles and teach them to self-actualize with the rescue game.

B. Answer B: An Experiential therapist would consider it very important to create a safe setting. Although "a safe holding environment" is an Object Relations term, it describes well what Satir does. Recognizing discrepant communication and learning new communication styles are consistent with the Experiential model.

Question ID #26812: You have been in private practice for 5 years and wish to raise your fee. Ethically, the best way to clinically manage this issue would be to: Select one: A.Contact a few colleagues in your area and see what they are charging for professional services at this time. B.Raise your fee according to your office policy in the Rights and Responsibility form that each client signs. C.Raise your fee for clients for whom you accept insurance coverage for their sessions. D.According to CAMFT ethical standards, it is unethical to raise your fees for existing clients. Increase your fees for new clients only.

B. Answer B: As stated in CAMFT Ethical Standards, a therapist must "give reasonable notice of any changes in fees." Having such a policy stated in an informed consent form gives clients advance notice of possible fee changes.

Question ID #24104: Claire, a 41-year-old post office clerk, was physically abused as a child by her mother and father from the time she was 2 until she was 15. She has memories of going to the doctor because of her injuries and her parents telling lies about what happened. She was always afraid to tell anyone about the abuse. She now has two children of her own and is very proud to have broken the cycle of abuse. She tells you that her husband really taught her what a family is supposed to be. Presently, what symptoms would she be likely to display? Select one: A.General anxiety, quick to trust, and an abusive relationship. B.Avoidance of childhood discussions, preference for physical distance, an abusive relationship. C.Avoidance of childhood discussions, quick to trust, sexual difficulty. D.General anxiety, perpetrating abuse on her children, learning disability.

B. Answer B: Avoiding childhood discussions, preference for physical distance, and having an abusive relationship are all possible symptoms in an adult physically abused as a child. Trauma survivors often want to avoid stimuli that reminds them of the trauma, physically abused people can be uncomfortable with trust, and can recapitulate their abuse in their current relationships.

For three months, you have been treating the Barron couple for issues of anger management and communication problems. Some progress has been made. Mrs. Barron arrives for session and is visibly angered. She stares at her husband and shouts, "Have you seen the credit card bill? You have no control! I'm so livid I can barely see straight!" How would you initially proceed? Select one: A.Ask Mr. Barron to discuss the bill with Mrs. Barron using "I" statements. B.Tell Mrs. Barron she needs to stop shouting so you and Mr. Barron can understand her and hear her concerns. C.Remind Mrs. Barron that she has learned self-soothing techniques. D.Tell Mrs. Barron you will call 911 to keep everyone in session safe if she cannot contain her anger.

B. Answer B: Helping a client contain her anger and stop aggressive behaviors such as shouting are good initial interventions. This answer choice is the first step toward de-escalating an emotionally-laden and possibly volatile situation. Answer C: Simply reminding an angry client that she has learned self-soothing techniques is insufficient to intervene with a person demonstrating lability and low-impulse control.

A couple from El Salvador, Armando and Sylvia, come to therapy because of sexual problems. Armando desperately wants a son. He is furious because, although Sylvia has expressed a willingness to have another child, he recently found birth control pills hidden in Sylvia's dresser drawer. Sylvia appears tired, speaking only when a question is directed her way. . How would a Humanistic Experiential therapist conceptualize this case? B.Armando and Sylvia have low self-esteem. Armando acts as a Blamer in the family system. Sylvia and Armando are deficient in their ability to be direct and honest with each other. C.Sylvia acts as a Placater in the family system. Armando acts as a Blamer in the family system. Model healthy communication skills. D.The family pain is not being directly expressed and communicated. Model healthy communication skills. Armando and Sylvia have low self-esteem.

B. Answer B: Humanistic Experiential therapists feel that the inability to get one's wants and needs met leads to low self-esteem. Because Armando is angry in session, the stance of Blamer seems likely. There is ample evidence in the vignette that the current communication patterns leave many important wants and needs unmet. "Modeling healthy communication" is an intervention, not a Humanistic Experiential case conceptualization, which is what the question is asking for.

In preparation for termination, a therapist tells a family that they will try some practice conversations to help prepare for life without therapy. As they do so, you conclude that they are ready to stop therapy and tell them that this should be their last session. At that, one of the children says to you, "Really? Just talking to each other means this is all over?" Which of the following is the LEAST ACCURATE use of conversational enactments during termination? Select one: A.Role-play family interactions. B.Invite the family for termination sessions to re-enact family problems. C.Rehearse positive self-talk and affirmations. D.Use of "I" statements.

B. Answer B: If you were at termination, re-enactments of problems would no longer be appropriate. Re-enactments are middle stage Structural therapy interventions.

A self-referred client comes to you wanting therapy for work relationship problems. During the intake, the client reveals he has been going to another therapist for the last four months but states, "I'm planning to leave her anyway." The client admits he has not discussed this with his current therapist and says, "I'm seeing her for a different issue, anyway." What is your ethical responsibility in this situation? Select one: A.Accept the new client, as he intends to terminate with his current therapist. B.Inform the client that you will be unable to see him until he has terminated with his current therapist. C.Contact the other therapist to discuss the treatment goals before deciding whether to take the client on long-term. D.Accept the new client, as he reports his goals with the other therapist differ from the goals he wants to explore with you

B. Answer B: Informing the client that you will be unable to see him until he has terminated with his current therapist would be the most ethical solution. Answer C: Without a written release of information from the client, contacting the current therapist is a breach of confidentiality.

Marvin, age 67, comes in with his girlfriend of six months. They describe having sexual problems in which he is prematurely ejaculating. His girlfriend thinks that maybe the problem is that he works all time and whenever they have time together, he just wants to have sex and just get back to work. He says that he had the same problem with his wife, but she didn't care that much about sex and was okay with having it end early. Marvin's wife died 2 years ago and he started dating about a year after her death. How would you proceed with treatment? Select one: A.Explain the grieving process by going over Kubler-Ross' five stages of adapting to grief and loss. B.Introduce them to sensate focus exercises. C.Discuss a referral to a physician for medication. D.Have Marvin bring in a picture of his wife so that she can be separated from the current relationship.

B. Answer B: Introducing them to sensate focus exercises addresses the presenting problem of premature ejaculation. A behavioral intervention is a good first line intervention which would come before delving into historical issues which may or may not have been resolved. Answer C: Discussing a referral to a physician for medication does not address a commonplace physiological reaction that may be occurring in a relatively new couple.

Ted, age 72, comes to see you and discloses that Diana, his wife of 35 years, has terminal cancer. He spends several sessions talking about how he always knew she would go first and now the time has come. He tells you that they have decided to commit suicide together. You assess and find out that they have the means to carry out their plan. They have two grown children who have families of their own. The couple recently made a will dividing their assets among their children. How would you intervene? Select one: A.Call Diana and arrange for a conjoint session. B.Alert the children to Ted's plan. C.Call the P.E.T. or police. D.Make a "self-care plan" with Ted and Diana.

B. Answer B: Of these four answer choices, this is the only one that addresses immediate safety. The therapist needs to ensure client safety and Section 1024 of the Evidence Code gives us the right to break confidentiality. Answer C: While this couple is showing suicidal intent, calling the P.E.T. or police is too intrusive at this point. Working from the least intrusive intervention first, attempting a 24-hour watch by alerting the children would be done prior to calling the police or P.E.T.

In session, you are working with a couple who is arguing. During the session, the wife becomes extremely agitated and angry with both you and her spouse. First, you: Select one: A.Get the husband out of the room and work with the client to reduce emotional reactivity. B.Get yourself and the husband out of the room and allow the client to calm down. C.Allow the client to leave the room to "cool off." D.Call the P.E.T. to initiate a 5150 for danger to others.

B. Answer B: Taking yourself and the client's spouse out of the room allows the angry client to calm down without endangering other people. If the wife cannot contain herself, then contacting the police would be an appropriate next step. Answer C: Allowing an angry client to leave your room may place others outside your office in danger. The client may "go off" on people in the waiting room, other colleagues, etc.

Karen comes to therapy and tells you that she and Bob have been married for 18 years and have two teenagers. Karen has never worked outside of the home. Bob wants a divorce, refuses to give her any money, and has moved out. Karen is stressed and asks you to refer her to a psychiatrist. After the psychiatric consultation, you ask Karen to sign an authorization to release confidential information so that you may speak with the psychiatrist. For such a form to be in compliance with the Confidentiality of Medical Information Act, it must include all of the following except: Select one: A.A specific, limited expiration date. B.A statement that the client must receive a copy. C.Restrictions on the uses and limitations of the confidential information. D.A font size of at least 14-points or be handwritten by the client.

B. Answer B: The law requires release authorizations to include a statement of the client's right to receive a copy. Clients are not required by law to receive a copy. Answer C: The California Medical Information Act says valid release authorizations must state the limits upon and uses of the confidential information.

Torie, age 14, is brought in by her parents. They are concerned about her recent "personality changes:" falling grades, constant defiance at home, fighting with her new step-sister. The parents have recently married and are now a "blended family" of mom and daughter, dad, and daughter. A Bowen family systems therapist would be MOST concerned with: Select one: A.Torie's developmental and early history. B.The danger of the parents "taking sides." C.The involvement of Torie's biological father. D.Helping Torie learn how to differentiate her thoughts from her feelings.

B. Answer B: The parents have the biggest challenge in this family: how not to take sides with their own child against either the step-sibling or the other spouse. This is triangling. Teaching them how to detriangle will be a major focus of treatment. Answer D: This is a Bowenian focus, but "B" is the primary concern for this family. Helping any or all family members learn to differentiate thoughts from feelings will help reduce emotional reactivity, and be a treatment focus.

An African American mother brings her 10 year-old son in for therapy because he has been diagnosed as having ADHD. She tells the therapist that she's a single parent, and works full-time as a sales clerk. She tells the therapist, who is Latino, that she wasn't sure about coming to therapy because she was afraid of being "stereotyped" as a bad mother because she gets angry at her son. The therapist, who is Latino, says, "I can see that you are a strong Black woman, and asking for help must be hard for you." The mother looks taken aback at this statement. What could be going on here? B.The client may be left feeling that she now has to live up the therapist's expectations to be strong, and therefore cannot be free to share her weaknesses and vulnerabilities. D.The therapist committed a microaggression by stereotyping the woman.

B. Answer B: The therapist has pigeonholed the woman as a "strong black woman," which, although potentially flattering, disallows her from being "not strong." The "strong black woman" archetype often keeps black women from asking for help, for fear of non-African Americans that people like her can have problems too. Answer D: This is true, but Answer B. is more detailed, and is therefore a better answer.

Which answer choice would help you make a differential diagnosis between Autism Spectrum Disorder and Social (Pragmatic) Communication Disorder? Select one: A.Impairment in the use of multiple non-verbal behaviors. B.Clinically significant delay in developing spoken language. C.Cannot develop peer relationships appropriate to his/her developmental level. D.Lack of social or emotional reciprocity.

B. Answer B: This answer choice would enable you to make a differential diagnosis. With Social (Pragmatic) Communication Disorder Disorder, there is NO clinically significant delay in the development of spoken language. For example, the child can use single words by age 2 and phrases by age 3. With Autism Spectrum Disorder Disorder, there IS a delay (or total lack) of the development of spoken language. All other answers describe a symptom criterion shared by both disorders.

Deshawn and Michelle have come to see the clinician because they have a long history of domestic violence. Deshawn has served time for domestic violence as well as burglary and is now on probation. Deshawn states that "I'm not nearly as bad as everybody makes it out to be. Michelle can be really hard to get along with sometimes, especially when she drinks." Michelle hotly denies that she drinks, and say's "It's all Deshawn's fault." What would be included in treatment in this situation? Select one: A.A combination of group therapy and aversion therapy for Deshawn, and alcohol treatment for Michelle. B.Group therapy for Deshawn and individual therapy for Michelle. C.Couple's therapy to learn how they each contribute to the reciprocal patterns of their dysfunctional relationship. D.Teach Deshawn the "Cycle of Violence" model and teach communication skills such as "I messages," active listening, etc.

B. Answer B: This answer refers Deshawn to group therapy whichhas been shown to be the best choice for treatment for batterers. Individual therapy and a support group (as well as an alcohol assessment) would be most appropriate for Michelle. Answer C: Couple's therapy is inappropriate, and possibly even dangerous, as it tends to bring up many emotional issues which could easily spark more violence.

Labha and Gabino have been together for 12 years, and come to therapy because they are both "dissatisfied" with the relationship. Labha says that Gabino doesn't want to have sex anymore, and seems emotionally distant. Gabino says that Labha is "needy" and "wants more than I can give." The therapist notices that when Gabino shows any weakness, Labha interprets it as a complaint, which leads Gabino to shut down. How would the therapist describe this dynamic? Select one: A.Codependent B.Pursuer-distancer C.Demand-withdraw dynamic D.Active-passive

B. Answer B: This describes the pursuer-distancer relationship. The pursuer seeks increased closeness and reassurance when they feel isolated in the relationship and the distancer feels overwhelmed by their partner's pursuit and withdraws to relieve anxiety. Answer C: In the demand-withdraw dynamic, one partner attempts to control the other through criticism, complaints, or coercion, while the other seeks control through distraction or isolation.

Don and Ginny, a couple in their 30s, come to see you with their 6-year-old daughter, Ellen. They tell you that Ellen was frightened by an earthquake two years ago and came into their bed to sleep. Since then, she refuses to sleep in her own bed. Don wants this stopped, but Ginny says she can't stand hearing Ellen scream when she's returned to her own bed. How would you intervene? A.Have the couple get a lock for their bedroom door. B.Utilize a reward system to get Ellen to sleep in her own bed. C.Refer Don and Ginny to parenting classes D.Refer Ellen to an M.D. for an evaluation.

B. Answer B: Utilizing a reward system is the best answer available. Answer C: Referring the parents to a parenting class might be helpful, but it is not specific to this problem, which you are equipped to treat.

You negotiate a fee with your new client Chetwyn, who asks if his insurance company will pay for the sessions. He brought his insurance card for you to copy, and you put a copy of it in your file. You tell him that having worked with this company in the past, you're certain that they will pay for your work together. When you receive a check from the insurance company, only half the sessions are reimbursed because you have been meeting with Chetwyn twice a week. You would: Select one: A.Bill Chetwyn for services provided that the insurance company did not cover. B.Forgo payment because you did not adequately explain the process of fee collection and insurance billing to Chetwyn. C.Advocate for full coverage of Chetwyn's mental health treatment with the insurance company. D.Explain to Chetwyn what happened and inform him that he is responsible for any fees not paid by his insurance company.

B. Answer B: You would forgo payment because you did not adequately explain the process of fee collection and insurance billing to your client. Answer C: Although ethical standards oblige therapists to advocate for health care coverage of their clients, in this case the therapist may have made an error in assuming that the insurance company would cover two sessions per week. Advocating would be appropriate, but it does not address the central ethical problem here, the failure to adequately inform Chetwyn about fees and insurance coverage.

Question ID #25310: You are treating a client who has been referred to you by her school. She has been having difficulty getting along with her classmates and difficulty sustaining attention in class. Her parents are recently divorced and her grandmother has just died. You want to consult with the child's teacher. What type of question would you ask the teacher to elicit the information you are seeking? Select one: A."Who?" questions. B."What?" questions. C."How?" questions. D."Why?" questions.

B. Answer B: Your purpose in contacting the teacher is to get more information about the child and to determine the nature of the problem as perceived by the school. "What" questions gather information about the nature of the problem; other forms of questions would ask for specific information related to specific incidents. Answer C: " "How" questions are designed to evaluate process.

Marina comes in with her husband, Ben, and her two children from a former marriage. Dorinda, 11, is failing at school because she refuses to do her homework. She says she wants to stay home and take care of her baby sister, who is 3. Ben complains of the stress of being a parent, and how hard it is to get Dorinda to mind him. Marina says she is frustrated because she knows Dorinda is very bright, but she has become completely "unmanageable." As a Solution Focused therapist, what would your treatment plan include? B.Develop goals with the family in behavioral terms; help the parents notice Dorinda's small, positive changes; help the parents notice what they are doing differently when Dorinda is more cooperative. D.Collaborate with the family to name the problem; have the family members describe how they are being affected; help the parents notice Dorinda's small, positive changes.

B. B are Solution Focused interventions and D are narrative interventions

What is the required length of time to keep client records after the client has terminated therapy? Select one: A.If the client is a minor, until the minor turns 21 B.At least 7 years after the termination of an adult client C.At least 7 years after the termination of an adult client or until a minor client turns 21 D.For an adult client, at least 10 years after termination; for a minor, 10 years after termination or until the minor reaches 21, whichever is longer

B. The law requires that client records be kept a minimum of 7 years after the date of termination. The law also requires that records be kept for a minor for at least 7 years after they would have been 18, or until the minor would have been 25.

The Warshaw Family is made up of John, his wife Georgina, and their twin boys, Adam and Aaron, age 9. In family counseling, Georgina tells you that John never helps her with the kids and now they misbehave all the time. John tells you that he helps as soon as he gets home, but he works late and his wife doesn't understand. As an Experiential family therapist, what would be your early stage interventions? A.Taking a family history going back three generations. Have the couple speak directly to you. B.Taking a family history going back three generations. Have a member of the family create a spatial metaphor of the family roles and rules. C.Make a map of the family's relationships Interactional patterns and modeling congruent communication. D.Make a map of the family's relationships and interactional patterns. Explore the feelings behind the pain the family is experiencing.

B. This question tests your knowledge of Satirian interventions. Answer A: An Experiential therapist does take a family history, known as the Family Life Chronology. It is Bowen who has couples speak directly to him to de-escalate tension in the room. Answer B: An Experiential therapist does take a family history, known as the Family Life Chronology. With this intervention, the Experiential therapist asks ONE family member to create a spatial metaphor or sculpture of their family members' bodies to demonstrate family dynamics. Answer C: Making a map of the family's relationships and interactional patterns is descriptive of a Structural family map. Modeling congruent communication is an Experiential intervention. Answer D: Making a map of the family's relationships and interactional patterns is descriptive of a Structural family map. Exploring the underlying pain the family is feeling is an Experiential intervention.

A therapist is running a therapy group for people going through divorce. The therapist suspects that one member of the group is abusing drugs and determines that his erratic participation is detrimental to the group process. The therapist should FIRST: A. Confront the client in the group. B. Schedule an individual session with the client. C. Provide the client with a referral for substance abuse treatment. D. Process the group members' feelings about the client's departure.

B. schedule outside session to address terminating group member from group, C can be done during B

Maria and Lourdes ask for help with their communication. Lourdes states that they have had "very serious problems" for a long time. Lourdes becomes visibly upset during the session and starts shouting at Maria. When the therapist tries to intervene, Lourdes storms out of the room. What are the initial goals in this situation? Select one: A.Ask each client individually about domestic violence, go through an informed consent process, instill hope that therapy will help them stay together. B.See each client individually to assess for possible abuse issues and potential substance abuse, instill hope. C.Formulate a treatment plan, instill hope, assess for substance abuse. D.Repair the fractures in the relationship, formulate a treatment plan, assess for domestic violence.

B. Answer B: All three of these elements are appropriate for the early stage. The clinician would want to assess for possible substance abuse as well as domestic violence, not only because it is standard protocol to do so, but because if there is DV, substance abuse can make the DV more dangers. "Instill hope" is an appropriate goal in that the client(s) need to leave the first sessions with a sense that things could get better by coming to therapy why would they come back for additional sessions if they did not leave with some sense of hopefulness. Answer D: "Repair the fractures in the relationship" is not an early stage goal, by any means.

During a family therapy session, the therapist notices that both the 6-year-old and the 4-year-old children have bandages on their hands. The motherdiscloses tearfully that she can't trust her 15-year-old stepson to stay alone with her young children because he super-glued their hands to his door.The husband shakes his head and says, "We already dealt with this. It won't happen again." What should the therapist do NEXT: A. Find out how they dealt with it. B. Document the incident in your notes. C. Inform the family that you must file a child abuse report. D. Ask if other incidents like this have happened before.

C

A therapist has been treating George for one year, most of which focused upon his change of life that occurred when he lost his job. He spent most of his young adult life "climbing the corporate ladder" and realized at 38 that he wanted to spend the next half of his life doing something else. "Anything else," he said. He decided to become a history teacher and went back to school to get a teaching credential. As you get ready to terminate, he begins to become distressed and requests to continue therapy with you instead of terminating. You believe that therapy should be terminated. You should: Select one: A.Review the presenting issues and develop a new treatment plan. B.Empathize with his feelings of distress and add some sessions before proceeding with termination. C.Re-assess the need for termination. D.Empathize with his distressed feelings, explain they are normal, and proceed with termination.

C Answer A: A whole new treatment plan should not be necessary in the later stage of therapy. A review of current termination goals and timing would be more appropriate, answer "C". Answer B: It would be inappropriate to proceed with termination without re-assessing the timing. A clinician needs to remain open-minded in order to meet his/her client's needs. Proceeding with termination after some extra sessions may not meet this client's needs. More information would need to be gathered before making this choice. Answer C: Even though you believe therapy should be terminated, it is still necessary to gather more information. Before proceeding with termination, you need to insure that a new situation has not arisen that may require a change in the current termination goals. Answer D: Distress might represent feelings of loss in a client terminating; however it cannot be assumed that a new situation has not arisen which may affect termination.

Thomas and Loretta see you for Cognitive-Behavioral couples counseling for four months. Thomas says that he doesn't think that therapy is working, he hates automatic thought records,\ Loretta says that "Thomas is always putting me down, and can't be happy with anything in our relationship." As a Cognitive-Behavioral therapist, your next step would be to: A.See why they are having trouble with the automatic thought record. Teach them "I" statements; notice the words they use, such as "always" and "never" to restructure their thoughts.Incorrect B.Assign homework more specific to their treatment. Teach them "I" statements; terminate therapy when both of them have more positive expectations and thoughts about the relationship. C.Explain the cognitive distortion, over-generalizing. Teach them "I" statements; terminate therapy when both of them have more realistic expectations and thoughts about the relationship.

C Answer A: Exploring why they are having trouble with the Automatic Thought Record is not specific enough to Thomas and Loretta's needs. Thomas did NOT say he was having trouble doing an Automatic Thought Record, he said he hated them. Addressing overgeneralizing thoughts, "C", would be more specific to their needs. They are blaming each other which is a type of distortion. Cognitive-behavioral therapists would use an educational approach to changing behavior. Noticing the words the use, all by itself, would not restructure their thinking. Answer B: Assigning homework more specific to their treatment is too general a statement. They are blaming each other which is a type of distortion. Cognitive-behavioral therapists would use an educational approach to changing behavior. The goal would not be "positive expectations and thoughts". It would be "balanced" expectations and thoughts. Answer C: Explaining overgeneralization to Thomas and Loretta would be an appropriate intervention. Thomas makes a possible overgeneralization when he says "Loretta will NEVER change." Loretta also makes another possible overgeneralization when she says that, "Thomas is ALWAYS putting me down." They are blaming each other which is a type of distortion. Cognitive-behavioral therapists would use an educational approach to changing behavior. Balanced thinking is one of the goals of Cognitive-Behavioral therapy.

Joyce is a 44-year-old single Caucasian parent who is concerned about her 16-year-old son, John. She says that in the last six months, he has become increasingly violent at school and was recently suspended for fighting. Joyce avoids eye contact, has been withdrawing from her friends, and has been missing work at least one day a week. What would be Joyce's most likely DSM-5 diagnosis? Select one: A.Persistent Depressive Disorder B.Avoidant Personality Disorder C.Adult Physical Abuse by nonspouse or nonpartner D.Conduct Disorder

C Answer A: Persistent Depressive Disorder would require two years of low-grade or severe depression. John's behavioral change, which is impacting Joyce, only has occurred for the past 6 months. Answer C: Adult Physical Abuse by nonspouse or nonpartner is warranted by the son's behavior.

All of the following are true about a Solution-Focused treatment plan EXCEPT: Select one: A.Identifying client treatment goals is a client-driven activity. B.The client's goals don't necessarily match the presenting problem. C.The therapist provides guidance in identifying appropriate treatment goals. D.Goals are typically described in interactional terms.

C Answer B: This is a true statement: what the client sees as a goal may not always relate specifically to the presenting problem or diagnosis. For example, a client diagnosed with Major Depressive Disorder may identify doing more things with her daughter or getting to work every day as her goals. Answer C: This statement is not completely true from a Solution-Focused perspective: while the therapist does provide guidance to help the client describe the goal in behavioral and interactional terms (see "D" below), the appropriateness of the goal is determined by the client. Answer D: This is a true statement: goals are typically described in interactional terms. An example would be an adolescent with suicidal ideation whose goal is to make one new friend and have him over to play video games.

Jane, age 11, calls you because she ran away from home. She tells you that she is really sad because her parents fight all the time and she just can't take it anymore. She wants you to help her. Initially, your plan of action with Jane is to: A.Immediately have her come in for a session. Ask if there is another adult in her life who could sign a Caregiver's Authorization Affidavit. B.Bring her family in for a session. Tell them the limits of confidentiality for child abuse and domestic violence. C.Call Child Protective Services to report child abuse. Refer her to a shelter. D.Refer her to a shelter. Ask if there is another adult in her life who could sign a Caregiver's Authorization Affidavit.

C Answer C: A call to Child Protective Services to report child abuse might be in order given the fact that she is sad and says that she can't take it anymore. While possible child abuse is still "up in the air," the need for immediate shelter is apparent. At the shelter, further assessments would be done. Answer D: While possible child abuse is still "up in the air," the need for immediate shelter is apparent. At the shelter, further assessments would be done. If you determined it was not safe to get consent from a parent, and she could be seen in a session, you would need some other form of consent. But first, her immediate safety must be managed.

In a first session with a Multigenerational therapist, the therapist explains the role that anxiety plays in relationships. From an Extended Family therapy perspective, anxiety refers to a: Select one: A.Fact of life, where the goal of therapy is to help the client accept it. B.Feeling that can be mitigated by achieving balanced thoughts. C.Feeling that drives the family projection process. D.Symptom of a client's multi-generational transmission process.

C Answer C: Extended Family therapists assume that between any two people, inevitable tension/anxiety causes people to discharge it onto a third person (i.e., "triangulation"). Triangulation is the result of the family projection process according to Bowenian/Multigenerational theory. Answer D: Although Extended Family therapists assume that between any two people inevitable tension/anxiety causes people to discharge it onto a third person (i.e., "triangulation"), in any particular family, anxiety may not be the main pattern that is handed down.

During a family session the mother says, "The only reason I get behind on the housework is because no one ever helps me - you are all so lazy". The father explains that everyone is simply preoccupied with designated tasks that are necessary to make the family run efficiently. The son says that all he wants is help with his homework. An Experiential therapist would react to this exchange by: Select one: A.Highlighting the triangles occurring between the family members. B.Having the mother come in for individual work. C.Highlighting blaming behavior in the mother and super-reasonable behavior in the father. D.Putting the father in charge of housework and the mother in charge of the son's homework.

C Answer C: Highlighting blaming behavior in the mother and super-reasonable behavior in the father would correctly identify two styles of communication, which an Experiential therapist would use in identifying dysfunctional communication styles (Blaming and computing). Answer D: Putting the father in charge of housework and the mother in charge of the son's homework is an intervention more typical of Strategic and Structural therapies.

You are a newly licensed therapist and are designing your business card. All of the following would be acceptable ways of arranging your titles on a business card EXCEPT: Select one: A.Anita Burger, MA; Licensed Marriage and Family Therapist. B.Anita Burger, Licensed Marriage and Family Therapist; Individual and Couples Psychotherapy. C.Anita Burger, MA, LMFT; Licensed Psychotherapist. D.Anita Burger, MA, LMFT; Hypnotherapist.

C There is no such title as a "Licensed Psychotherapist."

Cindy, age 37, is a new client of yours. She is not married but has been living with a man for five years. She recently had her fifth miscarriage and tearfully tells you that no one understands. She says that her mother has been very supportive but your client knows she was really hoping for another grandchild. Cindy says that she is depressed about having to re-imagine the rest of her life. How would you respond? Select one: A.Explain to her how common her feelings are for her situation. B.Share a loss that you have experienced in your life. C.Agree with her assertion that no one else understands her experience. D.Tell her that you understand.

C This human diversity question looks at diversity of experience, how to handle it in session, and how to build a therapeutic alliance. Answer A: This scenario describes a new client who has had a difficult experience. Going straight to educating her about common responses to her situation does not allow for the important rapport building that enables her to feel heard in the early stage of therapy. Answer B: Sharing a loss that you have had in your life would impair clinical boundaries. Answer C: Agreeing with her assertion that no one else understands her experience will help validate her position and allow her the freedom to continue expressing her feelings. Answer D: Most clients are offended when a therapist claims to understand, especially without fully hearing the person out. An important consideration when dealing with a client is that each person's experience is unique even within a common group or cohort.

A 23-year-old woman seeks therapy for relationship issues. When she arrives at the first session she is visibly underweight with pale skin and thinhair. During the intake it is clear that the client suffers from Anorexia Nervosa. What resources should be included when formulating the treatmentplan? A. Medical stabilization; Pharmacotherapy; Peer support B. Pharmacotherapy; Nutritional rehabilitation; Cognitive Behavioral Therapy C. Medical stabilization; Nutritional rehabilitation; Cognitive Behavioral Therapy D. Nutritional rehabilitation; Peer support; Psychodynamic psychotherapy

C research shows psychotropic medication don't work w/ anorexia

Consuela and Judy are working on their relationship in couple's counseling. Judy describes her relationship history as being one that is "pretty happy," and that she grew up in a home where her parents' marriage was "pretty good." Consuela says that Judy "neglects" her and is "only interested in doing her own thing." Judy says, "She's just so needy." She says that she doesn't understand why things have to be so difficult with Consuela. What is the problem here? Select one: A.They are playing out negative cycles which are self-reinforcing and self-perpetuating. B.They lack communication skills that are necessary to achieve true intimacy. C.They are enacting an unconscious Marital Contract. D.As a lesbian couple, their experience is influenced by unconscious gender role expectations.

C. Answer A: The is probably true, but the answer doesn't say very much about the cause of the negative cycles. Answer C: Judy obviously expects a pretty individuated role in the relationship, while Consuela clearly desires more closeness. Neither is "right" the problem is that their expectations about what a relationship should be like is mismatched. Couples tend to follow a script or a set of expectations that are based on the role models they grew up with (the "Unconscious Marital Contract"). People tend to expect that the couples' relationship will in some way mirror, be the opposite of, or in some other way reflect their parents' relationships. When one's partner doesn't follow through with one's unspoken rules, the person may feel unloved, unappreciated or disappointed.

Bonnie and Ricardo, a couple in their 30s, are seeing a Strategic family therapist. They have been unable to achieve any closeness in their relationship. Bonnie says that she knows that she starts fights when things are going well, and Ricardo says that sometimes he looks at other women just to make Bonnie mad. Bonnie tells you that she spends most of her free time shopping on the internet and Ricardo spends a lot of his time on fantasy sports. Which intervention would a Strategic family therapist NOT use with this couple? A.Assist people to get to the next developmental level. Formulate a set of goals at the start of treatment. B.Watch family communication patterns. Comment on what appear to be nonverbal signals. C.Explain the rationale for therapeutic interventions. Focus on first and second order change. D.Look for how power is distributed in a family. Focus on how the parents discipline the children.

C. Answer A: A Strategic therapist DOES assist people to get to the next developmental level. Family therapists (including Strategic family therapists) believe that people come to therapy because of a developmental crisis. A Strategic therapist DOES formulate a set of goals at the start of treatment Answer B: A Strategic therapist DOES watch family communication patterns. Strategic family therapists observe overt and covert communication patterns, as well as, the metacommunication occurring in session. A Strategic therapist DOES comment on what appear to be nonverbal signals, or metacommunication. Answer C: A Strategic therapist does NOT usually explain the rationales for his interventions. This would be especially true when using a paradoxical intervention. A Strategic therapist is more likely to focus only on first order change. Second order change is not out of the question, but Strategic therapists do not necessarily focus on deep work. Answer D: A Strategic therapist DOES look at how power is distributed in the family system. Strategic family therapists believe symptoms are an attempt to achieve power in a family. A Strategic therapist would focus on how the parents discipline the children. This would be part of the "power and communication" for Strategic therapy.

A client reports that she is unable to get out of relationships. She tells you that being single is hard, but getting out of relationships is even harder. She tells you that she has never really been alone for very long. She is now seeing a new guy she met on social media. If the client is seeing a Cognitive-Behavioral therapist, how would the therapist approach the goal of individuation? A.Disrupt and differentiate the cognitive triad. Create a problem list to clarify her perspective. B.Use boundary marking to separate thoughts and feelings. Teach her to use an Automatic Thought Record to clarify her perspective. C.Talk about how she thinks relationships should be. Present her with opposite conclusions to the ones she is making. D.Provide a positive reframe of the fusion she feels in relationships. Help the client think in ways that avoid a systematic bias.

C. Answer A: Cognitive-behavioral therapists do not "disrupt" or "differentiate" the cognitive triad. The cognitive triad (self-world-future) is a concept that defines a person's outlook and perceptual habits. Creating a problem list is an early stage Cognitive-behavioral intervention that is used to get a sense of a client's goals. Answer B: "Boundary marking" is a Structural therapy intervention that aims to disrupt dysfunctional coalitions and alliances within families, not between thoughts and feelings. Creating an Automatic Thought Record is a Cognitive-Behavioral intervention that is used to get a sense of a client's thought process. Answer C: A Cognitive-behavioral therapist takes an educator/collaborative approach to discuss how automatic thoughts and assumptions might be balanced with more reasonable thinking patterns. "Shoulds" can reveal a client's (distorted) assumptions or expectations and would be the focus of her perspective on self and relationships. A Cognitive-behavioral therapist might suggest contrary ways of making conclusions so that clients can see a systematic bias and begin to consider other ways of thinking. Answer D: Although all therapists use reframing in the early stages of therapy to avoid pathologizing or blaming the client, "fusion" is a Bowenian and Structural therapy focus of family treatment. In contrast, the focus of Cognitive-Behavioral therapy is to first change thinking patterns, and the family or behavioral patterns come second. A Cognitive-behavioral therapist would focus on the skills for balanced thinking.

All of the following are middle stage Cognitive-Behavioral goals EXCEPT: Select one: A.Focusing on connections among thoughts, emotions, and behaviors. Balanced and realistic thinking. B.Shifting patterns of thinking. Developing skills for challenging one's own thoughts and beliefs. C.Focusing on symptom reduction. Using thought tracking to help the client gain insight into his/her patterns of distortions. D.Moving attention from changing others to changing the self. Developing skills for challenging one's own thoughts and beliefs.

C. Answer A: Focusing on connections among thoughts, emotions, and behaviors is a middle stage Cognitive-Behavioral goal that can be achieved through the use of an automatic thought record. Balanced and realistic thinking is a middle stage Cognitive-Behavioral goal. Answer C: Focusing on symptom reduction is an early stage goal as it is necessary to deal with the client's symptoms before attempting to change the client's dysfunctional or faulty belief system about himself, the world, or the future. Using thought tracking is an intervention and "insight" is not a Cognitive-Behavioral goal.

Question ID #25637: You're doing play therapy with Josh, age 8, who has been sexually abused. You set out a variety of toys for him to play with including a set of anatomically correct dolls. Josh avoids the dolls and interacts with all the rest of the toys. Your next step would be to: Select one: A.Hand him the dolls directly. B.Ask him why he avoids the dolls. C.Follow his lead and leave the dolls alone. D.Go sit by the dolls.

C. Answer A: Handing Josh the dolls directly would be too intrusive. Play therapy is usually a non-directive process and accordingly a therapist would wait for children to address the issues for which they are ready. Answer B: Asking Josh why he avoids the dolls would be too directive. Play therapy is usually a non-directive process. Answer C: Following Josh's lead and leaving the dolls alone in is accordance with non-directive play therapy. Answer D: Going to sit by the dolls is also too directive in most play therapy situations.

The intervention of deconstruction is intended to accomplish the goal of: Select one: A.Demystifying the therapist's "expert" role. B.Eliminating the concept of stages in therapy. C.Clarifying the goals of treatment. D.Pointing out dynamics of metacommunication.

C. Answer A: Narrative therapists use deconstruction to identify and ultimately reduce the power of a client's fixed narrative (i.e., narrative about the self, the "problem", the family, etc.). Answer B: Deconstruction is not directly related to the therapist's role. Answer C: Narrative therapists use deconstruction to identify and ultimately reduce the power of a client's fixed narrative (i.e., narrative about the self, the "problem", the family, etc.) to then find unique outcomes, points of strength, and factors to help determine client goals. Answer D: Deconstruction is not directed at assessing how a family communicates; deconstruction is more related to the data that a client provides about his/her narrative.

Question ID #25518: After years of therapy, a 35-year-old man decides that he wants to quit smoking. He thought that getting in touch with his feelings would cut the cravings, but when he tries to stop smoking, he reports strong anxiety and nervous symptoms. He tells you that the nicotine patches and the vapor cigarettes are effective for the nervousness, but he still feels anxiety. If working with the client's anxiety, a Behavioral therapist would use counterconditioning to accomplish the goal of: Select one: A.Negative reinforcement B.Aversive conditioning C.Extinction D.Systematic Desensitization

C. Answer A: Negative reinforcement, like counterconditioning, is an intervention, not a goal. Answer B: Aversive conditioning, like counterconditioning, is an intervention, not a goal. The intention of aversive conditioning (pairing an unpleasant stimulus with a habituated response) is to eliminate the anxiety response by making it even more uncomfortable than it already is. Answer C: The intention/goal of counterconditioning (pairing an incompatible response with an innate response - e.g., relaxation and anxiety or nausea and craving) is extinction of the anxiety response by making it impossible to have two experiences simultaneously. Answer D: Systematic desensitization, like counterconditioning, is an intervention, not a goal.

After years of therapy, a 35-year-old man decides that he wants to quit smoking. He thought that getting in touch with his feelings would cut the cravings, but when he tries to stop smoking, he reports strong anxiety and nervous symptoms. He tells you that the nicotine patches and the vapor cigarettes are effective for the nervousness, but he still feels anxiety. If working with the client's anxiety, a Behavioral therapist would use counterconditioning to accomplish the goal of: Select one: A.Negative reinforcement B.Aversive conditioning C.Extinction D.Systematic Desensitization

C. Answer A: Negative reinforcement, like counterconditioning, is an intervention, not a goal. Answer B: Aversive conditioning, like counterconditioning, is an intervention, not a goal. The intention of aversive conditioning (pairing an unpleasant stimulus with a habituated response) is to eliminate the anxiety response by making it even more uncomfortable than it already is. Answer C: The intention/goal of counterconditioning (pairing an incompatible response with an innate response e.g., relaxation and anxiety or nausea and craving) is extinction of the anxiety response by making it impossible to have two experiences simultaneously. Answer D: Systematic desensitization, like counterconditioning, is an intervention, not a goal.

Louis, age 11, is brought into therapy by his mother, Susan, at the request of Child Protective Services after the school janitor caught him setting a fire at school and called the police. Susan is tearful and smells of alcohol. She says, "I don't know nothing about this fire stuff." What goals would a Structural therapist have in this case? A.Disrupt dysfunctional roles and rules that support drinking and fire setting. Resolve the presenting problem. Strengthen the parent-child subsystem. B.Reframe Louis' fire setting as an effort to get his mother's attention. Achieve sobriety and eliminate fire setting. Promote open, honest communication between Louis and his mother. C.Join with Louis and Susan. Promote open, honest communication between Louis and his mother. Disrupt dysfunctional roles and rules that support drinking and fire setting.

C. Answer A: One goal of Structural therapy is to disrupt system roles and rules that underlie symptomatic behavior. Because all therapies address the presenting problem, "resolving the presenting problem" is a vague and answer choice. Although Structural therapists would establish subsystem changes as a primary goal, in this vignette, there is no "parent-child" subsystem; there is only the family unit. Answer B: Reframing is an intervention, not a goal. Achieving sobriety and eliminating fire-setting are vignette-specific goals. All Family System therapies subscribe to the importance of communication as the means by which family and relational dynamics are created and maintained. Answer C: Joining is an early stage Structural goal, achieved by such interventions as accommodation and mimesis. All Family System therapies subscribe to the importance of communication as the means by which family and relational dynamics are created and maintained. One goal of Structural therapy is to disrupt system roles and rules that underlie symptomatic behavior, through the use of process comments, affective intensity, and other techniques.

Sam, age 41, and Theresa, age 35, have been married for 12 years. They have two children, ages 4 and 8. They are in marital counseling due to Theresa's recent affair. Sam took Theresa back following a previous affair seven years ago. Theresa says that she loves Sam and that she'll do anything to keep their marriage together. Theresa tells you that she often feels neglected by Sam. As a Cognitive-Behavioral therapist, what interventions would you use with Sam and Theresa? Select one: A.Have the couple enact their problem and use an automatic thought record. B.Listen for each partner's projections and mirror their responses. C.Utilize circular questioning and a cost-benefit analysis. D.Use a responsibility pie and block dysfunctional interaction patterns.

C. Answer A: Only one of the interventions is correct. A Structural therapist would use enactment to get a general assessment and overview of the current systemic dynamics. A Cognitive-Behavioral therapist would use an automatic thought record to identify automatic thoughts and examine their validity. Answer C: A Cognitive-Behavioral therapist would use circular questioning as a part of guided discovery and utilize a cost-benefit analysis to look at the advantages and disadvantages of maintaining distorted cognitions.

Peter is very sure of himself, to the point that he cannot accept criticism from anyone, which often creates problems in his marriage and his work. How would Freud describe this person? Select one: A.He has an oral fixation B.Peter is anal-retentive C.He has a phallic fixation D.Peter has a latency fixation

C. Answer A: Oral fixations result in behaviors such as nail-biting, smoking, gum-chewing, or excessive drinking. These are seen as a result in problems with the weaning process. Answer B: Anal-retentive individuals may have experienced overly strict and harsh potty training as children and may grow to be overly obsessed with orderliness and tidiness. Answer C: Freud postulates that fixation at the phallic stage promotes the character development of a person who is narcissistic, i.e., excessively vain and proud. Answer D: There is no such thing as a latency fixation.

Question ID #26739: You have been working with a couple for 4 months. They are seeking counseling to assist their separation process because they realize that they are not compatible. Things are moving along, and they have communicated and agreed on arrangements related to their separation. As they come back for another session, they suddenly decide to put their separation on hold because their 14-year-old daughter has begun to experiment with drugs and sex. They are worried about her, and they disagree on how to help her. What systemic concept would describe what is happening? Select one: A.Positive feedback. B.Complementarity. C.Negative feedback. D.Circular causality.

C. Answer A: Positive feedback is the input to a system that produces change. Their daughter's behaviors seemed to interrupt the couple's change process, but now the couple is back to disagreeing with each other. Answer B: They are not "complementary." Complementarity describes distinct family roles that complement each other (e.g., a spouse who is the breadwinner and another spouse who is the homemaker). Answer C: Negative feedback is the input to a system that helps to maintain homeostasis. Their daughter's behaviors only seemed to interrupt the couple's change process, but now the couple is back to disagreeing with each other. Answer D: Every system has circular causality; this answer choice is too vague to describe the dynamics described in the vignette.

Katherine brings her 10-year-old son Benjamin to therapy. Benjamin's school has referred him because he's hitting other children and "cussing out his teacher." Which interventions would an Object Relations therapist use to achieve the middle-stage goal of helping Katherine control her anger? A.Ask Katherine what she thinks and feels about angry people. Reflect Katherine's angry feelings to help her empathize with the way Benjamin feels when he experiences her anger. C.Use psychoeducation to teach Katherine and Benjamin anger management skills. Ask Katherine what she thinks and feels about angry people. D.Interrupt projections that cause Benjamin to take on Katherine's anger. Psychoeducate about positive self-soothing strategies to help Katherine when she is depressed.

C. Answer A: Psychodynamic therapists are unlikely to use anger in this reflective and experiential kind of way. Answer C: Psychoeducation is an Object Relations word for providing clients with new information or enlightening them about theoretical ideas of human development and behavior. As an anger management technique, this will help Katherine talk about how she feels about herself as an angry person, but to do it once-removed by talking about others, potentially leading to an insight into her own expression of anger what she thinks and feels about that. Answer D: This would be an Object Relations approach to improving her insight. The question asked about Object Relations interventions directed at anger, not at depression.

Dan calls you after not seeing you for 8 years. wants to return to therapy. Lately, he has been feeling as though nothing is important to him. "I feel worthless," he tells you. You remember that he used to drink heavily and smoke pot daily. He says that he is now clean and sober and out of debt. As a Client-centered therapist, what would be your initial treatment plan for Dan? A.Reconnect to make sure that Dan feels safe. Assess for suicide ideation. Refer to a psychiatrist for a medication evaluation. Promote insight into how the past is affecting the present. B.Establish a collaborative relationship. Identify what goals Dan is looking to achieve and prioritizing them on a problem list. Do a thorough assessment. Make the proper referrals. C.Provide unconditional positive regard. Provide empathy and congruence. Facilitate Dan's self-awareness and trust. Make the proper referrals.

C. Answer A: Reconnecting to make sure that Dan feels safe would be typical of Client-centered (Humanistic) therapy. Assessing for suicide would be appropriate for any theoretical approach. A referral to a psychiatrist for a medication evaluation would be appropriate for any theoretical approach. Promoting insight into how the past is affecting the present is what an Object Relations/Psychodynamic therapist might do. Answer B: Establishing a collaborative relationship is typical of a Client-centered (Humanistic) approach. Identifying what goals Dan is looking to achieve and prioritizing them on a problem list is what a Cognitive-Behavioral therapist might do. Doing a thorough assessment would be appropriate for any theoretical approach. Making the proper referrals is correct but generic. Answer C: Providing unconditional positive regard would be typical of Client-centered (Humanistic) therapy. Providing empathy and congruence would be typical of Client-centered (Humanistic) therapy. Facilitating Dan's self-awareness and trust would be typical of Client-centered (Humanistic) therapy. Making the proper referrals is correct but generic.

An MFT intern works at an agency where there are also LCSWs. As new clients are assigned to therapists, he wonders why some clients go to the social workers, and others are assigned to the MFTs. All of the following statements are accurate regarding "Scope of Competence" for an MFT EXCEPT: Select one: A.Scope of competence refers to a therapist's ability to treat various clinical issues. It refers to a therapist's ability to maintain boundaries. B.Scope of competence is determined by education, training, and experience. It refers to the therapist's theoretical orientation. C.Scope of competence changes when an intern becomes licensed. Scope of competence must be described during informed consent. D.Scope of competence is defined for each licensee. Failure to maintain scope of competence could be legally understood as "unprofessional conduct".

C. Answer A: Scope of competence refers to a therapist's ability to treat various clinical issues. Scope of competence refers to a therapist's ability to maintain boundaries. These items DO describe the scope of competence, and therefore they are both incorrect for an "EXCEPT" question. Answer C: Scope of competence may or may not change when a person becomes licensed. The entire scope of competence would not have to be described as part of informed consent -- just the area that affects a particular client. These items DO NOT describe the scope of competence, and therefore they are both correct for an "EXCEPT" question.

Question ID #25734: A Mexican-American family comes in because their teenage son has been acting out. They were referred by their son's school and have been in therapy for a couple of sessions. They have three children and want him to be more respectful of his role in the family. He is the oldest and they tell you that he needs to start acting like a man, not a boy. Both of his parents work outside of the home and he is responsible for taking care of his younger sisters. You would: Select one: A.Encourage participation from all family members so that they can each have an equal voice B.Encourage the children so that they can express their feelings. C.Present them with a plan and gauge their reaction to it. D.Understand that the process this family is going through is due to acculturation.

C. Answer A: Since Mexican-American culture is (generally) patriarchal, encouraging participation from all family members so that they can each have an equal voice would not be a culturally congruent intervention strategy. Answer B: Encouraging the children so that they can express their feelings is not sensitive to the well-defined hierarchy which is (generally) typical of a Mexican-American family. Answer C: Presenting them with a plan and gauging their reaction to it would be respectful to the decision-making power that the father (generally) has in the Mexican-American culture. Answer D: There is no indication as to what generation this Mexican-American family is in. Accordingly, it would be presumptuous to assume that the teen's acting-out behavior is due to acculturation. The behavior could be the result of substance use, ineffective parenting, child abuse, domestic violence, or developmental tensions.

Question ID #25426: You notice that you are yawning a lot and are very fidgety during your last session of the evening. Your reactions are strong and very uncomfortable. At one point, your client comments on your fidgeting and asks if you are bored. You were not aware that your feelings were being conveyed to your client. As a psychodynamic therapist you: Select one: A.Tell him the truth, that you are tired and want to be home, in a way that is clinically appropriate. Provide containment for his feelings. B.Interpret his question and respond to the countertransference. Use the transference as material for further exploration. C.Acknowledge your behavior and ask if your client is aware of feeling anxious or uncomfortable. Avoid defensiveness about the client's comments. D.Gently but firmly redirect your client back to the original discussion. Use the transference as material for further exploration.

C. Answer A: Telling a client that you are tired and want to be home is inappropriate in any therapeutic orientation. His feelings are contained; he just made an observation. Answer B: This is psychobabble. The client wasn't transferring feelings; he was just making an observation. Answer C: Acknowledging your behavior and exploring the client's feelings is the best choice, since it brings the client's thoughts into the open which then encourages a deeper discussion of his own issues. As a psychodynamic therapist you would want to stay neutral. Answer D: Redirecting the focus of the discussion, without acknowledging how your behavior affected the client, ignores the observation and misses an opportunity to explore feelings triggered by your behavior. The client wasn't transferring feelings; he was just making an observation.

Kirsten LaRue brings her 9-year-old son Kyle to you for therapy, and produces a copy of his birth certificate to prove that she is Kyle's mother. When you ask about Kyle's father, Kirsten says that 6 years ago, he left to buy a pack of cigarettes and never came back. There was never a custody order and as far as she knows, there wasn't even a divorce. How would you proceed to obtain proper consent to treat Kyle? A.Since Kirsten is the biological mother, she can consent to treatment. Tell her the fee for therapy. B.Ask Kirsten to obtain a court order for Kyle's therapy. Tell her the fee for therapy. C.Have Kirsten sign a Caregivers Authorization Affidavit. Tell his mother about the information you will and will not share with her.

C. Answer A: The biological mother cannot, as a rule of law, always consent to treatment. She may, for example, not have legal custody. Although she likely does in this case, her ability to sign for Kyle is not contingent on her being his biological mother. The fee must have been disclosed before this session. Answer C: A Caregivers Authorization Affidavit would cover the legal requirement of consent to treat a minor. A mother who is raising a child in the father's absence would qualify to sign the authorization, giving the therapist proper consent. When working with minors whose parent is consenting to therapy, you should tell them about how must confidentiality the minor has.

Question ID #23996: A family you are treating stops coming to therapy on a regular basis. They would often come late and most of the time, not all of them would come to the session. You found that it was difficult to get any feedback from them about what they wanted to work on, and the mother would often say, "We were hoping you could tell us what is wrong." What would be the best way of dealing with their behavior? Select one: A.Confront them about their behavior. B.Bill them for sessions they missed. C.Educate them about resistance. D.Refer them to another therapist.

C. Answer A: The option of "confronting their behavior" is too strongly worded. Answer C: You need to educate the family about the meaning of their actions, therefore working with them on their resistance issues would be appropriate.

Question ID #24761: Ted, age 26, has been seeing you for the past few months. He discloses that he has failed in yet another relationship. His boyfriend of the past few months left him. Ted is HIV positive and is on an anti-depressant. He states that he had to make another adjustment in his medication because the virus has mutated. Ted begins crying and tells you that, while drinking at a party last night, he stood on an eighth floor balcony and thought about jumping. Ted says he doesn't think he'll be able to resist "next time." You would: Select one: A.Suggest that Ted voluntarily commit himself to a hospital. B.Create a "self-care plan" and refer him back to his psychiatrist. C.Call the county psychiatric mobile response team or the police, since Ted is a danger to himself. D.Further assess for a plan, means and timetable.

C. Answer A: Though you would want to start with the least invasive means, Ted is a higher risk case. He has a plan, means, and timetable, making involuntary hospitalization necessary. Answer B: You would have Ted sign a "self-care plan" and refer him back to his psychiatrist if he didn't exhibit such high risk as having a plan, means, and timetable. Answer C: Having Ted involuntarily hospitalized would be necessary in such as high risk case. Answer D: Ted has indicated that there is likely to be a next time and that he feels he may jump, so no further assessment is required. Now it is time to take protective action.

After 9 months of treatment, Meredith tells you that while you are very nice, she doesn't feel she has made any progress in therapy, and sees no reason to be in therapy with you or anyone else. You had diagnosed her with depression. She announces that this will be her last session. What would you do? Select one: A.Explain to Meredith that termination is best managed over two to three sessions. Assess for suicidal ideation or avoidance. B.Refer Meredith to another therapist. Explain your "open door" policy. C.Terminate treatment. Explain your "open door" policy. D.Explore with Meredith the issues in your relationship that are interfering with treatment. Assess for suicidal ideation or avoidance.

C. Answer A: While termination is ideally a part of the therapeutic process, your client has indicated directly that she is done with therapy. Meredith does not feel you are effective, does not see any reason to be in therapy, and has already said that this will be her last session. Regardless of theoretical beliefs, clients have a right to terminate when they want to terminate. Although she does have a depression diagnosis, there are not clues of suicidal ideation in the vignette. Answer B: Referring Meredith to another therapist ignores her wish not to be in therapy with anyone. You could do this in case she decides to return to therapy. Answer C: Terminating treatment would be in line with the client's expressed desire. You could do this in case she decides to return to therapy. Answer D: It is only an assumption that Meredith is terminating because of issues in the relationship that are interfering with treatment. Although she does have a depression diagnosis, there are not clues of suicidal ideation in the vignette.

A therapist is attempting to help a family understand the impact of establishing treatment goals in the early stages of therapy. As the father explains that he is skeptical about how you can know the "end point when we are still at the beginning," the therapist begins to track how the other family members react when he talks. The therapist then uses the intervention of family sculpting, which has the goal of: Select one: A.Demystification of family boundaries. B.Creating a metaphor for family rules. C.Revealing family stances. D.Modeling congruent emotions.

C. Answer B: "Creating a metaphor" for family RULES is incorrect because family sculpting is the metaphor for family ROLES. Answer C: The intervention of family sculpting asks a family member to use his/her body or molding clay to visually construct each family member's role/stance in tangible form.

A wealthy couple brings in their 16-year-old daughter Heather because her grades have been slipping. They are afraid that she will not be accepted at Harvard and they want you to help her. She tells you that she has always wanted to go to an Ivy League college, but it doesn't have to be Harvard. Her parents tell you that their 12-year-old daughter has soccer and ballet lessons so they will not be able to come for family sessions. As a Behavioral family therapist, you would: Select one: A.See Heather and help her with impending separation-individuation issues. B.See the entire family and help Heather tell her parents what she wants to do with her life. C.Observe the actions of each individual. D.Assess how the parents were treated by their parents regarding the issues of schooling and careers.

C. Answer B: A Psychodynamic or systems family therapist may explore these issues with the entire family present. Answer C: A Behavioral family therapist would analyze specific behaviors in order to make an assessment.

Question ID #25131: Which of the following is a clinically appropriate reason for temporarily increasing therapy sessions from once a week to twice a week? Select one: A.The client requests it. B.The client accidentally overdoses on pain pills and is hospitalized overnight. C.The client tells the therapist of detailed dreams and thoughts of impending death. D.The client's insurance provider requests it.

C. Answer B: An accidental overdose is not a reason to increase the frequency of sessions. Answer C: Part of a suicide protocol is to increase contact with the client, by telephone or extra sessions. Of the answers provided here, this is the only one that presents a clear justification for temporarily increasing sessions to twice per week.

You are a therapist working with a new family. One of the techniques that you use in the early stages of treatment is the Family Life Chronology. What would be your reason for using this intervention with a family? Select one: A.You would use this diagram to depict the family members over three generations, noting pertinent information about ages, deaths, years of marriage and divorce, births, and possibly disorders that run in the family. B.This diagram is helpful in depicting and understanding patterns, relationships, and dynamics in the family. C.This diagram is helpful in understanding the history of the family's development. D.You would use this in order to understand the history of the problem's influence on the family's life and relationships.

C. Answer B: Diagramming patterns, relationships, and dynamics in the family describe the Structural technique of family mapping. Answer C: Understanding the history of the family's development in order to gain information about family ideology and values correctly describes what the Family Life Chronology does. - Experiential theory

Kendall, age 19, comes to you complaining of depression and anxiety. His symptoms have intensified since he left home and he reports, "I've been depressed and anxious all my life, just like my mother." .Which of the following statements is true? B.A Cognitive-Behavioral therapist would use shaping techniques to relieve the maladaptive cognitions leading to depression and anxiety. Kendall would be assigned homework in the middle stage of therapy.Incorrect C.A Narrative therapist would help Kendall deconstruct the story of his depression and anxiety. The therapist and Kendall would map the times when depression is not a part of his life. D.A Family Systems therapist would challenge the equifinality of Kendall's assessment about the origins of his anxiety and depression. The therapist would also reframe Kendall's assumptions so that he can make second order change.

C. Answer B: Shaping is not used to "relieve maladaptive cognitions." Shaping is a behavioral technique of using positive reinforcement of small changes that move in the direction of the overall desired goal (e.g., quitting smoking by using rewards to gradually cut down on the number of cigarettes smoked). A Cognitive-Behavioral therapist would assign homework in the middle stage of therapy. Answer C: Kendall's story--that he is just like his mother and therefore needs depression and anxiety as coping mechanisms--is just a story from the Narrative perspective. So a Narrative therapist would help Kendall to challenge the taken-for-granted truth of Kendall's story in a process known as "deconstruction." Mapping the influence of the problem is a Narrative intervention. Answer D: The choice misuses the term "equifinality," which means that the same results (goals) can be achieved by entering the system (intervening) in various ways. A systems therapist would reframe, but the reframing is more an early stage intervention, while second order change is a termination criterion or goal.

Question ID #25332: Burt came into therapy because his latest television series had been cancelled. He tells you that his wife divorced him six months ago. Currently he's living with his mother who is always nagging him about being a failure as an actor. Burt recently signed a deal for a new sitcom. He tells you that he thinks he's going to stop therapy now because his life is on track. Your BEST intervention would be to: Select one: A.Full-heartedly support his decision to leave therapy. B.Suggest that he consider continuing therapy to work on any issues that come up. C.Explain that he may benefit from examining the issues that led to his divorce and his return to his mother. D.Support his decision to leave therapy and remind him that the door is always open for him to return.

C. Answer B: This answer is incorrect because it is not in Burt's best interest to continue therapy without definite treatment goals. Answer C: Burt does not appear to have addressed his divorce and his relationship with his mother and it is in his interest that you point this out before assuming that termination is appropriate. Answer D: This choice would be your next intervention if Burt decides not to explore the issues regarding his divorce and moving in with his mother.

Question ID #24201: You are treating Nina, age 40, whose 63-year-old mother is in a rest home. Nina spends much of her therapy time talking about her guilt in having put her mother in a home. After a visit with her mother, Nina calls to say that she found her mother tied to her bed. The nurses told Nina that she was only tied up for a few minutes and that it was a necessary punishment for being aggressive with the staff. How would you proceed? Select one: A.Suggest that Nina find alternative care for her mother. B.Report the physical abuse to the facility's licensing agency and the ombudsman. C.Report the physical abuse as mandated by law. D.Explain that nursing homes are allowed to reasonably restrain combative patients who represent a physical threat to health care personnel.

C. Answer B: This answer is incorrect because it leaves out the telephone report to law enforcement, which must occur within 24 hours because the abuse was physical and did not result in serious bodily harm. Answer C: Using physical restraints to punish an elder or dependent adult is a reportable form of abuse. Since the abuse occurred in a long-term care setting, and it is physical abuse without serious bodily harm, a telephone report must be made to law enforcement within 24 hours, and a written report must be made within 24 hours to law enforcement, the facility's licensing agency, and the ombudsman.

Edward, age 37, comes in to see you because the guys at work at his used car lot are upset that he smashes windshields and screams at them when he loses a sale. Edward says that he's dissatisfied with his job. Edward is a recovering alcoholic with one year of recovery. He's in the third year of his second marriage that he says is "breaking down just like the first one." He is afraid his wife will leave him. They have a 1-year-old daughter. What crisis issues and psychosocial stressors would you consider in this case? Select one: A.Marital problems, job dissatisfaction, possible divorce, raising a young child B.Child abuse, spousal abuse, substance abuse, explosive anger C.Child abuse, spousal abuse, marital problems, job dissatisfaction D.Potential Tarasoff due to explosive anger, substance abuse, raising a young child, possible divorce

C. Answer C addresses both crisis issues and psychosocial stressors that are relevant to case

Question ID #26875: Bonnie and Bill come to counseling with their three children, Betsy, age 12, Bridget, age 10, and Calvin, age 3. Bonnie reports that Calvin is still in his "terrible twos" and is tearing up the house while Bill is at work. Bill explains that Bonnie just doesn't understand that boys are different than girls and that Calvin is simply energetic. A paradoxical intervention to help this couple perceive Calvin the same way might be to have: Select one: A.Bonnie, Betsy and Bridget "try on" Bill's clothes. B.Calvin talk about his feelings. C.Bill take charge of Calvin's care since he is more in touch with the differences between boys and girls. D.Bonnie record every cooperative behavior Calvin makes.

C. Answer C: By acknowledging Bill's wisdom of the differences of the sexes, a Strategic therapist's paradoxical intervention would force Bill to spend significant time with his son, reducing some of Bonnie's tension and possibly allowing Bill to acknowledge some of Calvin's disruptive behaviors. Answer D: Having Bonnie record every cooperative behavior Calvin makes might be helpful in changing the family's dynamics, but this would not represent a paradoxical intervention.

According to ethical standards, all of the following are clinically sound reasons for a therapist to terminate therapeutic relationships EXCEPT: Select one: A.Non-compliance with treatment. B.Client is not benefitting from treatment. C.The therapist notices that his/her scope of competence is not adequate to meet the client's needs. D.The client is seeing another therapist concurrently.

C. Answer C: If a therapist notices that his/her training, experience or education are inadequate to meet a client's needs, the ethical obligation is to obtain consultation before terminating the client. Answer D: Concurrent therapy is not an ethical reason to terminate, UNLESS you confirm the treatment is for the same issue.

You've been seeing a couple for marital therapy. The husband arrives for their weekly session alone and reports that his wife is staying in the car. He says that she refuses to come to your office because you are always taking his side. He wants to go ahead with the session without her. This has only happened once before, and you thought that you had helped them both to understand your role. You decide to: Select one: A.Proceed with the session, seeing him alone. Refrain from telling the client what to do. B.Terminate the conjoint therapy. Give him a referral to another therapist. C.Make another appointment for both of them, since the couple is your client. Provide informed consent about your policies. D.Go down to the car and ask the wife to come in so that you can explore this issue. Do your best to make sure that both clients can continue to benefit from therapy.

C. Answer C: In conducting marital therapy, your client is the couple. By asking that both partners be present, you are demonstrating that you do not take sides. This might encourage the wife to attend the next session in order to explore her feelings of being treated unfairly. Providing informed consent throughout the therapeutic process is an ethical obligation, especially when something has changed, such as a client's desire to come to therapy. Answer D: Going down to the car weakens the therapeutic boundary. You would want to evaluate clients' ability to benefit from therapy.

You have been leading a therapy group whose organizing principle is anxiety problems. The group is supposed to last six months. If a client drops out, it would most typically be due to: Select one: A.Social inhibition. B.Lack of group cohesiveness. C.The goals of the group are not defined. D.Introduction of a new member.

C. Answer C: It is imperative when running a group that a therapist has clearly defined and stated goals so the members can have a sense of direction and purpose. The other answers listed may at times be reasons why people drop out of groups, but "C" is the best choice.

Narrative therapists believe: Select one: A.If something isn't broken, you shouldn't fix it. B.Behavior is a function of its consequences. C.It is not important what the truth is, just what people believe about it. D.The person isn't the problem. The dominant discourse is the problem.

C. Answer C: Narrative therapists say there isn't a knowable, objective truth about life and that what is important is what people believe about their own truth and lives. Answer D: The Narrative phrase is, "The person isn't the problem. The problem is the problem."

Question ID #24597: You have been working with a substance-abusing client in your private practice for the past three months. The client has not progressed in treatment and is still abusing substances. Your BEST treatment approach would be to: Select one: A.Discharge because of failure to progress. B.Implement an abstinence contract and refer to Alcoholics Anonymous. C.Refer to detoxification and inpatient treatment. D.Refer to a substance abuse specialist.

C. Answer C: Referring a substance-abusing client to detoxification and inpatient treatment would be an appropriate intervention because the client is not able to abstain in an outpatient setting. If the client has been in treatment for three months, this is a sufficient amount of time for the client to become abstinent. Answer D: Referring the client to a substance abuse specialist would be an early stage intervention. It is not something you would do after working with a client for three months. If the therapist is not sufficiently trained to work with substance-abusing clients, it is imperative that s/he be referred to a specialist, rather than work with the client.

You are an Experiential family therapist beginning treatment with Susan who complains of feelings of depression and anxiety related to the turmoil in her relationship. She tells you, "We don't talk anymore, we just fight." She adds, "I really want to salvage this relationship because I love him. I guess we need help with our communication." You would: Select one: A.Do a family life chronology for both Susan and her boyfriend to look at dysfunctional rules and roles. B.Activate a dialogue between her and her boyfriend to work on improving communication, since this is why she's coming in to see you. C.Assess her depression and anxiety and then engage her in a sculpting exercise. D.Increase the couple's awareness of their dysfunctional communication stances and improve their communication skills.

C. Answer C: Susan talks about feelings of anxiety and depression, so it would be incumbent upon a therapist to address these issues. Engaging her in a sculpting exercise might be something an Experiential therapist would also do, but regardless of the theoretical orientation, crisis issues need to be addressed first. Additionally, this is the only answer that takes into consideration that the boyfriend is not present. Answer D: Although these are Experiential techniques, the boyfriend is not in treatment and it would be important to attend to her level of depression and anxiety.

According to CAMFT's Ethical Standards, under what circumstances may a therapist disclose client confidences? When: Select one: A.The therapist deems this necessary. B.It's in the best interest of the client. C.Permitted by the law. D.The therapist is a defendant in a civil action.

C. Answer C: When permitted by the law, such as to initiate a 5150 or under the Evidence Code 1024, a therapist can break confidentiality to protect the client. Answer D: The civil action must arise from the therapy.

Question ID #26864: Lisa, age 16, calls you and states she is in trouble and must see you right away. You happen to have an available hour and schedule an appointment with her that afternoon. Lisa looks as though she has not slept, showered, or changed her clothes in a few days. Lisa tells you that her father has been molesting her for several years. She ran away a week ago and has no place to go, and is fearful that her father will beat her if she goes home. She reports that she feels sick and weak all of the time and can't keep much food down. She indicates that if she can drink a little rum in the morning, it helps her nausea. Your first intervention, in this case, would be to: Select one: A.Help Lisa find food, clothing, and shelter. B.Assess Lisa for drug or alcohol abuse. C.Report Lisa's situation to the sheriff. D.Refer her to a doctor for a pregnancy test.

C. Food, clothing, and shelter would come second to the child abuse report.

Question ID #25501: A therapist is treating a 42-year-old client who reports that the time has finally come for "me to come to terms with who I am." She tells the therapist that she has spent all of her adult life trying to be what other people wanted. She says that now is really the first time she has even felt like getting to know herself is something she would want to do. If the therapist decides to use the strategy of externalizing the problem, which of the following statements would be most typical of this intervention? Select one: A.Tell me what you mean by "the time has finally come". B.Up until now, who has defined who you are? C.How do other people's expectations shape your life? D.Can you make a timeline of the last year that brought you to find yourself now?

C. This question tests your knowledge of the Narrative therapy intervention of externalization. Answer A: Although asking for a client's understanding of the words they use is typical of the Narrative approach, this would be more typical of "deconstruction". The process of externalization is best represented in answer choice C. Answer B: Narrative therapists focus on the future - this question orients the client to the past. It would be more typical of "deconstruction" in the Narrative approach. Answer C: Asking about the "problem" as separate from the client is an example of externalizing. Answer D: This question is an example of a mapping question used by Narrative therapists. The question asked about externalizing.

Question ID #25016: A friend refers her neighbor to you for therapy. You should: Select one: A.See the neighbor and say nothing to your friend.Incorrect B.See the neighbor and thank your friend at her house warming party. C.Give her neighbor three referrals because seeing him or her would create a dual relationship. D.Consider your relationship with your friend.

D

Jenny 40 yo calls you for an appointment and tells you that she is depressed. She comes in with her husband Lionel, a 31-year-old African American male. Lionel works in a factory and is reluctant to be in therapy. Their children are ages 2, 3 and 4. Jenny says that and she suspects Lionel is having affairs with other women at work. Lionel, says that he loves Jenny and that He is not interested in other women. If Lionel called you and told you that he is having an affair and he is regretful, how would you clinically manage the issue of confidentiality? A.Do not breach Lionel's confidentiality about the affair. Terminate therapy if Lionel does not disclose his affair soon. C.Reiterate your no-secrets policy to Lionel. Terminate therapy if Lionel does not disclose his affair soon.Incorrect D.Reiterate your no-secrets policy to Lionel and Jenny. Tell Jenny about Lionel's secret if it is clinically appropriate.

D . Answer C: You would reiterate your "No secrets" policy but not only to Lionel. Ethically, you cannot terminate a client as an ultimatum. Answer D: It would be important to remind both clients about your no-secrets policy. Telling Jenny is a possible choice after the therapist has made serious consideration and decides if it can be done for the best interests for the couple.

Harry and Janet come in because their son, Jason, age 15, is acting out. His mother says that his grades are dropping, he listens to heavy metal music, and he stays out past his curfew. She says he is defiant of household rules and is hostile and sullen most of the time. She tells you that his hair used to be a lovely blond, and now it's purple. "He used to be such a sweet boy," she says, "and now my baby won't talk to me any more." As a Structural family therapist, you would treat: Select one: A.The parents to strengthen their executive subsystem. First order symptoms in the early stage of therapy. B.The entire family to map out the influences from previous generations. First order symptoms in the early stage of therapy. D.The entire family to evaluate the family's sequence of behaviors. Second order dynamics in the middle stage of therapy.

D Answer A: As a Structural family therapist, your preferred initial unit of treatment would be the entire family, not just the parents, in order to evaluate the family's interactional patterns. In the early stages of therapy, first order symptoms would be the focus. Answer D: As a Structural family therapist, your preferred initial unit of treatment would be the entire family in order to join and accommodate with the family and evaluate their patterns. In the middle stages of therapy, second order dynamics would be the focus.

Isaac and Fanny want their son Adam to have his Bar Mitzvah ceremony at the Orthodox synagogue that they belong to. Adam will only agree to study for his Bar Mitzvah at the local youth-oriented Hillel Temple that is less traditional. He tells you that most of his friends will only come to the party if it is not too religious. As a therapist, the most helpful initial step would be to: B.Ask permission to speak with both rabbis for their input. Coordinate treatment planning to be consistent with the family's beliefs. C.Ask the family members individually to share with you their thoughts about religion. Coordinate treatment planning to be consistent with the family's beliefs. D.Ask each family member to explain to you from their point-of-view the meaning this religious ceremony has to them and their family. Suggest a compromise and see how they respond.

D Answer B: Asking to speak with the rabbis is not working with the family, and the therapist is not the appropriate person to evaluate religious differences. Treatment planning may or may not need to be consistent with a client's religious beliefs. They may have come to therapy with larger or different goals than are specific to planning this event. Answer C: While asking family members their personal thoughts in individual sessions has some elements that are useful, it is not as encompassing as answer "4" which has each individual expand their perspective to discuss religion and its meaning to their family. Treatment planning may or may not need to be consistent with a client's religious beliefs. They may have come to therapy with larger or different goals than are specific to planning this event. Answer D: The most inclusive and culturally considerate answer would be to have each family member represent their own views on religion and discuss the impact of religion on the family as a whole. Suggesting a compromise could come with exploring the family's point of view.

From a family systems perspective, it is important to be aware of the cycles of behavior that characterize families where child abuse occurs. All of the following are patterns of child abuse EXCEPT: Select one: A.The mother often sets the father up as the disciplinarian. The father feels he must fulfill this expected role and the child may unconsciously seek attention from the father by misbehaving. B.The father beats the child, and then the child turns to the mother for consolation. When the mother confronts the father she is beaten. C.A child may assume the role of the family scapegoat in order to maintain some sense of stability. D.Since the child is being ignored at home, he seeks acceptance from other appropriate sources: peers, religion, teachers and coaches.

D Answer D: Children who live in an abusive household usually seek acceptance from inappropriate sources: such as troubled peers and gangs.

Question ID #25113: A male client comes to see you for the first time. As he talks, you begin to realize that he is definitely going to harm someone. He has a plan and is going to act, but he has not identified his intended victim to you yet. Just as he is about to tell you the identity of the name of the intended victim, you realize that you have not explained to him the limits of confidentiality. You would: Select one: A.Tell him to stop and refer him to someone else. B.Wait until he identifies the intended victim and then explain the limits of confidentiality, as you must do as part of obtaining informed consent. C.Ask him to stop and explain to him the limits of confidentiality, as part of informed consent.Incorrect D.Proceed with the session, and carry out your duty to protect, per Tarasoff, if he identifies the potential victim.

D Answer D: This is what you would have to do. At this point, the well-being of the potential victim outweighs the ethical concerns about informed consent.

Question ID #24027: Kim and Ron recently married, the second marriage for both. Living with them is Kim's 7-year-old daughter and Ron's 12-year-old daughter. Ron's daughter, Cindy, has run away three times since Ron and Kim have been together. Ron wants you to see Cindy individually because he's afraid she's going to "screw up her life just like her mother." You had been seeing them as a family, but agree to see Cindy for two sessions before resuming family therapy. In assessing Cindy, the LEAST helpful question would be: Select one: A.How do you feel about your dad remarrying? B.What do you do to feel better when you're down? C.Have you ever hurt yourself or tried to kill yourself?Incorrect D.Why do you run away? Feedback

D In assessing Cindy, you are concerned with her safety as well as providing empathy for and acceptance of her feelings about this stressful time. All of the above questions except "D" address these issues. Asking "why" questions, especially of an adolescent, invites defensiveness, which is not conducive to developing a therapeutic relationship.

Walker comes into your office expressing suicidal ideation. After some assessment, you determine that Walker does not need immediate hospitalization; rather, he needs a less intrusive form of intervention. Which of the following demonstrates a clinically sound intervention when working with Walker, a moderately high-risk client? Select one: A.Instructing Walker to contact you, regardless of the time, if his suicidal thoughts worsen. B.Contacting Walker's roommate, who agrees to a 24-hour watch, making sure the client does not have access to any lethal means. C.Obtaining a written agreement with Walker to contact you, the local ER, 911, a family member, friend, and/or a suicide hotline if his suicidal thoughts worsen. D.Setting up an agreement, which includes a plan for self-care and several support system contacts if Walker cannot contact you and his suicidal thoughts worsen.

D Setting up a "self-care plan" would include a support network allowing the client to have multiple opportunities to maintain his/her own safety. D is the most comprehensive of the answer choices offered.

Question ID #25642: Your client Sherri is a 15-year-old dancer. She has had anorexia for approximately 7 months and weighs 87 pounds. During your appointments with her, she generally complains about her weight and how "fat" she thinks she is in her leotard. She keeps trying to talk her parents into liposuction and doesn't understand why they can't see that it is "for my career." What would be the best set of interventions for Sherri? Select one: A.Regular medical monitoring. Family sessions. A journal of accomplishments. B.Regular individual sessions. Identifying dysfunctional beliefs regarding normal amounts of food. Paradoxically agreeing with her feelings of being "too fat." C.Regular individual sessions. A journal of accomplishments. A contract to gain weight. D.Regular medical monitoring. Identifying fears of failure. Family sessions.

D. Answer A. Making a journal of accomplishments would not be as helpful. Anorexics tend to be perfectionistic and this task would only reinforce that tendency. Sherri could benefit from learning how to be imperfect. Answer D: Having Sherri participate in regular medical monitoring would be helpful. Medical monitoring in addition to psychotherapy is a MUST for anorexics because of the array of health risks involved with Anorexia Nervosa. Helping Sherri to identify her fears of failure may help change her obsessions with perfection. Family sessions have been shown to be particularly effective with anorexics because the root of the problem often starts in the family relationships.

A client who has been diagnosed with Illness Anxiety Disorder is seeing a Cognitive-Behavioral therapist. She was referred after her most recent medical doctor suggested that her health is fine and her worries are more suited to psychotherapy. She tells you that she is so glad that she has good insurance, because it allowed her to take the referral even though you are out of her network. In working with anxiety, how would a Cognitive-Behavioral therapist conceptualize a goal of her treatment? Select one: A.First, confirm that in fact no medical condition is present. B.She can identify the distortion of catastrophizing in her Automatic Thought Record. C.Use the downward arrow to move from body sensations to assumptions about illness. D.She can use "thought stopping" when she experiences uncomfortable physical sensations.

D. Answer A: A therapist does not have the expertise to confirm or disconfirm the presence of a medical condition. Answer B: Although Cognitive-Behavioral therapists provide psychoeducation about cognitive distortions such as catastrophizing, the goal of treatment would be more about helping her manage (i.e., identify, moderate and create alternatives to) this distortion rather than merely naming it. Answer C: Although Cognitive-Behavioral therapists do use the downward arrow technique move from automatic thoughts to assumptions, doing so represents an intervention, and the question asked for a goal. Answer D: The client's ability to interrupt anxious thought processes would be a Cognitive-Behavioral goal.

A therapist is working with an elderly couple that has come to therapy because they have trouble communicating with one another. The therapist tells them not to speak to one another during the session, but to address their responses and questions to him. This instruction reflects which theoretical orientation? Select one: A.Strategic B.Structural C.Humanistic-Experiential D.Multigenerational

D. Answer A: Although on the surface, this might seem to be a paradoxical intervention, a couple having trouble communicating doesn't necessarily mean they don't speak to one another. It could mean that they speak to each other all the time, but only abusively. Answer B: Structural therapists like to have family members engage with one another to gather information about interactional patterns. Answer C: Humanistic-Experiential therapists do not use this approach. Answer D: Multigenerational therapists attempt to reduce anxiety and emotional reactivity by having members of the treatment unit address the therapist, not one another.

Geraldo, is married to Mia. They sought counseling because of protracted arguments that last up to 4 hours. Their arguments are hurtful and accusatory. Geraldo feels that his wife blames him for their problems. Mia just want a marriage like her parents'. What interventions would a Bowenian therapist use to improve this couple's communication skills? A.Teach and model communication skills. Reduce Mia and Geraldo's emotional reactivity. Improve their ability to communicate and listen to each other. B.Suggest that Mia and Geraldo speak directly to the therapist. Identify communication stances and model congruent communication. Use a genogram to gather information about relationship dynamics. D.Suggest that Mia and Geraldo speak directly to the therapist. Educate about couple dynamics to help engage their cognitive system. Teach communication skills and discourage blaming.

D. Answer A: Bowenian therapists teach communication skills and model such techniques as speaking in the first-person singular ("I statements"). The question asks for interventions, and this response describes a goal. Answer B: This answer choice describes a classic Bowenian technique utilized to reduce the emotional reactivity in a couple. This answer choice is reflective of a Satirian approach. This intervention does not directly achieve the desired goal of improving communication skills. Answer D: This answer choice describes a classic Bowenian technique utilized to reduce the emotional reactivity in a couple. A Bowenian therapist educates about relationship dynamics, which might reduce emotional reactivity by engaging their thinking processes. A Bowenian therapist teaches skills and encourages each spouse to take responsibility for how they contribute to the problem. This answer represents the theory asked for and describes interventions that speak to the goal at hand.

Question ID #25644: You are running a play therapy group that has 5 children in it. This group is non-directive and different children are playing with different toys. One boy is playing with the doctor's kit. You notice that he is purposely breaking the toys. How do you handle this situation? Select one: A.You let him break the toys because play therapy is non-directive and he is expressing his anger. B.You reflect his actions by commenting, "Wow, you seem to enjoy breaking those toys." C.You point out that other children are not breaking toys, as a model for appropriate behavior. D.You remind him of the rule which states that kids cannot break the toys.

D. Answer A: Breaking toys is not within the limits of non-directive play therapy. Just because play therapy is non-directive does not mean a child can be destructive. Answer B: Reflecting his actions by commenting "Wow, you seem to enjoy breaking those toys," is not enough. Boundaries need to be set for this child. Answer C: Pointing out that other children are not breaking toys, as a model for appropriate behavior could be detrimental to the child. He might then see the other children as "good" and himself as "bad." Answer D: It would be very appropriate to remind this child that it is not okay to break toys. Boundaries are necessary to help ensure safety and cohesion for the group.

Question ID #26863: Guy just returned from his tour of duty. He is out of the military and is having a hard time adjusting to family life after witnessing death and destruction. You determine that he is experiencing Post-traumatic Stress Disorder. Your treatment planning would include which of the following: Select one: A.Family therapy to help his family understand and adjust to what he is going through. Referral to a medical doctor for a medication evaluation. B.Cognitive restructuring and stress management training. Assessing for flashbacks or avoidance symptoms typical of PTSD. C.Insight-oriented psychotherapy. Referral to a medical doctor for a medication evaluation. D.Relaxation training and the provision of an environment where he can safely express his feelings. Journaling until he is able to talk about the trauma in session.

D. Answer A: Family therapy would be helpful, but the question asks about treatment of PTSD for Guy. A referral to a medical doctor for Guy would be appropriate. Answer B: Cognitive restructuring and stress management training would be helpful interventions. You don't need to assess for symptoms of PTSD because the vignette already said you have determined that the client is experiencing PTSD. Answer C: Insight-oriented psychotherapy is not the treatment of choice when working with PTSD clients. A referral to a medical doctor would be part of a PTSD treatment plan. Answer D: Behavioral interventions and stress reduction techniques are an important aspect of working with PTSD. In addition, providing a person experiencing PTSD a place to feel safe and begin talking about the trauma is imperative. Journaling can be used as an alternative to talking if the client is not ready.

Question ID #25384: In assessing a 15-year-old whose family has demanded he get help for "being rude to his parents and teachers", the therapist should: Select one: A.Prepare a series of questions to ask the boy since he might not fill out the intake form. Ask open-ended questions so that he can take the lead in a first session. B.Plan an interesting game or have art supplies ready to use since he might not want to talk to another adult. Interpret his behavior as age appropriate before treatment planning. C.Do a mini mental status exam. Ask the boy about his hobbies and friends to get an idea of his level of social maturity and functioning. D.Know the boy might be very resistant. Either ask him to bring in some of his favorite music for the first session or let him just "hang out" if he wants.

D. Answer A: He might not answer the questions; then what? Letting an adolescent client take the lead can help to empower or establish a tone of equality. Answer B: Playing a game could be helpful depending on the boy and whether or not he liked the game or wanted to do art; however if he was quite resistant, he'd refuse these things, too. Interpreting his behavior as age-appropriate rather than stigmatizing or pathologizing might be a good intervention in an assessment stage. Answer C: There are no indications yet that he is mentally unstable, disoriented, etc. Asking him about his hobbies may be an impossible task until some minimum level of rapport has been established. Why should he talk to you? Answer D: Teenagers with resistance must be addressed on their level and not "set-up" for yet another power struggle. "Allowing" this teen to "do whatever he wants" in therapy, at least initially, will begin the process of bonding and trust necessary to have an opening for therapy.

Question ID #24470: Craig, a 4-year-old, appears uncomfortable in play therapy. You would: Select one: A.Invite his parents into the room until he feels more at ease. B.Stand until he finds a task. C.Direct his play to help him feel more comfortable. D.Say nothing and allow Craig to explore.

D. Answer A: Inviting his parents into the session would be a possibility if the discomfort continues. However, he is simply "uncomfortable" and there is no evidence of fear or distress. Attempting to build rapport without his parents in the room would be an important therapeutic step. Answer D: Saying nothing and allowing Craig to explore is the best of the answers provided. It allows him the necessary space to direct play therapy at the rate he is most comfortable.

Question ID #26816: Your new client arrives for session, and you notice that one of her arms only extends to her elbow. She does not attempt to conceal it, and she does not mention it as part of her therapy. In your intake interview, she does not mention any physical problems or accidents. How would you handle this in the first session? Select one: A.Mentally note the missing appendage and wait for the client to bring up the issue. B.Not acknowledge the missing appendage and proceed to assess the client, treating her like everyone else. C.Refer the client to a therapist who has treated other clients with physical abnormalities. D.Address the missing appendage and explore the therapeutic impact.

D. Answer A: Mentally noting the difference and not bringing it up could do the client a disservice. In the United States, people are taught "not to stare" and "to act normal," muting any discussion about handicaps and deformities. The therapeutic environment needs to be a safe place for clients to explore these issues, and a therapist needs to open the discussion to make it safe. Answer D: It would be important to address the missing appendage and create a safe environment for this client to explore any issues related to it. If the client is uncomfortable initiating the subject, the therapist opening it up for discussion may give the client permission to talk about concerns that might not have been explored otherwise.

Question ID #26894: You are a psychodynamic therapist and have been working with Carl for many years. Originally, Carl sought therapy because he was having difficulty in his marriage. Today when he comes to session, he reports feeling a lot better lately. You have also noticed some changes. You would agree it is time to terminate when: Select one: A.Carl no longer has problems in his marriage. B.All of the unconscious material Carl has in his childhood has become conscious. C.You no longer feel uncomfortable with Carl's social awkwardness. D.Carl no longer responds to you as he would to his mother.

D. Answer A: Resolving the presenting problem, in this case, marital problems, is not very important in psychodynamic therapy. To a psychodynamic therapist, this is "only the tip of the iceberg" and would not result in termination. Answer B: It is impossible to work through all of Carl's unconscious material. Answer D: Psychodynamic therapists believe when the transference is worked through, it is time to terminate. If Carl was to stop responding to you as he would to his mother, this signifies that the transference was resolved.

Erika and Michael come in with their adopted son, Peter. He has been arguing with the teacher and fighting with other children at school and refusing to do his chores at home. Erika is very involved in her new career and wants to end the marriage. Michael does not believe in divorce as he feels strongly that children need two parents. How would you clinically manage the psychosocial stressor of marital separation? A.Teach communication skills. Refer to an attorney; educate about the impact of marital conflict on Peter.Incorrect B.Refer to an attorney; offer couples therapy to help facilitate co-parenting and to work out marital problems. Normalize feelings of anger, sadness and fear. C.Refer to an attorney. Create a plan for co-parenting; normalize feelings of anger, sadness and fear. D.Educate about the impact of marital conflict on Peter. Normalize feelings of anger, sadness, and fear; identify strengths.

D. Answer A: Teaching communication skills is a useful intervention to help a couple communicate and co-parent while separated. A referral to an attorney may be indicated, but might be premature. Educating the parents would be a good intervention because parents who are separating are often not aware of the damaging impact on their children. Answer D: Educating the parents would be a good intervention because parents who are separating are often not aware of the damaging impact on their children. It is important to normalize feelings when helping a family adjust to the stressor of marital separation. It is important to identify clients' strengths, but case specificity is needed.

A woman comes to your office with lacerations on her face and head that are still bleeding. She tells you that she feels okay but will not tell you what happened. "It's too embarrassing and really, I am fine." She opens her purse to find a tissue and wipes her face. She also checks herself in her pocket mirror and laughs, "This is not that bad. I have lived through a lot worse." What's the FIRST thing you would do? Select one: A.Give her the number to shelters and all other numbers that would be important to her. Take a history of violence that she has experienced. B.Assess for abuse. Take a mental status exam to make sure that she is coherent throughout the session. C.Ask her again to relate the circumstances in which she was injured. Take a history of violence that she has experienced. D.Refer her to a physician. Re-schedule her session for another time

D. Answer A: There is no indication in the vignette that her lacerations were the result of domestic violence. You would not take a history without first referring her to a doctor. Answer D: A physician can assess and treat the woman's injuries. You would not carry on with therapy with someone who is bleeding in your office.

A couple brings to counseling their 10-year-old twin boys, Fred and George. Fred is very aggressive; George is quiet and obedient. The parents talk about what a great kid George is and how they wish Fred was more like his brother. They tell you that Fred is having a difficult time making friends and the school counselor told them it might be a good idea to put them in different schools. A Humanistic Experiential family therapist would: Select one: A.See the boys without the parents to help them build self-esteem without the parents splitting them. B.Prescribe the symptom and suggest that Fred and George schedule their fights. C.Understand that the family pain comes from the stress of raising two same-age boys. D.Talk to Fred about how painful it must be to hear a parent talk badly about him.

D. Answer A: This response is not an Experiential intervention. Answer B: Paradoxical interventions are not reflective of Humanistic Experiential therapy; they are reflective of Strategic therapy. Answer C: This option does not explain family pain correctly. According to Experiential theory, "family pain" doesn't come from stress; it comes from old messages about ourselves and how we come to view ourselves based on family rules and ways of interacting that keep us from healthier ways of being. Answer D: Experiential therapy focuses on communication among family members, and commenting on how the parents talk about their sons in front of them is one way of introducing communication styles.

Question ID #25489: A teenager has been ordered by the court to see you. He's been involved with a gang and was caught stealing and fighting. He is a junior in high school and at risk of being expelled for his behavior. He tells you that he doesn't care and that a lot of his friends are doing fine without a high school diploma. He has one older brother who is going to community college and adds, "He did time and they let him in there." What would you do? Select one: A.Use an insight approach to try to understand gang beliefs. Assess any countertransference which may impact your interventions. B.Confront him regarding gang values. Assess any countertransference which may impact your interventions. C.Consult for more information on gangs. Create a safe place where he can talk about his perspective.Incorrect D.Assess his reality-based ideas about gangs. Create a safe place where he can talk about his perspective

D. Answer A: Your focus would not be on YOUR getting understanding first; your first focus would be on setting up the alliance with him. The vignette did not mention that you had any countertransference, but it is always a wise thing to evaluate. Answer B: Confrontation would not be advisable in dealing with someone who is potentially violent. This also imposes the therapist's views on the client rather than "meeting the client where they are". The vignette did not mention that you had any countertransference, but it is always a wise thing to evaluate. Answer C: Gaining information from the client himself would be more advantageous than gathering generalized information. A therapist's role is always to make the room safe for a client to say whatever s/he needs to say. Answer D: Assessing your client's ideas about gangs would better able you to understand your client's thought processes, as well as help you to gather more information that is specific to client. A therapist's role is always to make the room safe for a client to say whatever s/he needs to say.

Frank, age 28, has recently been expressing stronger feelings of rage towards his ex-wife, including wanting to kill her for betraying him and remarrying. He has been divorced for six months and just found out she got remarried. They have two children, and she has full custody. He tells you that she was "The love of my life, and I need to get her back." If you were to assess Frank's likelihood of hurting his ex-wife, what factors would be MOST important? A.Frank's long-standing depression, his age and his gender. Teaching him the Cycle of Violence. B.Frank's insistence on drinking a beer every night after work. His words and gestures in session that convey aggression. C.Frank's unexpressed feelings of failure related to the end of his marriage and his ex-wife's subsequent remarriage. Teaching him the Cycle of Violence. D.Frank's feelings of jealousy towards his wife's new husband. Inability to maintain a friendship.

D. Answer B: Alcohol can be an indicator of violence, but it is not automatically true. Also one beer a night is not considered an excessive amount of alcohol. His behavior in session, if aggressive, could help you assess for his risk of violence. Answer D: Jealousy and impulsivity are factors that contribute to domestic violence. Poor social skills is a factor that contributes to domestic violence.

Thomas and Loretta have been coming to see you for Object Relations couples counseling for four months. Neither of then had ever been in therapy before, although each of their children had been in counseling at school. Thomas says that he doesn't think that therapy is working, he hates talking about his childhood, and "Loretta is never going to change." Loretta says that "Thomas is always putting me down, and he can't be happy with anything in our relationship." As an Object Relations therapist your focus of therapy would be upon: Select one: A.Directing them to speak directly to the therapist in order to explore transference. B.Providing a safe holding environment in which the therapist can teach about defense mechanisms. C.Interrupting the family projection process to find a more adaptive homeostasis. D.Assessing whether their early life experiences are causing them to misperceive each other.

D. Answer B: An Object Relations therapist would want to provide a safe holding environment, but the therapy would be more focused upon their gaining insight into their relationship, and not as much the relationship with the therapist. Further, an Object Relations therapist would not so much teach about defense mechanisms as work away at them indirectly. Answer C: The "family projection process" is a Bowenian term and finding a more adaptive homeostasis is more a systems focus than Object Relations. Answer D: An Object Relations therapist would evaluate early life introjects and observe how they impact the current relationship, i.e., how partner experience each other.

therapist is assessing a family of four in an initial session. Dad and the 14-year-old daughter sit next to one another on the couch. Mom sits nearby in a chair and says little during the session. The 9-year-old son fidgets, jokes, and tries to bring attention to himself whenever there are moments of silence. When the therapist asks about sources of stress in the family, Dad says it irritates him that Mom dresses like a slob and says that she could use one of those "TV show makeovers." Mom's eyes get teary and she stares at the floor. How should the therapist proceed? Select one: A.Assess the family dynamics and explore the boundaries regarding subsystems. B.Clarify the relationship the therapist will have with the family and to each member of the family. C.Provide Mom with education about the cycle of violence and information about shelters and how to put together an escape kit. D.Assess for incest.

D. Answer B: As a general ethical rule, clarifying the relationship the therapist will have with the family is an important aspect of informed consent when working with a couple or a family. However, in this question, you are being pointed to an incestuous family dynamic that requires assessment. Answer D: This question is pointing the exam-taker to incest and sexual abuse of the daughter by the father. The indicators here are Dad and daughter's physical proximity, Dad and Mom's physical distance, Mom's withdrawn or depressed behavior, Dad's belittling of Mom's worth as a woman, and his suggestion of not being physically attracted to her.

You are conducting a research study on divorce. The research study will include 10 individual interviews with each adolescent, ranging from 13 to 18. You have been working with a lawyer to make sure that their stories are confidential. For legal reasons, you have obtained written consent from their parents and invite the whole family for an introductory meeting. In the informed consent process, what information do you need to provide your clients? B.That dual relationships may be inevitable due to the nature of the study. The participants must sign a release authorization before the study is published. C.That any information obtained may be used in the study. The client has the right to withdraw from the study at any time. D.The client has the right to withdraw from the study at any time. The limits to their confidentiality if they participate.

D. Answer B: Dual relationships must be avoided at all costs and considerations must be made to prevent such relationships. Participants would need to sign a release authorization but this is not part of informed consent. Answer C: Information obtained during the study will be divulged only if there is written consent to authorize such disclosures. Informed consent would indicate that the client has the right to withdraw from the study at any time. Answer D: Informed consent would indicate that the client has the right to withdraw from the study at any time. Participants must be advised of the potential limits of confidentiality.

Question ID #26766: Alicia and Brian Cook have been married for ten years and have three children, Rich, Aaron, and Cindy. In family therapy with the Cook family, you notice that each time they come to a session, the boys and Brian sit on one side of the room, and Cindy and Alicia sit on the other side. What interventions would you use as a Structural family therapist to strengthen the executive subsystem in this family? Select one: A.Have the boys and Cindy switch sides of the room. Observe the sibling subsystem. B.Have the children do an art project together as an enactment. Join the parental subsystem. C.Have Cindy sit beside her father. Map the new boundaries. D.Have Alicia and Brian talk about their relationship. Roleplay with them switching parental roles.

D. Answer B: Having the children do an art project together would be a "re-enactment," not an "enactment." Enactments in Structural therapy are just organic assessments, not directed assignments. It does not address what the parents would be doing. The therapist would not "join" only the parental subsystem; a Structural therapist would join the entire family unit of treatment. (Align w/ -- unbalancing) Answer D: Having Alicia and Brian talk about their relationship specifically addresses a strategy towards highlighting and strengthening the executive subsystem. Having Alicia and Brian role play specifically addresses a strategy towards highlighting and strengthening the executive subsystem.

ccording to DSM-5, all the following are true about Oppositional Defiant Disorder EXCEPT: Select one: A.Attention Deficit/Hyperactivity Disorder is common in children with Oppositional Defiant Disorder. B.Mild symptoms occur in one setting. C.Oppositional Defiant Disorder usually becomes evident before 5 years of age and usually not later than early adolescence. D.It is a precursor to Conduct Disorder.

D. Answer B: In DSM-5, the "mild" specifier is used if symptoms occur in only one setting for at least six months. Answer C: DSM-5 states that the onset for ODD is usually before age 5. Answer D: Oppositional Defiant Disorder is not necessarily a precursor to Conduct Disorder. DSM-5 states that the earlier a person is diagnosed with ODD, the more likely that person is to be diagnosed with CD later. However, people who are diagnosed with ODD may never get a CD diagnosis.

Karen comes to therapy referred by her physician. Two months ago she was involved in a car accident and experienced severe physical injuries. Karen says that her partner, Amy is unhappy with the relationship because Karen is withdrawn and has been sleeping on the couch. Karen is in a lesbian relationship. Identify ways you would incorporate this factor into the treatment plan. A.Explore the roles and rules within Karen's relationship. Ask Karen if she would prefer a "gay friendly" therapist. B.Invite Karen to share information about her sexual orientation. Maintain confidentiality about Karen's sexual orientation. C.Invite Karen to share information about her sexual orientation. Ask Karen if she would prefer a "gay friendly" therapist. D.Encourage Karen to share her experience as being part of the lesbian community. Ask direct questions about Karen's sexual orientation as needed.

D. Answer B: In order to be sensitive to Karen's sexual orientation and incorporate it into the treatment plan, it is important to hear her views and feelings about it. Maintaining confidentiality is a legal issue, not a treatment planning issue. Answer D: Encouraging Karen to share her experience would be a non-biased way to ask about her individual diversity. It is important to incorporate diversity issues in treatment.

Kathy, age 20, comes to see you self-referred. She and her son have been living with her parents since she separated from her husband 2 months ago. Since moving back with her parents, she has been having trouble sleeping at night. Sh says that it is culturally inappropriate to seek help, but that she is desperate. If using the empty chair technique was not effective in helping Kathy express her feelings about her husband, how would you proceed? B.Consider the possibility that this intervention may be culturally inappropriate. Have Kathy recount when and how she and her husband met. Have Kathy journal her feelings about her husband. Have Kathy speak to you as if you are her husband. D.Consider the possibility that this intervention may be culturally inappropriate. Have Kathy journal her feelings about her husband. Have Kathy recount when and how she and her husband met. Ask Kathy to bring in pictures of her husband.

D. Answer B: It would be important to consider how Kathy's cultural background may affect her reaction to different interventions. Kathy states that coming to therapy is culturally inappropriate. Considering and exploring this issue with Kathy, in a non-blaming manner, would be useful. Having Cathy tell stories about her husband and their relationship may be a good way to help Cathy begin expressing her feelings about the relationship. Journaling may help Cathy get in touch with her feelings about her husband in a safe, non-threatening manner and, eventually, she may want to bring in and share her writings with you. This intervention is too similar to the empty chair technique. The question asks you to try something different. Answer D: It would be important to consider how Kathy's cultural background may affect her reaction to different interventions. Kathy states that coming to therapy is culturally inappropriate. Considering and exploring this issue with Kathy, in a non-blaming manner, would be useful. Journaling may help Kathy get in touch with her feelings about her husband in a safe, non-threatening manner and, eventually, she may want to bring in and share her writings with you. Having Kathy tell stories about her husband and their relationship may be a good way to help Kathy begin expressing her feelings about the relationship. Pictures often trigger memories of events and the stories that go along with them. Having Kathy bring in pictures may help her get in touch with her feelings as she shares them with you.

Jose and Carolyn are in their mid 30s and have three school-aged children. Jose is a policeman and Carolyn is a housewife. They come to you for marital counseling because Carolyn is dissatisfied with her life and she wants to get a job. Jose is concerned that Carolyn won't be there for him and the children if she gets a job. He tells you that he is upset that what he provides for the family is "not good enough" for Carolyn. As a Cognitive-Behavioral therapist you would: B.Make observations about each partner to assist them in seeing aspects of self more clearly to increase insight. Teach them to use an Automatic Thought Record to track their feelings. Focus on improving their perspective toward more positive thinking. D.Guide them towards finding a rationale for change that comes from their own understanding. Restructure Jose's assumptions. Challenge Carolyn's expectations.

D. Answer B: Making observations about each partner, to assist them in seeing aspects of self more clearly to increase insight, would be used by an Object Relations therapist. The Automatic thought record would be used to track thoughts, not just feelings. Cognitive-Behavioral therapists don't focus on positive thinking as much as balanced thinking. Answer D: Guiding them towards finding a rationale for change that comes from their own understanding represents guided discovery, which would be used by a Cognitive-Behavioral therapist. Cognitive-Behavioral therapists work on restructuring assumptions and expectations. Cognitive-Behavioral therapists work on restructuring assumptions and expectations.

You are working with a newly blended family when the stepfather, James, tells you that in order to get his step-kids to do their homework, he locks them in their rooms for 24 hours without any food, water, or bathroom privileges. James is currently in a battle with his ex-wife for the custody of their children. Following the child abuse report, James' attorney calls you requesting a copy of the report. You would: Select one: A.Explain James' right to privilege to the attorney. B.Have the whole family sign a release. C.Wait for the judge to contact you. D.Verify that he is James' attorney, and release the report.

D. Answer B: No one needs to sign a release regarding a child abuse report in a court proceeding because it is an exception to privilege. Answer D: Upon verifying the attorney's identity, you would release the report because no privilege exists regarding information disclosed in a child abuse report.

Question ID #26792: Emily, 26, and Julian, 28, come to you for marriage therapy. They have been married for 3 years, and Julian would like to begin having children. Emily does not feel ready to have children at this time. They continually argue about this. As a Solution-Focused therapist, how might you begin each session? Select one: A."What conflicts have come up during the week?" B."Have you noticed any unique outcomes this week?" C.Have them review their automatic thought records with you. D."What did you notice was better this week?"

D. Answer B: The term "unique outcomes" belongs to the Narrative school of therapy. Answer D: A Solution-Focused therapist will tend to begin sessions with a question about what was better this week or what worked this week.

Question ID #26844: A couple in their 40s is seeking therapy to save their marriage. Recently, the husband has lost interest in sex and has been unable to maintain an erection. His wife complains that he has been irritable and angry for months. She is convinced that he no longer finds her attractive and that he is having an affair. She is tearful and anxious. They both report that they have been fighting a lot. Recently, the husband had a medical check-up and was reported to be in good health except for his long-standing hypertension. As a precautionary measure, his doctor increased his drug dosage. Regarding the husband's erectile dysfunction, you would: Select one: A.Teach the couple active listening and "I" messages. B.Assign them behavioral tasks such as sensate focus. C.Refer them back to the husband's doctor. D.Inform them that drugs for hypertension can cause erectile dysfunction.

D. Answer B: This choice is premature since it would be an outgrowth of conjoint therapy. Answer C: Because of the increase in medication, a referral to the prescribing doctor is prudent. The husband's physician would determine if there is an organic basis for his failure to maintain an erection.

Question ID #24293: A woman in her late sixties comes to see you because her husband of many years recently died. She tells you that this was her second marriage and that her first didn't last very long. She tells you that this is the first time she has ever tried therapy. Which of the following would be the most important for you to immediately assess? Select one: A.The extent of her social support system. B.Use of alcohol or drugs. C.Decline in health. D.Symptoms of depression.

D. Answer C: Concern about this client's health would be important, and a referral to an M.D. would be appropriate if any health problems were present. It is not within the MFT scope of practice to assess a decline in health. Answer D: When a client presents with bereavement issues, depression would be the most immediate concern, since it directly addresses her reaction to the loss, and would give valuable information about the possibility of suicidality, which can increase after the loss of a loved one.

Howard, an elderly man with diabetes, comes to therapy with his new wife, Beth. Beth is unhappy with Howard's erectile problems. Howard tells Beth in session that he is doing the best he can and if she wants a more exciting sex life, they could start talking about divorce. Beth responds that she does not want to split up because this would be her second failed marriage. What would you do initially with this couple? Select one: A.Sensate focus exercises B.Recommend that the couple refrain from intercourse for two months. C.Figure out underlying issues. D.Refer to an MD.

D. Answer C: Exploring underlying issues would not be done before ruling out or treating medical causes for the condition. Answer D: A medical evaluation would be the first step before proceeding with treatment for an erectile dysfunction. In the instance of diabetes, a frequent side-effect can be erectile problems because of the circulatory problems associated with the disease.

Georgia, age 82, comes to counseling at her children's insistence. Her daughter drives her to therapy and drops her off at the first session saying, "I hope you can help my mother. Ever since my dad died she hasn't been the same." When you begin speaking with Georgia, she tells you that there is nothing wrong with her and she cannot afford to pay for therapy. She asks if she can just stay in the waiting room until her daughter returns to pick her up. This case would be out of your scope of practice if: Select one: A.You are not trained in grief and loss issues. B.Georgia's daughter refuses to participate in therapy. C.Georgia needs psychotropic medication. D.Georgia is in the final stages of Alzheimer's disease.

D. Answer C: If Georgia requires psychotropic medication, you could still treat her for relationship issues. Answer D: If Georgia were in the final stages of Alzheimer's disease, she would have a medical condition whose treatment would be out of your scope of practice.

Question ID #24953: Georgia, age 82, comes to counseling at her children's insistence. Her daughter drives her to therapy and drops her off at the first session saying, "I hope you can help my mother. Ever since my dad died she hasn't been the same." When you begin speaking with Georgia, she tells you that there is nothing wrong with her and she cannot afford to pay for therapy. She asks if she can just stay in the waiting room until her daughter returns to pick her up. This case would be out of your scope of practice if: Select one: A.You are not trained in grief and loss issues. B.Georgia's daughter refuses to participate in therapy. C.Georgia needs psychotropic medication. D.Georgia is in the final stages of Alzheimer's disease.

D. Answer C: If Georgia requires psychotropic medication, you could still treat her for relationship issues. Answer D: If Georgia were in the final stages of Alzheimer's disease, she would have a medical condition whose treatment would be out of your scope of practice.

You are a therapist on vacation and while relaxing on the beach, you see a woman pull a belt out of her bag and scream at a child, "If you don't get back here right now, I'm gonna use the belt!" The child stops cold, starts crying hysterically, and says "No momma! Please don't use the belt on me again!" The child's father arrives soon after and the child returns to playing. What is your legal responsibility in this situation? Select one: A.The child's reaction constitutes a "traumatic condition" and you must report child abuse. B.The mother's threats coupled with a means to carry out the threat constitutes assault, a type of physical abuse and you must report child abuse. C.This could be an "optional" report because the therapist is not in a professional capacity.= D.A therapist has no legal responsibility in this situation but an anonymous report would be an option.

D. Answer C: Optional reporting is for emotional abuse, not when a therapist is not acting in a professional capacity. Answer D: A therapist who has knowledge or suspicion of child abuse is required by law to file a child abuse report only when the therapist is in his or her professional capacity, i.e, engaged in the work of doing psychotherapy. Mandated reporters may make anonymous reports when they are not in their professional capacity.

Emily, your client of eight months, wants you to come to her baby shower. She says that you have been with her through the whole pregnancy, even more than her best friends. Which of the following is NOT reflective of CAMFT ethical standards regarding dual relationships? Select one: A.MFTs shall avoid dual relationships that are likely to impair professional judgment. B.A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship simultaneously with a therapeutic relationship. C.A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship during a reasonable period of time after the termination of the therapeutic relationship. D.All dual relationships should be avoided.

D. Answer C: SECTION 1.2: A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship during a reasonable period of time after the termination of the therapeutic relationship. Answer D: NOT IN SECTION 1.2: Avoiding all dual relationships is not possible or practical in all situations (For example, encountering your client who is a veterinarian in the only animal hospital in your small town.)

Question ID #26818: The Humbergs come to counseling with their 16-year-old son, Cameron, because they found drugs in his room. They don't want the other two children, ages 9 and 11, to know. They want you to suggest some strategies to help Cameron overcome this problem. A Strategic therapist would most likely: Select one: A.Confront the couple about hiding Cameron's secret; terminate therapy when Cameron is neither using nor hiding drugs. B.Point out the power struggle in the house; ask Cameron to speak for himself. C.Recommend Cameron hide more drugs; recommend that the parents continue to exclude their younger children from the session. D.Reschedule the session when the whole family can attend; focus the therapy on the family dynamic of secrets.

D. Answer C: These paradoxical interventions might be appropriate once everyone is present in therapy. Answer D: Strategic therapists typically try to work with the whole family and focus on the metacommunication in a family.

Question ID #25340: As a protected class, elders and dependent adults receive similar protections with regard to abuse. As a mandated reporter, you must always report when you have reasonable suspicion of abuse or neglect. You may also obtain consultation in situations when you are not sure whether to report or not. Which of the following is NOT true about the Elder and Dependent Adult Abuse Reporting Law? Select one: A.Abandonment is a mandated reporting responsibility. B.Mandated reporters are protected from civil and criminal liability if they comply with the law. C.A report is filed with Adult Protective Services. D.A written report must be made within 48 hours.

D. Answer D: A written report for elder and dependent adult abuse is required within two working days of discovery, not 48 hours.

In Lidz's concept of marital schism, there is: Select one: A.A repetitive pattern of dysfunctional communication. B.An imbalanced, complementary relationship. C.Conflict involving a dominant spouse and one weak spouse. D.A symmetrical relationship that has become hostile and competitive.

D. Answer D: In a martial schism, there is a symmetrical relationship where periods of intense conflict result in a schism or split, where the couple becomes divided.

Question ID #24063: A marriage and family therapist is on a list that the court provides to clients to make their choice of a therapist for mandated therapy. For most of the clients, the therapist assigns homework to give them realistic tasks they can achieve. A few clients, however, report that coming to therapy is hard enough and they would rather just "talk it out in session." How would a Behavioral therapist develop an intervention that responds to their concerns? Select one: A.Accept that their coming to therapy is positive reinforcement. B.Assess what types of verbal reinforcement will work to help them come to therapy. C.Explain the importance of having concrete goals that they can point to for motivation. D.Remove the requirement that they do the homework in order to encourage them to do it.

D. Answer D: Removing a negative stimulus (i.e., "negative reinforcement" where the negative reinforcer is the "requirement" of homework) in behavioral theory is one way to increase the rate or presence of a desired behavior (i.e., doing the homework).

Noemi is a 14 year-old brought in by her mother. She appears very thin and openly tells the therapist that she has been using "stuff" to help her study. She states she is "tired of everyone telling me what to do all of the time," and says her mother nags her constantly. She wishes everyone would just "leave me alone." When the therapist asks her if she is depressed, she replies, "Who isn't?" What should the therapist assess for in this case? Select one: A.Suicidality, depression, mother-daughter relational problem B.Drug abuse, depression, scholastic problems C.Drug abuse, on-line bullying, mother-daughter relational problem D.Depression, drug abuse, scholastic problems

D. Answer D: The most pressing issue to evaluate is depression and potential suicidality, followed by substance abuse.

Doug, a 42-year-old construction worker, has recently been fired from his job for pushing a co-worker. He has been out of work for three weeks and tells you that he is looking for another job. He tells you that the other guy is just a "wimp".. He tells you that he has never been this angry and that someone should have to pay for his loss of income. Your next step would be to: B.Take a complete family history, paying attention to how anger was handled in his family-of-origin. Obtain a release to speak with his girlfriend who may have information about his behavior at home. C.Refer him to a job placement center to get him working as soon as possible. Take a history to determine if he "has never been this angry". D.Determine if there is a serious threat to an intended victim, and the possible location of that victim. Ask him what anger feels like to him and describe it.

D. Answer D: The statement of "making someone pay" would be a red flag to do a violence assessment. Asking him directly about his feelings would provide some insight into his immediate state of mind.

You are seeing a 14-year-old girl with parental consent for sleep problems. She had to switch schools because her dad got a new job and they could not afford to keep her in private school. Her dad is 56 and changing careers. She discloses she has been assaulted by gang members at school. She tells you she doesn't want you to tell anyone. The therapist must: Select one: A.Maintain confidentiality. Evaluate if she is traumatized or hurt. B.Report to the police. Notify her parents as they provided consent and have the right to access her treatment when she is unsafe. C.Report to her parents as they hold the privilege. Explore whether her sleep problems are affecting her mood or health. D.File a child abuse report. Determine if disclosure will endanger the girl, then tell the parents.

D. Answer D: This is a mandated reporting situation, not a "mutual affray". As the parents are likely to be involved once a report is made,it would be important to discuss this with the girl and then notify the parents. Assessing the danger to the girl is important. If the girl is in danger, the parents need to be informed of the situation.

Which of the following BEST describes a person who is a "co-alcoholic?" Select one: A.A family member or friend who wants the alcoholic to stop drinking. B.A family member or friend who drinks with the alcoholic. C.A family member or friend who leaves the alcoholic because of his/her drinking. D.A family member or friend whose behavior maintains the alcoholic's drinking problem.

D. Co-alcoholic" is a term used to describe any person whose behavior overtly or covertly maintains the alcoholic's drinking problem. This person is sometimes called an "enabler" or "co-dependent."

You are an MFT supervisor overseeing the practicum of several MFT trainees. One of the trainees, who is just beginning his hours, presents during supervision his first client who has Borderline personality traits, such as cutting, suicidal attempts, and volatile mood swings. How do you supervise this trainee? Select one: A.You provide this trainee with literature to deal with Borderline Personality Disorder. B.You meet with the client to determine the severity of the dysfunction. C.You work with the trainee to refer the client to another therapist in order for the client to receive the appropriate level of care D.You consider both your and the trainee's scope of competence and determine if the client would receive the appropriate level of care with your trainee.

D. Considering your trainee's scope of competence as well as your ability to supervise him/her would fulfill the supervisory responsibility to make sure your trainee does not work out of his scope of competence. You may decide to refer this client to another therapist, but it is important to consider the trainee's scope of competence, experience and training first.

A client tells you about a stock that is about to split. He is not a stock broker or a money manager, but often talks about his hopes of cashing out big one day so he can retire early. Which of the following statements is true about this situation? Select one: A.It is illegal and unethical for you to buy the stock B.It is legal for you to buy the stock as long as you inform all your clients equally about this situation. C.It is illegal and unethical for you to receive this information. D.It is legal for you to buy the stock.

D. D: It is legal for you to buy the stock, however it is still unethical for you to do so. Regardless of how the stock does, your purchase of the stock can result in strong countertransference towards your client. This kind of countertransference should be avoided when at all possible.

Martha tells you that she has been talking to her husband daily through her guardian angel. She is deeply religious and tells you that many times in her life, her faith has gotten her and her family through rough times. Her daughter told you that her father died of a heart attack three years ago. Martha says she hears the voice of the angel and believes that her husband sent the angel to look over her after he passed away. The angel speaks to her when no one else is around. Which of the following best describes Martha's symptoms? A.A stress reaction with psychotic features. B.Obsessive thinking, plus auditory hallucination. C.A defense mechanism created as a reaction to bereavement. D.A delusion, plus auditory hallucination.

D. Martha believes that the guardian angel is real. This is a delusion. Hearing the voice of the angel is an auditory hallucination.

Question ID #25486: A therapist is working with a family where there is a strong taboo about talking about strong feelings. When one person gets close to expressing an emotion, another person in the family will interrupt or change the subject. The therapist tells one person to stay with the emotion in spite of what anyone else says or does. In giving this "paradoxical directive" the therapist assumes that: Select one: A.Insight will occur as the emotional expression is pursued. B.The benefits of the paradox will occur only after second order change has occurred. C.First order change can only occur by "tricking" the clients D.System changes will occur in circular interactions.

D. This question tests your knowledge of Strategic therapy goals. Answer A: Strategic therapists do not identify "insight"; "insight" is more typical of psychodynamic therapy. Answer B: A paradoxical intervention occurs at the "symptom" level, that is, where first order change occurs. However, from a Strategic therapy point of view, benefits can occur at either first or second order levels; they are not restricted only to second order change. Answer C: Although paradoxical directives are "tricks" to get clients to take control of symptoms, they are not the ONLY interventions that can produce first or second order change. Answer D: Strategic therapists, like all systems therapists, assume that interventions which change the system will affect the entire system, in a circular causal pattern.

Fatemeh, a 15-year-old Jordanian. Recently she was raped. Fatemeh has been stealing Vicodin because she "wants the pain to go away." What interventions would an Object Relations therapist use to treat Fatemah for the rape-related PTSD? B.Early: Validate, mirror, and reflect to provide a safe holding environment. Middle: Interpret family-of-origin issues to link the past to the present. Late: Work through termination issues such as loss and abandonment. C.Early: Re-parent to provide a safe holding environment. Middle: Address recapitulated issues with family-of-origin work. Late: Interpret, to anticipate future problems. D.Early: Be a consistent and soothing object to contain Fatemeh's feelings. Middle: Interpret Fatemeh's negative introjects and confront dysfunctional coping mechanisms stimulated by the rape. Late: Interpret feelings of loss and abandonment in the termination.

D. Answer B: Early: Validating, mirroring and reflecting are Object Relations early stage interventions to create a safe holding environment. Middle: From an Object Relations perspective, the particular and idiosyncratic ways Fatemeh is reacting to the rape have their roots in her family-of-origin, and to help make these links conscious would give her the insight necessary to make choices about her behavior. Late: Working through termination issues is a goal, not an intervention in itself. Answer C: Early: Re-parenting is not an intervention; it is a goal. Middle: Addressing recapitulated issues means looking at the problematic self-concepts or coping behaviors from the past that have been brought into the present by a trauma, which is an Object Relations approach. Late: An Object Relations therapist would, in the late stage of therapy, interpret what was happening with Fatemeh in the room to speculate about her worries of life after therapy. Answer D: Early: Being a consistent/soothing object is an early stage Object Relations intervention to create a safe environment in which Fatemeh could begin to heal. Middle: Negative introjects (destructive self-concepts, ideas and beliefs about herself taken in, or introjected from Fatemeh's childhood environment) would be activated by a trauma such as a rape and converted into self-destructive or other dysfunctional coping mechanisms. Late: Interpreting feelings of loss and abandonment in the termination stage is an intervention an Object Relations therapist would use.

Jenny, a homemaker, calls you for an appointment and tells you that she is depressed. She comes in with her husband Lionel, who works in a factory. Jenny says that she feels "old" and "ugly" as a result of taking care of young children all the time, and she suspects Lionel is having affairs at work. How would you clinically manage the psychosocial stressor of marital estrangement of this couple? A.Normalize the loss of intimacy that can occur when w/ children. Confront Lionel's secret about the possible affairs; B.Help Jenny and Lionel identify resources for childcare. Explore Jenny's low self-esteem; teach communication skills. Promote acceptance of lack of intimacy as they have young children C.Teach Jenny and Lionel the importance of maintaining intimacy. Facilitate Jenny and Lionel's on the trust issues in their relationship. Teach communication skills; help Jenny and Lionel strengthen their support systems.

c. Answer B: Jenny is described as "taking care of the children all the time" and it appears that the couple doesn't have enough couple's time. Accordingly, this could be a valuable resource in addressing the marital estrangement. The exhibit has clearly stated Jenny's feelings of being old and ugly, which can possibly affect her relationship with Lionel. This only merits a single check because it doesn't directly address the marital estrangement. This sounds a bit general, but helping Jenny and Lionel improve their communication skills is certainly essential to the improvement of their relationship. Couples with young children may have less intimacy, but it does not mean that they should be inured to this. Answer C: Intimacy is an issue that couples with young children usually struggle with due to the extra energy and time spent for caring for the new addition to the family. It is relevant to address intimacy issues with Jenny and Lionel from the perspective of the family life cycle. However, this item merely stresses the importance of intimacy without actually teaching the couple skills to maintain closeness. Trust is the core theme for this case as Jenny is suspecting Lionel of having affairs and Lionel showed non-verbal cues that suggested the possibility of withholding the truth. This sounds a bit general, but helping Jenny and Lionel improve their communication skills is certainly essential to the improvement of their relationship. Improving social support is a critical element in the clinical management of all psychosocial stressors.