TDC Questions

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Clinical - maybe not appropriate 1. A social worker sees a couple who describe frequent conflict and arguments. During a session, the wife tells the social worker that her husband never wants to talk about his feelings. The husband confirms this but says that when he tries to express himself his wife gets upset and yells at him. The wife jumps in and says loudly, "That's not true! He's always making things up about me!" The husband then says, "See?" and crosses his arms, sitting in silence. The social worker should NEXT: A. Recommend that the husband and wife be seen individually. B. Point out the communication pattern that just occurred. C. Move the conversation to a topic that is less conflictual. D. Teach the couple more effective communication techniques.

1. B - Rationale: B is the best answer because the therapist should first help the couple become more aware of their existing communication patterns. A does not make sense because the problem is in the relationship. C avoids the problem for which they are being seen, which is counterproductive. D may be a useful intervention but not until the clients are more aware of their current communication style.

1. A therapist is meeting with a client for an initial evaluation. The client reports feeling moody and has been having many headaches. The client states that she lost a lot of weight recently and has noticed a decrease in appetite. The clinician should FIRST: A. Assess the client for suicidality B. Refer the client to a psychiatrist C. Complete a mental status exam D. Refer the client to a MD

1. For this ASWB exam practice question, the correct answer would be D. The FIRST thing we need to do is make sure there isn't a medical reason for the client's recent physical symptoms. A lot of people choose A due to the client's report of moodiness. The key word here is what should the therapist do FIRST? It doesn't mean we wouldn't do the other answer options at some point during this session, but we need to first address the client's medical symptoms.

10. A social worker is doing a home visit for a family with three kids who recently lost their mother in a car accident. The family was living in a homeless shelter and recently moved into a new home. When the social worker arrives, the social worker sees the father push one of his children on the ground and begins to punch the wall next to the child. The social worker's FIRST response should be to: A. Call the police B. Make a CPS report C. Intervene with the father D. Take pictures of the event

10. On this ASWB exam practice question, the FIRST option here is A. Anytime immediate danger is happening the social worker needs to call the police. B would be done after A has been done. C would put the social worker in danger and should not be done. D would not be done by the social worker, as the police would take pictures of the event as needed.

Clinical - maybe not appropriate 2. A social worker facilitates an inpatient therapy group for adolescents. One member of the group, a 14-year-old female, has been prescribed medication for a mood disorder and shares that she does not want to take it. The other members of the group identify with the girl's feelings and become angry, yelling at the social worker and demanding that the social worker do something on the client's behalf. The social worker should FIRST: A. Explore group members feelings about medications. B. Bring the conversation back to the client's behaviors that prompted the medication. C. Acknowledge the group members' anger and explore underlying issues. D. Maintain confidentiality and refuse to discuss the case.

2. C - Rationale: C is the best answer because the social worker needs to start where the group members are and help identify any underlying issues that may be contributing to their responses. B and D both disregard the group members' feelings of anger. A might be useful but not until the social worker has recognized the feelings that are being expressed and allowed group members' to process them.

2. A therapist has been conducting a closed 10-week group for men living with AIDS. After the 3rd session, a group member reports to the leader that they are feeling frustrated and disconnected with other members of the group. They question whether or not they want to continue. The social worker should FIRST: A. Initiate an individual session with this group member to address their feelings of frustration and disconnect B. Tell the group member that it isn't possible to leave the group at this time due to the closed nature of the group C. Encourage the group member to bring this up in the next group session D. Use the next group session to explore how other group members are feeling and whether anyone relates to how this group member is feeling in order to encourage cohesiveness

2. The correct answer here is C. When working with groups we want to make sure we keep any issues that come up around the group within the group. So in this case, it's important to encourage the client to address their feelings with the group. A would not keep the issue within the group, and B would not be appropriate because a group member has the right to leave a group. D could be done at some point, but not before we give the client an opportunity to share his own feelings with the group.

Clinical - maybe not appropriate 3. A 28-year-old man seeks treatment from a social worker. He reports being dissatisfied with his career but cannot identify why or what he would like to be different. He also states that he's unhappy about his current relationship, wishes he was in better shape, and can't seem to find a way to change. He says, "Every time I try to change something, I get overwhelmed and end up right back where I started . . . or worse." The social worker should FIRST: A. Assist the client in prioritizing his concerns. B. Identify behavioral objectives to help the client change his behavior. C. Apply a strengths-based perspective by focusing on his strengths. D. Use mindfulness-based skills to help decrease stress.

3. A - Rationale: When a client reports having multiple concerns and feels overwhelmed, the most helpful intervention is to help them separate and prioritize their concerns (A). B, C, and D might all be useful interventions but not until the client feels more in control.

3. Studies that collect and analyze data from the whole study population at one point in time is called: A. Single Subject Design B. Cross-sectional Studies C. Retrospective Study D. Case Study

3. This is a recall question based on the ASWB exam. B is the correct answer because cross-sectional studies collect data at a single point in time from participants who are a variety of ages to see how change occurs as a person ages.

4. A father recently noticed an upswing in the amount of gun violence in his neighborhood. As a result he reaches out to other members of the neighborhood to hold a meeting and discuss the impact this is having on each individual, while also looking at the ways that each member can contribute to creating change. This is an example of: A. Advocacy B. Program Development C. Community Organizing D. Social Planning

4. C is correct because community organizing involves engaging with groups, organizations, and communities in order to bring about positive changes within the community and to solve social problems identified by members of the community. For this ASWB practice test question, the key aspect here is that the social problem has been identified by the father, who is a member of the community. A, B, and D would all be described differently.

Clinical - maybe not appropriate 4. A 26-year-old woman is referred to a social worker in private practice by a close friend. During the initial session, the client describes a number of problems, including a recent breakup with her boyfriend, a history of trauma, and almost daily methamphetamine use. The social worker should FIRST: A. Explore the client's reasons for drug use. B. Assess the client's motivation for change. C. Explore the connection between the trauma and the client's current problems. D. Refer the client for a substance abuse evaluation.

4. D - Rationale: D is the best answer because substance abuse should be addressed first. A, B, and C are all useful interventions but only after the therapist refers the client for a substance abuse evaluation.

Clinical - maybe not appropriate 5. A social worker at a community agency begins working with a family which reports frequent arguments centering around the teenage son's behavior. The mother reports that while he maintains good grades and participation on the school soccer team, he is "totally uninterested" in family life. The father then interrupts and states that his wife has "unrealistic expectations" for his son. They continue to bicker about discipline while their son sits silently, rolling his eyes. The social worker should FIRST: A. Refer the parents for couple's treatment. B. Suggest individual treatment for the son. C. Concentrate on interpersonal communication between family members. D. Obtain a release of information to contact the son's teacher.

5. C - Rationale: The family is demonstrating the communication patterns that are causing their distress, so the social worker should start where they are (C). A and B might be useful later if it becomes apparent that either the son or the parents are in need of focused treatment. D does not really make sense at this time since the son is described as doing well in school.

5. A social worker is developing a program that assists youth who are coming out of the juvenile justice system in finding a job. The social worker has already conducted a needs assessment and identified goals for the program. Which of the following should be the NEXT step? A. Create an action plan along with a timeline for implementation B. Create a planning team which includes identifying key staff C. Put the identified goals in action to ensure they are productive and accurate based on the identified population D. Using the identified goals, implement an action plan and evaluate progress as needed

5. Since the social worker has already conducted a needs assessment and identified the goals for the program, they NEXT need to create a team of people who are able to plan, develop, and implement the program. Therefore, for this ASWB practice question, B is correct. A, C, and D would be done once the social worker has created a team of people who can then oversee that the goals are put into action.

Clinical - maybe not appropriate 6. An emergency room social worker is asked to evaluate a 43-year-old woman who was brought in complaining of heart palpitations and an inability to sleep. The social worker notes that the woman's pupils are dilated and that she is wrapped in a large blanket despite the reasonable temperature in the ER. The client has most likely been using: A. Cocaine B. Oxycontin C. Alcohol D. Heroine

6. A - Rationale: This is a recall question. The symptoms described in the stem are all indicative of cocaine abuse. B, C, and D would all be described differently. You can expect 3-5 exam questions related to substance abuse and different drug effects.

6. A 15-year-old client was recently referred to a therapist at a community counseling center for an initial assessment after throwing a chair at another student at school. The mother reports this is the first incident of this type, but that the client's parents recently divorced a month ago. In order to develop the therapeutic relationship, the therapist must FIRST: A. Go over the limitations of confidentiality with the client B. Complete a biopsychosocial assessment C. Play a game to lessen the stress of the first session D. Get a release of confidentiality from the mother to talk to the client's teacher

6. On this ASWB practice exam, the best answer here is A. It's important for the client to be aware of the limits of confidentiality before starting therapy. B, C, and D would all be options to do NEXT, but not until the therapist has addressed confidentiality with the client.

Clinical - maybe not appropriate 7. A social worker has been working with a 9-year-old boy and his parents to address emotional and behavioral issues. A psychological evaluation has revealed that the boy has a learning disorder; the parents have requested an IEP from the boy's school but have had difficulty making contact with the special education coordinator. The social worker's calls to the school administration are not returned. The social worker should FIRST: A. Recommend that the family obtain legal representation. B. Request that the psychologist attempt to contact the special education coordinator directly. C. Send a registered letter to the special education coordinator and administration with the psychologist's recommendations. D. Contact the school board about the need for action.

7. C - Rationale: C is the best answer because it creates a paper trail that can be referenced in later interactions and ensures that someone in the school will receive the communication. A may be necessary, but attempts to contact the school in writing should be done FIRST. B and D may not do anything to accomplish the family's goal if these telephone calls are also not returned.

7. A therapist receives a court order to release the records of a client who is going through a custody disagreement with his partner. The therapist is worried about releasing certain aspects of the record believing that it will be harmful to the client, so the therapist advocates to release only limited aspects of the record. The judge denies the request. The therapist SHOULD: A. Release the records to the court immediately B. Release only aspects of the records that the therapist believes aren't harmful C. Speak with a lawyer D. Speak with the client about the subpoena

7. The best answer here is A. Since the subpoena is coming from a court directly, we must provide the court with the records. The therapist has already advocated for only part of the record to be released and since the request was denied we can't do B. We could do C and D at a later point, but not before releasing the records to the court. Between the time we receive the initial request and advocated for limited release we should have already been discussing with the client the next steps in case that request is denied.

Clinical - maybe not appropriate 8. A client seeks services at a community mental health center. He reports that his chief complaint is that he can't get a job so he is "stuck living in his parents' basement." He is dressed in pajamas with a neck tie. He reports that his only friends are people he knows online in an alien tracking club. He asks if the social worker believes in ghosts. What diagnosis should be considered for this client? A. Schizoid Personality Disorder B. Schizophrenia C. Schizotypal Personality Disorder D. Schizopreniform

8. C - Rationale: This is a good example of a diagnosis question. Schizotypal Personality Disorder is characterized by social isolation, odd behavior, unusual dress and thinking, and unconventional beliefs.

8. During an assessment a client reports a low mood, lack of sleep, and trouble concentrating. The client reports this has been going on for the past three years. The client shares they were sexually assaulted seven years ago, but reports that they, "don't really think about it anymore." The client's MOST likely diagnosis is: A. Major Depressive Disorder B. Persistent Depressive Disorder C. Cyclothymic Disorder D. Acute Stress Disorder

8.The best answer here is B. Persistent depressive disorder is diagnosed when symptoms have been present for at least two years. Cyclothymic disorder C also has a 2 year period, however for cyclothymic disorder to be diagnosed, hypomanic symptoms and depressive symptoms must be present for at least two years which isn't noted in this stem. A is incorrect because the symptoms are not severe enough to give a diagnosis of Major Depressive Disorder. D is incorrect because ASD is only diagnosed when the traumatic event has happened within the last month. Since the event was seven years ago, this would make D incorrect.

9. A therapist is developing a website to promote her private practice. It would be unethical to do which of the following: A. Highlight the therapist's expertise B. Share extensive information about the therapist's training and background C. Include information about the therapist's fees and sliding scale D. Collect clients' testimonials highlighting the effectiveness of treatment

9. D is correct because it is unethical for the therapist to collect testimonials for previous or present clients. A, B, and C are all areas that are ok for the therapist to highlight on their website.

A woman is referred to a social worker by her EAP. The referral indicates that the woman is frequently absent from work and has difficulty completing projects. During the initial assessment, the woman avoids answering questions about her relationship with her spouse. The woman becomes tearful when asked about her family and social supports. The woman shares that her husband does not "allow" her to go out in the evening or on weekends. She goes on to tell the social worker that she is pregnant, but has not told her husband about the baby. What should the social worker do NEXT? A Refer the client to a doctor for prenatal care B Suggest couples treatment to address issues of stress around the move C Redirect the client back to issues of absence and incomplete job performance D Assess the woman for domestic violence and help her create a safety plan

According to the Social Work Dictionary, domestic violence is defined as "abuse of children, older people, spouses, and others in the home, usually by other members of the family or other residents; or the social problem in which one's property, health, or life are endangered or harmed as a result of the intentional behavior of another family member," (Barker, 2003). Most therapists are familiar with the cycle of violence, but are not always aware of the more subtle signs of abuse and ways the client may hint towards domestic violence dynamics.? What does the perpetrator and their abuse look like when described through a client's eyes? As therapists, we want to be on the lookout for clients describing partners who are possessive, sexually jealous, insecure, or controlling. Clients may describe scenarios that highlight their partner's inability to cope with stress effectively or tendency to blame the client or others for their behavior. Substance abuse or dependence may be mentioned. Social isolation and pregnancy are additional risk factors for domestic violence that can increase risk. The ASWB, AAMFT and BBS all want to make sure that you can identify symptoms and behaviors that indicate a violent relationship — from either side. Answer: In the item above, the strongest answer is D, since the stem provides the test-taker with multiple risk factors for domestic violence. Answer A is incorrect because our priority is to assess for domestic violence. A referral to a doctor for prenatal care would follow risk assessment and safety planning. Additionally, answer A wrongly assumes the woman is not receiving prenatal care. Answer B is incorrect as we would need to rule out domestic violence before considering couples counseling. Couples counseling is contraindicated if domestic violence is suspected. Answer C is incorrect because issues of safety warrant immediate attention and this answer disregards the red flags raised in the vignette. Now, let's consider a slightly different scenario for the next LCSW practice exam question.

A 66-year-old man is referred to a social worker by his adult daughter. During the initial assessment, the man reports poor sleep, decreased appetite, and increased feelings of agitation and restlessness after being laid off from his job. He goes on to tell the social worker that "things just seem to keep going downhill since my wife died a year ago." What action should the social worker take FIRST: A. Refer the client to an MD to rule out any medical issues B. Teach the client relaxation skills to help him sleep C. Ask the client if he's having any thoughts of suicide or self harm D. Normalize the client's feelings of grief and loss

After looking at the question and answer set yesterday, what did you think? This is a good example of an item that could show up on any of the ASWB exams, and one in which there are multiple answer options that look "right." So, let's go through the answer choices one at a time and think about them. Answer A: does the client need a medical evaluation? Probably. He's having symptoms (sleep disturbance, change in appetite, restlessness) that could indicate a medical problem, so we would want to rule that out. In many cases, this answer would take priority, but let's see what else we have going on here. Answer B: does the client need concrete coping skills to help address his stress and sleep issues? Probably. This would be something you would, in most cases, do with a client in this situation, but it wouldn't be prioritized over an answer like A. Answer C: should we ask this client if he's having thoughts of suicide or self harm? ABSOLUTELY. He has a number of factors that put him at an extremely high risk: he's an older male, he's had multiple losses (spouse and job), he's experiencing symptoms consistent with depression, and maybe most significantly, he's expressing HOPELESSNESS (feeling like things are going downhill). This is the best answer, and would take priority over the medical referral because the suicidal risk is imminent (we want him to live to make it to the doctor's office). Answer D: should we respond to his feelings? Of course we would want to demonstrate empathy and compassion for this client. C is still a better answer to the question, though, as the social worker should feel comfortable directly addressing the potential for risk in this situation.

A 25-year-old woman has been working with a social worker for two years around issues of anxiety, depression, and non suicidal self-injury. For the past 18 months, the client has abstained from cutting herself, but came into the most recent session wearing long sleeves on a hot summer day. The social worker inquired about this and the client lifted her sleeves to reveal several shallow cuts on her forearms that appeared to be healing. The client stated that she got into a fight with her best friend a few nights ago and in a moment of intense emotion engaged in cutting. What should the social worker do FIRST? A. Discuss voluntary hospitalization with the client B. Teach the client coping skills to utilize in moments of intense emotion C. Explore the thoughts and feelings that preceded the client's self-injury D. Refer the client to an MD to take care of the client's injuries

Answer A: does the client need to be hospitalized? Not at this time. Nothing in the question stem indicates that the client is having suicidal thoughts or is a risk to herself. The question stem specifies that the client engages in non suicidal self injury, meaning, she is engaging in self harm without the intent of killing herself. Further, the cuts are on her forearm and are described as shallow and healing normally, so there is no medical emergency that would indicate a need for hospitalization. Especially for therapists inexperienced with self-injury, seeing a client's self-inflicted injuries can be alarming and upsetting. From a place of concern and wanting to make sure our clients are safe, we can jump to too extreme of interventions, such as unnecessary hospitalization. Answer B: does the client need concrete coping skills to help her cope during moments of intense emotion? Definitely. This is something you would want to do, but is not necessarily what you would do. Answer C: should we explore the thoughts and feelings the client had before engaging in self-injury? Yes! This answer option allows us to stay in the moment and respond to what the client has shared. Exploring her thoughts and feelings leading up to her self-injury will help us gain a better understanding of the precipitating factors and triggers for this behavior. From there we could discuss various coping skills for the thoughts and emotions that triggered this behavior (B). Answer D: does the client need a medical evaluation? Probably not. The question indicates that the cuts were shallow and healing normally. Nothing else in the question stem indicates a need to seek medical attention.

Sample: A 35 year-old woman seeks the services of a therapist in private practice. She tells the therapist in the initial appointment that she is recently divorced and has been feeling "down" since her husband left. She goes on to say that while she misses her husband, she knows that "we're much better at being friends than we were at being married — this is the best thing that could have happened." The client's response represents: A. Denial B. Cognitive Dissonance C. Rationalization D. Repression

Answer: Hopefully it's no surprise that the correct answer is C, rationalization. The client is demonstrating this process by saying things that intellectually make sense: "we're better as friends" and "this is the best thing that could have happened" instead of talking about why she's feeling "down" after the end of her marriage. Rationalization is a defense mechanism that is associated with a higher level of functioning. Even though it will give the answer away, I'm going to go through a brief definition for each of the answers above. Denial refers to a process of refusing to acknowledge an emotion that is uncomfortable, often through a distortion of reality. Cognitive Dissonance refers to the discomfort that results from holding conflicting cognitions (ideas, beliefs, feelings, values) simultaneously. Rationalization refers to a process in which plausible reasons are used to justify a feeling or action, or a process in which disappointments are blamed or explained by external circumstances to decrease feelings of discomfort. Repression refers to a process in which unacceptable feelings or impulses are kept out of conscious awareness, but continue to influence behavior on an unconscious level. Knowing these definitions is helpful, but it's even more helpful to understand what the terms look like in a real-life situation — what does it look and sound like when a person is using denial as a defense mechanism? How about reaction formation (this is one that always trips me up)?

Which of the following BEST describes xenophobia? A. A persistant fear of confined spaces. B. A pattern of behavior, frequently seen in victims of spouse abuse and child abuse, in which the individual responds passively to risks of harm. C. A dislike or fear of people from other countries or of that which is perceived to be foreign or strange. D. A persistant fear of open spaces or crowds.

Answer: It's pretty obvious by this point, but the best answer here is C. The other possible answers include (A) claustrophobia, (B) learned helplessness, and (D) agoraphobia. Some of the symptoms of xenophobia to know for the LMSW exam can include feelings of fear, dread, hostility, and distrust when exposed to people or cultural items that are perceived as being different. There are many different ways that xenophobia can develop. This can include one's upbringing, alienation from other cultures, or even veterans who fought in Vietnam may have developed xenophobia through PTSD. When working with individuals who deal with this it can be helpful to target the initial factor which incited fear in that individual and then work through the causes and symptoms. Some therapists have discussed the use of CBT with xenophobia which has allowed the client to face the fear head on. The Social Work Dictionary defines xenophobia as, "Persistent, intense, and unreasonable fear of strangers or foreign people" (Barker, 2003).

Which of the following BEST defines unconscious motivation? A. The process of being aware of one's environment and existence. B. Hidden, repressed, and unknown desires that control one's actions. C. The advantages or benefits one derives from a physical or mental illness, such as attention, freedom from responsibility, and disability benefits. D. Conscious or unconscious avoidance behavior used by the client to protect oneself from negative feelings.

Answer: The best answer here is (B). (A) better describes conscious motivation which Freud discusses as being the part of our minds that is available for direct observations, and focuses more on problem solving. (C) defines secondary gain, where an individual benefits from a physical or mental illness. Lastly, (D) contains aspects of unconscious motivation, but better defines the term defense mechanism since this is done at either a conscious or unconscious level. Freud discusses unconscious motivation in his theory on human behavior. He states that human behavior is the result of desires, impulses and memories that have been repressed into an unconscious state. While these are unconscious memories, they still have a large impact on us and control much of our actions. Freud believed that if we can help client's bring their unconscious thoughts to a conscious level than we can better assist clients in overcoming various struggles. Maslow looked at it from a similar view by saying that all behaviors can be understood by looking at what basic need it satisfies. This behavior more often than not stems from an unconscious level. An example to help you remember this term for the LMSW exam is if a woman is constantly moving from one relationship to the next. While she has a strong desire to be in a relationship, she is afraid of rejection or being let down. Therefore, she breaks off the relationships before someone else can reject her. In this example, the woman's unconscious desires (fear of being rejected) are controlling her behavior (breaking off her relationships). The Social Work Dictionary defines unconscious motivation as, "A compelling wish or drive that is out of an individuals immediate awareness but that influences him or her to act in a way that would seem contrary to his or her rational objectives" (Barker, 2003).

Which of the following BEST describes the term values? A. The customs, beliefs, standards of conduct, and principles considered desirable by a culture, group of people, or individual. B. An ethical principle in social work that recognizes the rights and needs of clients to be free to make their own choices and decision. C. A system of moral principles and perceptions about right versus wrong and the resulting philosophy of conduct that is practices. D. An ideal condition in which all members of society have the same basic rights, protection, opportunities, and social benefits.

Answer: The best answer here is A. However, the other possible answers are all other terms that you may come across on the LMSW exam. (B) defines self-determination, (C) defines ethics, and (D) defines social justice. Values has a bit of a two-fold meaning when it comes to social workers. It's important to know not only the meaning that values have for our clients, but also what values means to us as social workers. You can take a look at the NASW Code of Ethics here. They give a good description of what values are embraced by our profession and why they are important to uphold. The Social Work Dictionary defines values as, "The customs, beliefs, standards of conduct, and principles considered desirable by a culture, a group of people, or an individual. Social workers, as one group, ascribe to a set of core values on which social work's mission is based. These core values, as specified in the NASW Code of Ethics, are service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence" (Barker, 2003).

Which of the following terms BEST defines jurisdiction? A. The defined area of responsibility by a territory or state over which authority or justice is administered. B. The philosophy and science of law in terms of its origins, nature, and structure. C. A system of rules and legislative pronouncements established and recognized by a state, nation, or society as binding to its members. D. The social institutions, facilities, and people who provide the means for enforcing and interpreting the laws.

Answer: The best answer here would be A. B, C and D are all more broader definitions of laws and the justice system as a whole. The incorrect definitions each leave out the important piece of defining jurisdiction which is a territory or area that is governed by an authority in order to administer laws and regulations. A provides a more specific definition to include each of these various aspects. While this may seem like an obvious term, it is one that often appears on the LMSW exam in various ways. Jurisdiction is defined by the ASWB as the the state or provincial social work regulatory board who has the power and authority to interpret and apply the law. It is important to understand the laws of the jurisdiction in which you practice so that you are aware of your legal obligations. These obligations include reporting violence or harm towards others, child and elder abuse or neglect based upon your jurisdictional law. Even as we go through the licensing process, each jurisdiction has a different set of rules and requirements that enable you to be licensed in that particular state. It can definitely make things more confusing which is why it's important to understand the laws of your own jurisdiction. The ASWB has a comprehensive list of the statutes and regulations for each jurisdiction that can be found here: http://www.aswb.org/SWL/statutesregulations.asp

Which of the following BEST defines welfare rights?A. The advantages or benefits one derives from a physical or mental illness, such as attention, freedom from responsibility, and disability benefits.B. An alliance of individuals and ideological groups to achieve a specific goal or address a single issue or social problem; the group is expected to disband once the goals are reached.C. Privately funded and administered federated organizations, usually with chapters or recreational facilities in most communities with the purpose of helping young people achieve their developmental potentials.D. The view that public assistance and other social services are entitlements available to any of a nation's citizens.

Answer: The best answer here would be D. This is the best answer because it describes the rights that are entitled to a wide variety of individuals who are in need. Welfare may also be referred to as public aid/assistance, and is something that as social workers we should become aware of the in's and out's of this complicated system. This role in particular is important for social workers who fill the shoes of community social workers and case managers. Both of these roles, as Bethany has discussed in other blogs, may come up on the LMSW exam. Welfare is generally provided by the government and it's agencies, private organizations or a combination of these. The Social Work Dictionary defines welfare rights as, "The view that public assistance and other social services are entitlements available to any of a nation's citizens" (Barker, 2003).

Values has a bit of a two-fold meaning when it comes to social workers. It's important to know not only the meaning that values have for our clients, but also what values means to us as social workers. You can take a look at the NASW Code of Ethics here. They give a good description of what values are embraced by our profession and why they are important to uphold. The Social Work Dictionary defines values as, "The customs, beliefs, standards of conduct, and principles considered desirable by a culture, a group of people, or an individual. Social workers, as one group, ascribe to a set of core values on which social work's mission is based. These core values, as specified in the NASW Code of Ethics, are service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence" (Barker, 2003).

Answer: The best answer to the question above is D: the length of time the treatment protocol is administered. A is not the best answer because it doesn't address the question. If the question asked what the therapist should do FIRST or NEXT, then A would be the best answer, but the question asks about the factor that is MOST important when evaluating the treatment's efficacy. B is not the best answer because where the client starts doesn't matter as much as the amount of change that takes place over time. C is not the best answer because it's vague and doesn't address the question. When you see questions on the test that deal with research, it can be easy to become flustered and feel like you don't know which way to turn. We at TDC want you to KEEP CALM and remember all of the things that you DO know about measuring progress and efficacy. This is a perfect time to call on your knowledge of treatment planning (the kind of evaluation that most of us do all the time). Probably the most important factor in evaluating whether or not a treatment plan is working is the amount of change that occurs over time — if a client with anxiety experiences a decrease in panic attacks from 2x/week to 1x/week after a year of treatment, it means something very different than the same improvement after 6 weeks of treatment. This same concept could also be applied to questions regarding program evaluation.

A therapist in private practice has received a referral of a middle school girl. According to a referral source, the youngster is struggling with low self-esteem, social anxiety and low academic performance. The therapist feels comfortable working with children since she has worked with both elementary and high school kids for several years. The therapist has no experience, however, working with middle school population. In deciding to take this client on, the therapist can increase her scope of competence by doing which of the following: A Obtaining supervision from a supervisor who is highly competent in working with middle school population B Attending a workshop that is focused on tips and strategies of working with middle school population C Familiarizing herself with literature that discusses the specifics of working with middle school population D Securing ongoing consultation from a colleague who is experienced in working with middle school population.

Answer: The correct answer is D. Ethically, the best way to increase this therapist's scope of competence would be via ongoing consultation (D). This way, the therapist can have continuing support with the case and have any questions answered as the work with this girl progresses. Reading literature (C) is a good way to increase competence and very well might be done in addition to receiving consultation. So is attending a workshop (B). On their own, however, these methods are not enough to make sure that the client is receiving proper care. As licensed therapists we receive consultation, but not supervision, so answer (A) would not be something we go towards.

A 53 year-old man seeks help from a social worker in private practice. During the assessment, the man reports that his wife of 25 years died a month ago in a car accident. The man tells the social worker that he has been having difficulty sleeping and does not feel like spending time with his grown children or friends. He says, "the most troubling thing is that I keep going to her grave and talking to her like she's still here...I feel like I'm nuts." What should the social worker do FIRST: A. refer the client for a psychiatric evaluation B. provide the client with information about a grief support group C. normalize the client's experience as a typical expression of grief D. contact the client's children to elicit additional support

C is the correct answer to the question above; the client is describing a very typical expression of grief, including going to the grave site to "talk" with his wife; A would not be necessary at this time; B may be helpful, but not before the therapist acknowledges and normalizes the client's feelings; D is incorrect as it would violate confidentiality and may not be helpful. Grief is a normal response when a loved one dies; this can include family members, spouses, friends, and even pets. As therapists, we should be able to identify typical signs and symptoms of grief reactions and assess whether or not the person is experiencing a clinical disturbance as a result. The signs of grief often look like other symptoms of mental illness, including, but not limited to: deep feelings of sadness or anxiety, tearfulness, decreased sleeping and/or eating, isolative behavior, irritability and difficulty focusing on work/tasks. One way therapists can help is by reassuring clients that grief is not inherently pathological and that their responses and behaviors can actually facilitate healing.

Clinical A 24 year-old woman presents for an initial appointment wearing what appears to be an afghan and 3-D glasses. She tells the social worker that her mother recommended that she see a therapist for "social issues." With prompting, the woman reports that she does not have any close friends and has never had an intimate relationship. She says, "These glasses give me the ability to see the future, and it seems to freak people out. No one wants to hang out with me because I know what's going to happen." What is the most likely diagnosis in this case? A. Psychotic Disorder, NOS B. Schizotypal Personality Disorder C. Schizoid Personality Disorder D. Avoidant Personality Disorder

Clinical After the description above, it should come as no surprise that the answer to the question is B; the woman's odd appearance, lack of close relationships, and odd belief in her ability to "see the future" all point to a Schizotypal Personality Disorder. D. Avoidant Personality Disorder Differential diagnosis among Cluster A Personality Disorders is one of the most frequent topics of conversation with test-takers — there are several in this category that sound similar, and in which the name doesn't give away the distinguishing characteristics. It's pretty easy to guess at least a few of the symptoms associated with Dependent Personality Disorder, but Schizotypal? What does that mean? In particular, folks seem to get Schizotypal Personality Disorder and Schizoid Personality Disorder confused, so let's break it down. Schizotypal Personality Disorder involves inappropriate or constricted affect, irrational beliefs, magical thinking, ideas of reference, extreme social anxiety, unusual perceptual experiences (illusions), lack of close friends, paranoid ideation, and eccentric appearance. The eccentric appearance, unusual perceptual experiences and magical thinking all distinguish this disorder from others that might have similar social symptoms. Schizoid Personality Disorder involves detachment from social relationships, a preference for being alone, restricted range of affect, lack of close friends, flat affect, emotionally cold, lack of desire for relationships, lack of sexual desire, indifference to opinion of others, lack of pleasure in activities. The lack of desire for relationships and overall indifference to others will likely be the distinguishing characteristic that stands out in a test item.

All of the following are aspects of self-determination, EXCEPT: A. The right for individuals to have full power over their own lives, regardless of the presence of an illness or disability. B. The client's right to direct their own services and make decisions regarding their health and well-being with the help of others of their choice. C. The social worker's responsibility to assist client's in being informed regarding the impact of resources and choices. D. Encouraging a client to make a choice based solely on the social worker's opinion.

D In the end it isn't our responsibility as a social worker, or ethical really, to put our own opinion on a client. It is our responsibility, however, to help a client make an informed decision regarding their own life and to help them understand the impact of that decision.

A social worker begins treatment with a 14 year-old girl and her parents; the family has been referred by a school social worker due to truancy issues. The parents report that although her grades are still good, their daughter's behavior is "getting out of control" and ask the social worker to reason with her. The girl tells the social worker that she has been skipping school to spend time with her friends because her parents won't allow her to see them outside of school or speak to them over the phone. "You guys still think of me as a little kid — it's so annoying!" she tells her parents. What should the social worker do NEXT? A. Teach the family members effective communication skills and engage in role-playing exercises B. Explain typical adolescent development to the parents and encourage leniency around socialization C. Assist the daughter in understanding her parents' perspective and help the family find a topic that encourages consensus D. Acknowledge family members' differing perspectives and offer psychoeducation around typical adolescent development

D is the best answer because it acknowledges both the parents and the daughter, while providing the parents with information that may help them understand their daughter's behavior and make a different decision about how to set age appropriate limits with her. A is not the best answer because it bypasses the developmental information and assumes that there is a communication issue. B starts out well enough, but encouraging the parents to be more lenient may alienate them and damage the therapeutic alliance. Likewise, C starts off okay, but moving onto a less controversial topic will not do anything to help the family with their current conflict. There are two points I'd like to make about adolescent development. First, as was stated above, adolescents go through a period of development that is very similar to the development of toddlers, but on a grander scale. There's a push for individuation, separation from the family, and independent (at times seemingly questionable) decision-making. When you are looking at questions on the test, have these developmental tasks in mind, but don't assume that all behavior attributed to the adolescent can be explained by them. Second, remember that the adolescent brain is still developing — those frontal lobes aren't completely connected to the rest of the brain until the mid-twenties, so mood swings, impulsive behavior, poor decision making, and lack of insight are all par for the course. Helping families understand what's going on in their teen's brain may be a good place to start.

A family contacts a social worker for help with an increase in conflict and fighting. During the intake, the wife tells the social worker that her husband's mother recently moved in with the family after his father passed away. She goes on to say that her husband wants the family "to all just bend to his mother's wishes." The son and daughter, both adolescents, complain about the fact that they now have to share a room "because of grandma." The husband sits silently while these exchanges are occurring. What should the social worker do NEXT? A. Provide the father with referrals for a bereavement support group B. Help the family figure out how to set limits with the grandmother C. Teach the family effective conflict resolution skills D. Explore the father's feelings about his father's death and mother's arrival

D is the best answer to the question above because it encourages the father to express his perspective and takes into account that he has recently lost his father, an additional psychosocial stressor. A, B, and C may all be useful interventions, but hearing and understanding how the stressors have affected all family members is more important in this initial stage of treatment. The entire family is experiencing the stressor of having the grandmother move in, but only the father is experiencing the additional stressor of losing a parent. Without understanding how these stressors are affecting him, the therapist cannot proceed with additional interventions. At first, when you look at this question, you may think it's asking you about family therapy techniques, and it is, but it's also asking you to consider the environmental and psychosocial factors affecting this family and respond accordingly. This happens on tests pretty frequently — questions appear to be focused on therapeutic interventions but are actually testing your ability to identify and weigh the various factors that the stem presents. And don't forget to pay particular attention to the word "NEXT" and use it as a prompt to put the answer choices in the order in which you would use them instead of trying to rule any of them out.

A 35 year-old man is referred to a social worker after being released from prison, where he served 5 years for aggravated assault. He is in need of job placement services, housing resources and legal services regarding his impending divorce. When the social worker inquires about his job-related skills, the client becomes agitated and states, "It's all my wife's fault...if it weren't for her, I'd have a great job right now. I'll make her pay...". What should the social worker do NEXT? A. Refer the client to an employment agency to help him find employment B. Provide client with referrals for mediation services to assist with the divorce C. Assist the client in prioritizing his needs D. Clarify the client's comments and assess his risk of danger to his wife

D is the correct answer, as the client is presenting with several risk factors and also makes the ambiguous statement about making his wife pay; A, B, and C may all be part of a viable treatment plan, but not until safety is established. As therapists, we should be looking for risk factors for violent behavior, including, but not limited to: prior history of violence, substance abuse, childhood experiences of having been abused, and social isolation. In order to effectively intervene with clients who may be a danger to others, therapists need to accurately clarify the level of danger. It should come as no surprise that the level of lethality increases with the specificity of the plan and a past history of violent behavior.

Clinical A 17 year-old girl is admitted to a psychiatric unit after sudden onset of symptoms. According to her assessment, 2 weeks before her admission, she began experiencing frequent motor tics, shaking, and paralysis on her right side; she was evaluated by a team of doctors, but they were unable to account for her symptoms. Her history indicates a lack of mental health symptoms earlier in her life, no substance use or abuse, and her academic records indicate that she has been an honors' student since she entered high school. When the social worker interviews the girl, she states, "I've just been really stressed out...the SAT's are a week away and my whole future is riding on that." What is the most likely diagnosis in this case? A. Tourette's Disorder B. Hypochondriasis C. Somatization Disorder D. Conversion Disorder

For our purposes, health-related disorders include both eating disorder and Somatoform Disorders. All Somatoform Disorders include the presence of physical symptoms that suggest a medical condition and are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder. In particular, Conversion Disorder is defined by the following criteria: one or more symptoms or deficits affecting voluntary motor or sensory functioning that suggest a neurological or general medical condition; psychological factors are judged to be associated with the symptoms because the initiation of symptoms is preceded by stress or other conflict; the symptoms are not intentionally produced; the symptoms, after appropriate investigation, cannot be fully explained by a general medical condition, substance use, or a culturally sanctioned behavior/experience; the symptoms are not limited to pain or sexual dysfunction. Answer: D is the best answer to the question above because the client is experiencing physical symptoms that would suggest a neurological condition but cannot be explained by a general medical or neurological condition and have been preceded by an increase in stress (SAT's). A is not the best choice due to the paralysis and shaking; B is not the best choice because the client has no history of preoccupation with fears of having a medical condition; C is not the best answer because Somatization Disorder involves a variety of physical complaints that occur over a period of years.

A 32 year-old man seeks treatment from a social worker for ongoing problems with both his personal and professional functioning. He reports that even though he has been moderately successful in his career, he continues to feel uncertain about his abilities, feeling as if at any moment he will be exposed as a fraud. When the social worker inquires about his personal relationships, he looks down and says that he doesn't really let anyone get close to him. According to Erikson, this client likely experienced difficulty during which developmental stage? A. Trust vs. Mistrust B. Industry vs. Inferiority C. Autonomy vs. Shame and Doubt D. Initiative vs. Guilt

I hope it's clear from the summary above that the correct answer to the question above is C, Autonomy vs. Shame and Doubt. The prevailing characteristic that comes through about the client is his lackof self-assurance - we see him doubting himself professionally and perhaps also personally, which may explain his tendency to keep others at arm's length (protecting himself from failure). Several stages of development in Erikson's theory can be particularly confusing... How can you remember the difference between inferiority, guilt, or shame and doubt when they all sound like similar concepts? Try thinking about building blocks. Still confused? One of the tricks I used when I was studying for the exam was to focus on the first word in each stage and think about building blocks - each stage builds on the one before it. Let's just think about answers B, C, and D above, since these are the most frequently confused stages. First, the child must learn to be autonomous (a big part of this is learning to walk and separate physically from caregivers) - success at this stage translates into feelings of self-assurance in adults. Then, once the child learns to be independent, they can take the initiative to explore and play in their world (think of the imaginative play that preschoolers are known for!) - success at this stage of development translates into motivated, goal-directed behavior in adults. Finally, now that the child has both independence and the urge to do things, they can be industrious (keep in mind all of the work, academic and social, that happens for school-age children) - success at this stage translates into competence and achievement in adults.

A therapist has been working with a client with Borderline Personality Disorder for several months with minimal progress; the client has had periods of suicidal ideation, erratic and intense personal relationships, and is in danger of being fired at work due to an all-or-nothing attitude. The therapist is considering terminating with the client and referring the client to a new therapist, but would like to use her monthly consultation group to process the case. What should the therapist do FIRST? A. Tell the client at the next session that the case will be discussed by the consultation group B. Ensure that the informed consent provides for this disclosure C. Proceed with the consultation while keeping identifying details of the client's identity confidential D. Explore the potential benefits of the consultation with the client at the next session

I'm going to admit here that I kind of agonized over this question — whether or not it really represented what I wanted it to, and whether or not I got the answer right myself! The best answer here, though, is B: ensure that the informed consent provides for this disclosure. In many cases, the section of the informed consent that deals with treatment processes and procedures (or the purpose of the services) contains a subsection that deals with supervision and/or consultation. Befo re the therapist takes any other step, she should ensure that the informed consent covers the consultation. If it does, then the therapist could proceed with A or D (D is probably a better option). If it doesn't, the therapist would have to obtain consent to proceed with the consultation; C is not a good answer choice in either case. The NASW Code of Ethics gives the following guidelines regarding informed consent (this is not the entire text — for the entire text, visit: https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English): "Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a thirdparty payer, relevant costs, reasonable alternatives, clients' right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions." Similarly, in an article for CAMFT, Michael Griffin, J.D., LCSW, discusses the standards in the AAMFT's Code of Ethics: "Marriage and family therapists obtain appropriate informed consent to therapy or related procedures as early as feasible in the therapeutic relationship, and use language that is reasonably understandable to clients. The content of informed consent may vary depending upon the client and treatment plan; however, informed consent generally necessitates that the client: (a) has the capacity to consent; (b) has been adequately informed of significant information concerning treatment processes and procedures; (c) has been adequately informed of potential risks and benefits of treatments for which generally recognized standards do not yet exist; (d) has freely and without undue influence expressed consent; and (e) has provided consent that is appropriately documented. When persons, due to age or mental status, are legally incapable of giving informed consent, marriage and family therapists obtain informed permission from a legally authorized person, if such substitute consent is legally permissible." The full text of this article can be found here: http://www.camft.org/AM/Template.cfm?Section=Michael_Griffin&CONTENTID=10497&TEMPLATE=/CM/ContentDisplay.cfm

A 43 year-old woman begins working with a therapist, reporting significant issues in both her personal and professional relationships that have begun over the past month. During the initial session, the therapist has difficulty following the client's train of thought, and despite several redirections, cannot keep the client focused on the question or topic at hand. Which category in the mental status exam BEST captures these observations? A. Thought Content B. Abstract Thinking C. Associations D. Perceptions

I'm hoping it comes as no surprise that the correct answer is C, Associations. The stem refers to a person who is exhibiting flight of ideas and tangential speech, both of which indicate a problem with the flow of the client's thoughts (this may be why she's having relationship issues). While there's no guarantee that the mental status exam will come up on YOUR exam, understanding and utilizing these categories can give you important information about your clients and can occur without using any kind of formal instrument — most of it only requires that you be observant during interactions. Even though it will give the answer away, let's go through each of the answer categories above and consider them. So what's covered under Thought Content? A therapist might record things like delusions, general paranoia, and preoccupations in this category. You could think of this simply as "what the person is thinking about." How about Abstract Thinking? This is always one that I need reminders on, because sometimes it can be tricky for me to recognize. Abstract thinking is the ability to see a specific example of something and draw from it a general principle that can be applied to other situations. The classic way to test this in the mental status exam is through the use of familiar proverbs ("Don't look a gift horse in the mouth"). If the client explains the meaning of this proverb literally (like saying that the proverb means you shouldn't look animals in the eye), it tells you that their abstract thinking is compromised. Moving on to Associations: this is a category where you use the client's flow of speech to understand their flow of thoughts. Things like flight of ideas (bouncing from one topic to another with no logical connection) and tangential speech (answers that don't relate to the question asked) are captured in this category. Finally, let's look at Perceptions. This category tries to assess the accuracy of the person's senses (Do they hear things accurately? Do they see what's presented to them?). This is the category in which hallucinations or illusions would be evident.

A 19 year-old male arrives at a community mental health clinic in a state of agitation. He reports to the intake social worker that both of his parents were killed in an automobile accident a week ago, and he has been unable to sleep since then. He has no siblings or extended family in the area and is overwhelmed by the prospect of planning funerals for both of his parents. He reports that the funeral home has been contacting him, but he has been avoiding the calls because he cannot make a decision about what to do. What should the social worker do FIRST? A. Refer the client to a psychiatrist for a medication evaluation B. Teach the client relaxation skills to help him sleep C. Conduct a brief assessment and begin crisis intervention D. Assist the client in contacting the funeral home to discuss arrangements

If this comes up on the social work exam the best answer choice is, in this case, C, since the client appears to be experiencing a crisis. Answers A, B, and D may all be part of the action plan associated with the crisis intervention, but would not be the social worker's best FIRST step. According to the Social Work Dictionary, a crisis is defined as "a term social workers use in two ways: (1) an internal experience of emotional change and distress and (2) a social event in which a disastrous event disrupts some essential functions of existing social institutions," (Barker, 2003). In a basic sense, it may be helpful to think of a crisis as any event in which a person's typical methods of coping are inadequate. So, what are the essential steps in crisis intervention? Roberts provides a seven-stage crisis intervention model: lethality assessment, establish rapport, identify problems, deal with feelings, explore alternatives, develop action plan, and follow up (Roberts, 1991). As therapists, our goal is to assist the client in "mobilizing resources and developing plans to overcome the temporary situation," (Eaton & Roberts, 2002). It is not long-term treatment and does involve lengthy explorations into the client's past.

Sample Question: A 66 year-old man is referred to a social worker by his adult daughter. During the initial assessment, the man reports poor sleep and increased feelings of hopelessness after being laid off from his job. He goes on to tell the social worker that "things just seem to keep going downhill since my wife died a year ago." What should the social worker do FIRST: A. Refer the client to an employment agency B. Teach the client relaxation skills to help him sleep C. Assess the client for suicidal ideation D. Refer the client to a support group for widows/widowers

In the item above, the correct answer is C, since the stem provides the test-taker with multiple risk factors for suicide. Answers, A, B and D may all be viable options later in treatment, but not until client safety is established. Here's a quick LCSW exam tip: if you're reading an answer set and one of the options includes doing a risk assessment, or asking the client about suicidal feelings, etc., AND the risk of self-harm hasn't occurred to you yet, it's time to go back up to the stem and see if you missed something. While it's never 100%, if assessing for suicide or self harm is in an answer option, there's a good chance the stem gave you some clues of suicidal risk. I'm going to list some of the risk factors that have been linked with a high risk of suicide; these are all things that you can be looking for in test items as an indirect assessment of a person's risk. Taken individually, they may not necessarily point to a risk of suicide, but in conjunction with other factors (such as hopelessness or depression) they indicate a need for a risk assessment and direct questioning about a person's intentions or ideation. Some of the factors associated with a high risk of suicide are: gender (men are more likely than women to complete the act), age (older people are typically more likely than younger people), race (in most cases whites are more likely than any other group), marital status (being married is a protective factor) and life stressors (recent losses, unemployment, isolation, etc.).

A 66-year-old man is referred to a social worker by his adult daughter. During the initial assessment, the man reports poor sleep and increased feelings of hopelessness after being laid off from his job. He goes on to tell the social worker that "things just seem to keep going downhill since my wife died a year ago." What should the social worker do FIRST: A. Refer the client to an employment agency B. Teach the client relaxation skills to help him sleep C. Assess the client for suicidal ideation D. Refer the client to a support group for widows/widowers

In the item above, the correct answer is C, since the stem provides the test-taker with multiple risk factors for suicide. Answers, A, B and D may all be viable options later in treatment, but not until client safety is established. Here's a quick social work exam tip: if you're reading an answer set and one of the options includes doing a risk assessment, or asking the client about suicidal feelings, etc., AND the risk of self-harm hasn't occurred to you yet, it's time to go back up to the stem and see if you missed something. While it's never 100%, if assessing for suicide or self harm is in an answer option, there's a good chance the stem gave you some clues of suicidal risk. Most of us share an understanding of what suicide is: the act of intentionally taking one's own life. Self-harm is not defined in the Social Work Dictionary, but based on the previous idea my working definition is: intentional acts aimed at physically harming oneself. I'm going to list some of the risk factors that have been linked with a high risk of suicide; these are all things that you can be looking for in test items as an indirect assessment of a person's risk. Taken individually, they may not necessarily point to a risk of suicide, but in conjunction with other factors (such as hopelessness or depression) they indicate a need for a risk assessment and direct questioning about a person's intentions or ideation. Some of the factors associated with a high risk of suicide are: gender (men are more likely than women to complete the act), age (older people are typically more likely than younger people), race (in most cases whites are more likely than any other group), marital status (being married is a protective factor) and life stressors (recent losses, unemployment, isolation, etc.).

A woman is referred to her EAP for frequent absences and difficulty completing projects. During the brief interview, she initially deflects questions regarding her marriage, though she reports that her husband was laid off from his job 6 months ago and the couple was forced to move in order for the client to obtain work. The woman becomes tearful when discussing her lack of social support and states that her husband does not "allow" her to go out in the evening or on weekends. She goes on to tell the social worker that she is pregnant, but has not told her husband about the baby. What should the social worker do NEXT? A. Refer the client to a doctor for prenatal care B. Suggest couples treatment to address issues of stress around the move C. Redirect the client back to issues of absence and incomplete job performance D. Assess the woman for domestic violence and help her create a safety plan

In the item above, the correct answer is D, since the stem provides the test-taker with multiple risk factors for domestic violence. A is incorrect because it would follow risk assessment and safety planning, and there is nothing in the stem to indicate that the woman is not receiving prenatal care. B is incorrect as couples treatment would be contraindicated if domestic violence is suspected. C is incorrect because issues of safety warrant immediate attention. As therapists, we want to be on the lookout for clients describing partners who are possessive, sexually jealous, insecure, or controlling. Clients may describe scenarios that highlight their partner's inability to cope with stress effectively or tendency to blame the client or others for their behavior. Substance abuse or dependence may be mentioned. Social isolation and pregnancy are additional risk factors for domestic violence.

A woman is referred to a social worker by her EAP. The referral indicates that the woman is frequently absent from work and has difficulty completing projects. During the initial assessment, the woman avoids answering questions about her relationship with her spouse. The woman becomes tearful when asked about her family and social supports. The woman shares that her husband does not "allow" her to go out in the evening or on weekends. She goes on to tell the social worker that she is pregnant, but has not told her husband about the baby. What should the social worker do NEXT? A. Refer the client to a doctor for prenatal care B. Suggest couples treatment to address issues of stress around the move C. Redirect the client back to issues of absence and incomplete job performance D. Assess the woman for domestic violence and help her create a safety plan

In the item above, the strongest answer is D, since the stem provides the test-taker with multiple risk factors for domestic violence. Answer A is incorrect because our priority is to assess for domestic violence. A referral to a doctor for prenatal care would follow risk assessment and safety planning. Additionally, answer A wrongly assumes the woman is not receiving prenatal care. Answer B is incorrect as we would need to rule out domestic violence before considering couples counseling. Couples counseling is contraindicated if domestic violence is suspected. Answer C is incorrect because issues of safety warrant immediate attention and this answer disregards the red flags raised in the vignette.

A hospital social worker is called to the emergency room and asked to evaluate an 82 year-old woman who was found wandering on the street and picked up by paramedics. She is disoriented and talking rapidly about her son. Paramedics tell the social worker that the woman was "paranoid" and "begging" not to be taken home when they questioned her. What should the social worker do NEXT? A. Contact the woman's caregivers to alert them of her situation B. Evaluate the woman for additional signs of elder abuse C. Recommend antipsychotic medication to address the woman's paranoia D. Refer the woman to an adult day health center to prevent future wandering incidents

In this case, the best answer is B, since the woman is displaying several indicators of possible elder abuse; A would breach the woman's right to confidentiality, C is outside the scope of practice for a social worker and D goes too quickly to action without knowing more about the problem. According to the Social Work Dictionary, elder abuse is defined as" Mistreatment of older people and relatively dependent people, including physical battering, neglect, financial or other exploitation, and psychological harm. Abuse may be inflicted by the older person's adult children or other relatives, legal custodians, or other care providers,"(Barker, 2003). As therapists we would be looking for physical symptoms, like bruises, welts, or unexplained genital infections; psychological symptoms, like unexplained weight loss, depression, paranoia, or confusion/disorientation; and financial symptoms, like hunger, unexplained inability to pay utility bills, or overinvolvement of caregivers in financial affairs.

Clinical A social worker in private practice receives a referral for a 2 year-old girl. During the assessment, the social worker notices that the girl has no functional language, does not respond to prompts from her mother, and sits listlessly while wringing her hands. Her mother is very upset and reports that she doesn't understand her daughter's behavior. She states, "she used to play and have fun...now she can't even feed herself." What is the most likely diagnosis in this case? A. Rett's Disorder B. Autistic Disorder C. Childhood Disintegrative Disorder D. Mixed Receptive-Expressive Language Disorder

It's no surprise then, that in this question, the answer is A, based on the hand-wringing, the receptive and expressive language problems and the loss of previously held social and fine motor skills. We see components of B, C, and D in the stem, but not in the combination needed for any of these to be the best answer. Disorders Usually Diagnosed in Infancy, Childhood, and Adolescence takes up nearly 100 pages in the DSM IV-TR and encompasses 10 different categories of disorders. While you need not memorize every criteria of every disorder (for test-taking purposes OR real life, unless this is your niche, and perhaps not even then), it is important to know enough about each disorder to be able to give a differential diagnosis when presented with information. In this case, let's look at Rett's Disorder. Right out of the gate, one major distinguishing characteristic of Rett's is that it has only been found in females. So, if a test question is about a male child and Rett's is an answer: cross it out IMMEDIATELY. In terms of criteria, you would be looking for apparently normal prenatal, perinatal and early infant development (for at least the first 5 months). This would be followed by: the loss of previously acquired purposeful hand skills (play or feeding are examples) with the subsequent development of stereotyped hand movements (hand wringing is a BIG clue in test questions); loss of social engagement early in the course; appearance of poorly coordinated gait or trunk movements; and severely impaired expressive and receptive language development with severe psychomotor retardation. There is also the criteria of normal head circumference followed by a deceleration of head growth, but most clinicians aren't going to measure a client's head or have access to this information, so I think we can safely let ourselves off the hook in terms of what we commit to memory.

A 47 year-old man seeks services from a social worker for symptoms of depression. In the initial session, the man reports that he has had difficulty sleeping, has been feeling hopeless, and has been suffering from near-constant headaches since losing his job a month ago. After completing a risk assessment, what should the social worker do NEXT? A. Refer the client to a job-placement program B. Refer the client to a psychiatrist for a medical evaluation C. Initiate cognitive behavioral therapy to address the client's depression D. Refer the client to a primary care physician for a medical evaluation

It's probably no surprise that the answer to the question above is D. The difficulty sleeping and headaches give the social worker a clear indication that a medical referral is necessary. A, B, and C are all good interventions, but would not occur until a medical condition is ruled out or addressed. One other hint: If you are presented with a similar question and the option to send your client to a primary care physician or a specialist, go for the primary care doctor first (unless the stem indicates the client has already been) — a primary care physician would then make a referral to a specialist once other medical conditions were ruled out. It's probably no surprise that the answer to the question above is D. The difficulty sleeping and headaches give the social worker a clear indication that a medical referral is necessary. A, B, and C are all good interventions, but would not occur until a medical condition is ruled out or addressed. One other hint: If you are presented with a similar question and the option to send your client to a primary care physician or a specialist, go for the primary care doctor first (unless the stem indicates the client has already been) — a primary care physician would then make a referral to a specialist once other medical conditions were ruled out.

A therapist with a previous private practice is getting ready to move out of state and is packing up her office. It's been 5 years since she's actively seen clients, but she still has boxes of records and client files. What is the MOST appropriate course of action for the therapist to take? A. Consult state guidelines regarding keeping and disposing of records B. Ensure the records are disposed of appropriately C. Keep the records for an additional 2 years to comply with federal guidelines D. Consult with a colleague to ensure ethical practice

Regardless of where you live, the correct answer to the question above is A: consult state guidelines regarding keeping and disposing of records. B is no the best answer because state guidelines might require keeping the records longer than 5 years (like Cali). C is not the best answer, even if you are in California, because it references federal guidelines which, to my knowledge, don't exist. And D is not the best answer because a colleague may not know the proper state regulations and guidelines; it's better to go directly to the source on an issue like this that has a clear "right" answer. The social work exam or MFT exam that you're preparing for might ask questions about what to include in the record, who has rights to the record, what to release when a client requests information from their record, or what to do with a record after a client dies. The question above, though, speaks to the issue of how long you need to keep the record — and the answer's actually simple: it varies. If you happen to be taking the social work exam or MFT exam in California, then you probably already know that the answer for you is 7 years. But if you're preparing for the National social work exam or MFT exam, then what you need to know is that how long records are kept varies state-by-state and your responsibility is to learn your individual state's regulations and guidelines in preparation for clinical practice.

Clinical During an initial appointment, the social worker asks a husband and wife their reasons for seeking treatment. The wife hesitantly tells the social worker that it is because of "bedroom issues." Her husband cuts in and states that approximately a year ago, his wife seemed to lose interest in him sexually and that nothing he has done has been able to change this; he ends by saying, "I think she's having an affair." The wife insists, "I'm not cheating on him! It's not that I don't want to have sex with HIM, I don't want to have sex with ANYONE. I just don't feel that way anymore." What is the most likely diagnosis in this case? A. Sexual Aversion Disorder B. Female Sexual Arousal Disorder C. Hypoactive Sexual Desire Disorder D. Dyspareunia

Sexual and Gender Identity Disorders are broken down into 3 groups: Sexual Dysfunctions (all of the above fall into this category), Paraphilias, and Gender Identity Disorders. With the exception of Pedophilia (which should be pretty easy for most of us to remember), all of the Paraphilias end with "ism", which can help you identify them readily on the test. Sexual Dysfunctions all involve a disturbance in sexual desire or the sexual response cycle which causes marked distress and interpersonal difficulty. Paraphilias are characterized by recurrent, intense sexual urges, fantasies or behaviors that involve unusual objects, activities or situations, and cause significant distress or impairment. Gender Identity Disorders are characterized by strong and persistent cross-gender identification combined with a persistent discomfort with one's assigned sex. Answer: C is the correct answer; Hypoactive Sexual Desire Disorder is characterized by persistent and recurrently deficient (or absent) sexual fantasies and desire for sexual activity (the person does not have the desire to engage in sexual activity). A is not the best answer because Sexual Aversion Disorder is characterized by an extreme aversion or avoidance of all (or most) genital sexual contact. B is not the best answer because Female Sexual Arousal Disorder is characterized by persistent or recurrent inability to attain or maintain the physiological responses associated with sexual arousal. D is not the best answer because Dyspareunia is characterized by genital pain associated with sexual intercourse.

A 16-year-old girl and her parents are referred to a social worker by the child's pediatrician for concerns around social anxiety and depression. The family resides in a state where parental consent is required for treatment of anyone under the age of 18. What is BEST practice for the social worker during the initial session with the girl and her parents? A. Obtain written consent from the parents and discuss with the daughter how confidentiality will be maintained. B. Obtain written consent from the parents, obtain verbal consent from the daughter, and discuss confidentiality considerations with both the parents and daughter. C. Obtain written consent from the parents, obtain verbal consent from the daughter, and discuss with the parents how confidentiality will be maintained due to the daughter's age. D. Obtain written consent from the daughter, obtain verbal consent from the parents, and discuss confidentiality considerations with both the parents and daughter.

The Correct Answer is B A is incorrect because while we do want to obtain consent from the parents, we don't ever want to only discuss how confidentiality will be maintained; rather, we also want to discuss the very real limits of confidentiality. Additionally, this answer fails to acknowledge the parents right to having some information about progress in therapy as the ones who consented to treatment. C is incorrect because, again, we cannot simply keep all things confidential for a minor if the parents are the one who consented to therapy. There are limits to confidentiality and the parents have the right to some information about their child's progress in therapy. D is incorrect because written consent is needed from the parents since they live in a state where parental consent is required for therapy with minors. B is our best answer because it does three important things: 1. It acknowledges that the parents are the ones who need to formally complete consent forms. 2. It also has the daughter provide verbal consent for her therapy. While this is not required, it is best practice. 3. It has the social worker discuss confidentiality considerations with both the parents AND the daughter, which is crucial when working with minors (especially teens!). This discussion can include both what will be kept confidential between the minor and the therapist and what will be shared with the parents and why. When working with minors and their parents, this is always a discussion you want to have at the very beginning of therapy with both parties present so that everyone is on the same page. This way there (hopefully!) won't be any surprises for the parents or the teen when something is (or is not) shared.

A social worker has been meeting with a 30-year-old female client for a year. The client enters her most recent session visibly upset. Clenching her fists, the client angrily reports that she found out her boyfriend has been cheating on her with her best friend for the past several months. She states, "Honestly, I could just kill them both right now." What should the social worker do FIRST? A. Inform the client that she must warn the boyfriend and best friend and notify the proper authorities B. Immediately stop the session and call the police. C. Discuss voluntary hospitalization D. Explore whether the client plans to kill them

The Correct Answer is D In the question stem, the client made a concerning statement that warrants further exploration. Immediately contacting the boyfriend, best friend, and proper authorities (A) or stopping the session to contact the police (B) is jumping a step too far ahead. We do not yet know if the client actually plans to harm them in any way, or is simply upset about the infidelity. We do not want to jump to action without gathering information first. Nothing indicates a need to hospitalize the client (C). What we want to do FIRST is figure out whether the client actually intends to cause any serious physical harm to her boyfriend or best friend (D). If she does, then we can go ahead and do A.

Clinical A social worker at a VA clinic is assigned a new client: a 26 year-old male who was sent home after a roadside bomb killed several members of his unit 3 weeks ago. Since the explosion, the man has been unable to sleep and has been refusing to sit in the front seat of the car. When the social worker asks about the event, the man reports that he has no recollection of what happened but feels panicked and irritable most of the time. What is the most likely diagnosis in this case? A. Acute Stress Disorder B. Post Traumatic Stress Disorder C. Panic Disorder D. Generalized Anxiety Disorder

The answer is, in this case, A. The stem tells us that the time frame has only been 3 weeks and that the client is experiencing a sleep disturbance (increased arousal), refusal to sit in the front seat (likely avoidance), irritability and feelings of panic (more arousal), and lack of memory around the event (dissociative amnesia). None of the other diagnoses fit here. So, what are the major differences between Acute Stress Disorder and Post Traumatic Stress Disorder? The major difference is time frame: symptoms of Acute Stress Disorder last between 2 days and 4 weeks and have to occur within 4 weeks of the traumatic event; symptoms of Post Traumatic Stress Disorder last more than 1 month and can occur at any time after the traumatic event (there's even a "delayed onset" specifier for cases in which onset of symptoms is at least 6 months after the event). In addition, according to the DSM-IV-TR, Acute Stress Disorder involves the experience of dissociative symptoms during or after the event, which can include depersonalization, numbing or dissociative amnesia. The two disorders do share the 3 major components of: persistent reexperiencing of the trauma, persistent avoidance of stimuli associated with the event, and persistent symptoms of anxiety/increased arousal.

In an initial session with a therapist, a 42 year-old man reports feelings of nervousness and difficulty sleeping. When the therapist attempts to clarify the client's feelings, he begins discussing conflicts with coworkers and an increase in arguments with his wife. He goes on to report that he's been thinking about going back to school for an advanced degree but can't make a decision and would like the therapist's help. What should the therapist do NEXT? A. Refer the client for a psychiatric evaluation B. Assist the client in prioritizing treatment objectives C. Teach the client stress-reduction techniques D. Validate the client's feelings of anxiety

The answer to the above question is B; the client is presenting with a list of problems and symptoms of anxiety, which means that helping him prioritize treatment objectives should be a first step in helping reduce anxiety and focus treatment. A is not the best answer because the stem gives you no indication that the severity of the client's symptoms would warrant a psychiatric evaluation. C is not the best answer because this intervention would typically occur a bit later in treatment — after treatment objectives had been established. D is not the best answer because validating feelings of anxiety only addresses one piece of what the client is giving you, and it may only serve to increase the client's feelings of anxiety. While there are no hard and fast rules about which interventions occur when, you can think about the stages of treatment and the interventions that typically occur in each stage. It helps to create associations between specific words and the stage in which they usually occur — that way when you look at a stem or answer options, you can more easily rule out or rule in particular choices. Let's just think about the beginning stage of treatment. While this list is by no means exhaustive, here are some of the terms that I associate with the initial stage of treatment: joining, trust-building, assessing, prioritizing, goal-setting, objectives, treatment planning, problem identification, reason for referral. When the stem refers to the beginning stage of treatment, you may want to look for these words in your answer choices, BUT it's important to remember that just because an answer starts with the right word doesn't mean it's the BEST answer.

Clinical A social worker in a community mental health clinic begins an intake on a 22 year-old male. During the course of the intake, the social worker learns that about 2 months ago, the client had a 2 week period in which he experienced paranoid delusions about his neighbors and auditory hallucinations. While he reports that he has had no symptoms since then, the client's affect is blunted, he speaks in a monotonous voice and when prompted, reports that he still has not gone back to work and has gained 15 pounds. What is the most likely diagnosis in this case? A. Brief Psychotic Disorder B. Schizophreniform Disorder C. Schizophrenia D. Delusional Disorder

The answer to the question above is B; while the client's positive symptoms only lasted two weeks, it appears that he is still suffering from negative symptoms, which means his total episode is in the 1-6 month time frame of Schizophreniform Disorder. Schizophrenia, Schizophreniform Disorder, and Brief Psychotic Disorder all have similar symptom profiles, but differ in their duration of symptoms and in some of the fine details. In Brief Psychotic Disorder, the episode lasts for more than 1 day, but less than 1 month, and lacks the characteristic "negative" symptoms seen in the other two disorders; in addition, the person returns to premorbid functioning . In Schizophreniform Disorder, the episode (including prodromal, active phase, and residual phase) lasts for at least 1 month but less than 6 months. If the episode persists beyond the 6 month mark, a diagnosis of Schizophrenia is warranted. It is important in these disorders to rule out a substance abuse or general medical condition that could be causing the psychotic symptoms.

After 10 years together, a couple decides to seek treatment for increasing tension and feelings of disconnection and anger. They meet with a therapist and decide on a course of treatment that includes weekly sessions and homework. After several sessions, one partner calls the therapist and admits to having a long-term affair; the partner pleads with the therapist not to say anything and states a plan to end the affair to focus on the relationship. What should the therapist do NEXT? A. Explore the partner's reasons for telling the therapist about the affair now B. Validate the partner's feelings and encourage the partner to disclose the information before the next session C. Remind the partner of the therapist's no-secrets policy and the need to address this issue in session D. Clarify the partner's plan to end the affair and explore the impact on the current relationship

The answer to the question above is C; this is the ethical response and ensures that the therapist doesn't get pulled into a conflict that has the potential to completely derail treatment. A is a pretty good answer, but would not occur before C; likewise, the therapist might at some point do D, but not as a first step. B is not the best answer because encouraging the client to disclose the information before the next session may cause harm and result in abrupt termination. Knowing your discipline's code of ethics and really understanding its application can give you a huge advantage on the exam - and make you a better therapist (which is what we're really here for, right?). This is not the most creative question I've ever written - in fact, it's aclassic question that might get asked on an exam. The famous "no-secrets policy" is a concept that you should be very familiar with, as well as the ethical response to a situation like the one described above. Contrary to it's name, a no-secrets policy doesn't mean that everything shared in an individual session or phone call will be shared with the other partner - that would be pretty wild! What it does mean, is that the therapist won't keep a secret on behalf of one partner that has the potential to damage the couple's relationship or ability to benefit from treatment. In some cases, this may mean facilitating a disclosure at the next session, and in other cases, it may mean working with the individual over time to work up to a disclosure.

A 17-year-old client with a diagnosis of Bipolar Disorder comes to a first session with her parents. The mother informs you that their daughter met with a psychiatrist who prescribed medication, but the family's faith prohibits her from taking it. The parents tell the therapist they have been trying to "rid her of her demons by praying and relying on our faith." You notice that the girl appears disheveled, is frequently distracted during the session, and seems agitated. What actions should the therapist take in this case: A. Report the situation to CPS because client is a minor and she is not receiving proper treatment B. Initiate involuntary hospitalization since the client is exhibiting clear signs of psychosis C. Begin treatment with the client and maintain confidentiality due to religious exemptions with child abuse reporting D. Explore the pros and cons of taking psychotropic medications with the parents and their daughter, while acknowledging their religious rights.

The best answer choice in this situation is D. You likely ruled out answer B, since we would only initiate a 5150 (involuntary hospitalization) if there were a grave concern for the client's immediate safety, something that is not indicated based on the information shared. Answer C can also be ruled out, since it completely overlooks several of the key concerns specifically noted in the question stem. Namely, the potential risks facing the client and medication compliance. This leaves us with options A and D. As the law indicates, if a child is receiving treatment by religious means, or not receiving treatment due to religious reasons, this does not necessarily constitute neglect. In this case, the child is receiving care, has been seen by a psychiatrist and is now seeing a therapist—the parents have just decided against psychotropic medication for religious reasons. In addition, failure to take the medication is not a life or death decision. For these reasons, we would not choose A. This leaves us with answer D, which gives us an opportunity to have an honest conversation with the family regarding medication while still respecting the family's religious beliefs. This answer addresses all of the concerns mentioned in the question stem. This scenario is particularly challenging because the law is a bit vague when it comes to child abuse reporting and religious freedom. If religion were not mentioned in this question, we would search for an answer that includes reporting neglect and be justified in doing so. However, religion is mentioned and the parents state medication is expressly prohibited within their religion. This makes choosing the right answer trickier. According to the Child Abuse and Neglect Reporting Act, "a child receiving treatment by spiritual means...or not receiving specified medical treatment for religious reasons, shall not for that reason alone be considered a neglected child (CA Penal Code 11165.2)." With this in mind, let's evaluate our answer choices.

During an initial assessment with a 7-year-old boy, a therapist observes that the boy is small in stature and appears listless and gaunt. He is difficult to engage in play and mostly unresponsive to questions about school and friends. The therapist notices that the boy is trying to sneak candy from a dish into his pockets. What should the therapist do NEXT? A. Comment on the child's behavior B. Call in the boy's mother to tell her about the behavior C. Assess for further signs of child neglect D. Make a note of the behavior and intervene if it is repeated

The best answer choice is, in this case, C, since the child in the question is presenting with several indicators of possible child neglect. Answers A and C do not address the potential seriousness of the situation; answer B may be included in your assessment, but is not enough by itself. According to the Social Work Dictionary, child neglect is defined as "The failure of those responsible for the care of a minor to provide the resources needed for healthy physical, emotional, and social development. Child neglect is seen as an act of omission by caregivers because of limited abilities or resources or other circumstances; it is differentiated from child abuse, which is seen as more willful," (Barker, 2003). So, what are some indicators of child neglect? As clinicians, we would be looking for developmental indicators, like a delay in social or motor development; physical indicators, such as poor weight gain, failure to thrive, or a protruding abdomen; or emotional/behavioral indicators, such as self-stimulatory behaviors (instead of seeking out adults for comfort), chronic drowsiness, hoarding or stealing food, social withdrawal or awkward peer relationships.

The best answer choice is, in this case, C, since the client appears to be experiencing a crisis. Answers A, B, and D may all be part of the action plan associated with the crisis intervention, but would not be the social worker's best FIRST step. According to the Social Work Dictionary, a crisis is defined as "a term social workers use in two ways: (1) an internal experience of emotional change and distress and (2) a social event in which a disastrous event disrupts some essential functions of existing social institutions," (Barker, 2003). In a basic sense, it may be helpful to think of a crisis as any event in which a person's typical methods of coping are inadequate. So, what are the essential steps in crisis intervention? Roberts provides a seven-stage crisis intervention model: lethality assessment, establish rapport, identify problems, deal with feelings, explore alternatives, develop action plan, and follow up (Roberts, 1991). As therapists, our goal is to assist the client in "mobilizing resources and developing plans to overcome the temporary situation," (Eaton & Roberts, 2002). It is not long-term treatment and does involve lengthy explorations into the client's past.

A social worker meets with a couple seeking treatment due to an increase in tension and arguments. During the assessment, the wife reports that she has been on Oxycontin since having back surgery a year ago. When the social worker asks follow up questions, the wife admits that she has been taking more than the prescribed dose and that she gets "sick" if she misses a dose. What should the social worker do FIRST? A. Explore how the wife's medication use is affecting the couple's relationship B. Teach the couple communication skills to manage arguments more effectively C. Complete a comprehensive assessment of the couple's overall functioning D. Refer the wife for a substance abuse assessment

The best answer choice is, in this case, D, since the client is reporting problems in her relationship, use of a substance, and possible symptoms of withdrawal. A, B, and C might all be part of a viable treatment plan, but only after the substance abuse issue is addressed First, some clinical definitions: Substance Abuse A maladaptive pattern of using certain drugs, alcohol, medications, and toxins despite their adverse consequences. Substance Dependence Continued use; craving; and other cognitive, behavioral, and physiological symptoms that occur through the use of certain drugs, alcohol, medications, and toxins. Some symptoms include being preoccupied about the substance; taking greater amounts than intended; making persistent efforts to control its use; reducing occupational and social activities; and continually using the substance despite recognizing that it is causing recurrent physical, psychological, or social problems. Tolerance and withdrawal are essential. Oxycontin, along with morphine, heroin, codeine and many others, are all under the category of Opiods. Symptoms of Opiod Intoxication include: papillary constriction (or in extreme overdose cases, dilation), drowsiness or coma, slurred speech, and impairment in attention or memory. Symptoms of Opiod Withdrawal include: dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea (runny eyes or nose), papillary dilation,, diarrhea, yawning, fever, and insomnia. It is essential, in cases where a client is exhibiting signs or symptoms of substance abuse or dependence, to facilitate a substance abuse assessment and treatment before further mental health treatment is initiated. In most cases, this will mean a referral to a clinician specializing in the assessment and treatment of substance-related disorders.

A 46-year-old man who emigrated from Ecuador eight years earlier has been in therapy for several months to address symptoms of anxiety and difficulties with sleep. During the first month of treatment, the therapist developed a good rapport with the client and collaboratively identified goals for treatment. The client's chief complaint is that he is up most evenings with his mind racing about finances, and his family that is still in Ecuador, including his inability to care for his aging parents who are so far away. The client shares that due to the lack of sleep he has been exhausted at work and is constantly scared he is going to lose his job. Which of the following actions would a Cognitive Behavioral Therapist utilize in the middle stage of treatment? A. Practice diaphragmatic breathing in sessions with the client and discuss how he can integrate these skills into his daily routine to decrease anxiety levels. B. Utilize an automatic thought record on a daily basis to better understand cognitive distortions and develop healthier alternative thoughts. C. Ask the client to identify times when his anxiety did not interfere with his sleep and compliment his ability to use successful techniques. D. Educate the client about the different cognitive distortions and collaboratively identify those he is employing that cause his anxiety and sleep disorder.

The best answer in this situation is answer B. Answer (A) is something a CBT therapist would do and it is an appropriate intervention to use based on the presenting issue, but this would be more suitable to earlier stages of treatment. Remember, by the middle stage of treatment we've already laid the foundation for making change happen. This means we already would have identified ways for the client to integrate relaxation techniques into his daily routine. Answer (D) is wrong for a similar reason. Again, this is an intervention that would likely be used by a CBT therapist and it makes sense based on the information shared in the vignette. However, by the time you are in the middle stage of treatment, the client should already have an understanding of cognitive distortions. Answer (C) is wrong for a different reason. Similar to answers (A) and (D), this intervention would properly address the client's anxiety, but it is more closely associated with Solution Focused therapy, not CBT. Answer (B) is the best option available. The client would have learned how to use an automatic thought record at the onset of treatment, and would continue to utilize it through the middle stage of treatment. This intervention addresses the client's chief complaint, it is strongly linked to CBT, and it would be used in the middle stage of treatment. There are three parts to the question being asked (actions, CBT, and middle stage) and this is the only answer option that correctly addresses all of them.

A social worker is a vocal supporter of a local politician running for office. The social worker makes several posts on her personal social media page that speak negatively about the opposing candidate and his party. A client that the social worker has been meeting with for several months leaves a voicemail referencing these posts and exclaims, "I didn't know I was being counseled by some left wing nut job." What should the social worker do to avoid future situations like this? A Modify their social media settings so clients are unable to see their personal/political posts. B Discuss their political views at the outset of therapy to ensure they align with their clients' values. C Trust that clients should not be viewing their personal social media pages. D Acknowledge that this is an unavoidable occurrence and address it on a case by case basis.

The best answer for this question is A. The COE states that social workers should be aware that posting personal information can cause harm to clients. Social workers need to be cognizant of what they are posting that could be seen by clients and could subsequently damage the therapeutic relationship. Personal social media posts should be kept on private settings (A). It is inappropriate for the social worker to discuss their political views with clients (B). We cannot control what our clients choose to search on social media sites (C). It is important to keep in mind that anything we post publicly online could be seen by a client. This is not an unavoidable situation (D). While we cannot keep our clients from searching for us on social media, we can control what we choose to post privately vs. publicly and should be mindful of what we post.

A therapist meets with the parents of a 16-year-old boy who was recently suspended from school after being caught with alcohol on campus. The parents share that their son has been fighting and abusing alcohol for several years. The father cries as he expresses his sadness and frustration, noting his son's behavior has caused a serious strain in his relationship with his wife and that is why they are seeking therapy. The wife nods in agreement, sharing their lack of intimacy and constant arguing that she hopes to address through therapy. The wife states, "our son had a difficult childhood because his sister was constantly sick and he didn't get the attention he needed. My husband is too hard on him, he treats our son terribly." Which of the following goals should be included in the treatment plan for this case? A.Improve problem solving and conflict resolution between parents; Refer parents to Al Anon; Increase intimacy between parents B.Improve problem solving and conflict resolution between parents; Refer son to Alcoholics Anonymous; Increase levels of empathy between parents C. Increase positive communication within the family; Refer son to Alcoholics Anonymous; Increase levels of empathy between parents D. Increase positive communication within the family; Refer parents to Al Anon; Increase intimacy between parents

The best answer for this question is A. The question is asking which goals should be included in the treatment plan for this case. This question is not only testing your ability to identify appropriate goals for therapy, but also is ensuring you are able to understand who comprises the treatment unit. The parents are in the room and although they are having problems with their son, he is not part of the therapy and thus goals should not focus on him. The issues presented by the parents include arguing, lack of intimacy, and conflict due to their son's behaviors. Answer A directly addresses the parents expressed concerns about their relationship and a referral to Al Anon, a support group for family members coping with loved ones abusing alcohol, would help them to understand how alcohol abuse affects their family and their relationship. Answer B and C both include referrals for the son, which is inappropriate since the son is not part of the treatment unit. Answer D includes a focus on improving communication within the family, but again this is incorrect because the entire family is not working with the therapist.

A social worker has been meeting with a 24 year old woman for the past two months. The client presented with issues of anxiety, depression, and "ongoing relational difficulties." The client is closed off and shares very little in session and the social worker is struggling to get the necessary information to complete the client's biopsychosocial assessment. What should the social worker do FIRST? A. Continue meeting with the client and gather information as the client is ready to share B. Address the client's resistance in the next session C. Do a google search of the client to gather pertinent information necessary to complete the assessment and continue meeting with the client and gathering information as she is ready to share it D. Terminate services with the client as it is unethical to continue treating a client you are not making progress with

The best answer for this question is B. The question specifies that the social worker has been meeting with the client for two months without making progress. It is unethical to continue meeting with her as is (A), assuming things will change without addressing her resistance. If this were the first session or two, answer A could be an option, but given that it has been two months, her resistance needs to be addressed. The question is asking what we would do first, so you want to put the answers in order of operation. We want to begin by addressing the client's resistance that is keeping therapy from progressing (B). Once we explore this dynamic with the client we would have a better sense of how to proceed. This is a topic that was discussed during the NASW's webinar last week. Doing a google search of a client without their consent is unethical, as it does not honor their right to privacy. If we plan to include a google search as part of our assessment of the client, this would need to be reviewed during the informed consent. While we would not want to continue providing services to a client who is not progressing, there are several steps we would take before jumping to termination -premature termination would constitute client abandonment. There isn't a reason to terminate yet! We would want to start by addressing the issues or consulting with colleagues before moving to termination.

A social worker has been meeting with a local client using a combination of in-person and teletherapy for the past six months. The client is moving across the country and wishes to continue teletherapy with the social worker. Teletherapy is legal in the state the social worker and client are currently residing in, but not in the state the client is moving to. What must the social worker do? A.Continue therapy because it is legal in the state the social worker is licensed. B. Continue therapy because not doing so would be considered client abandonment. C. Discontinue therapy and help connect the client to services where she is moving. D. Allow the client to determine whether or not she wants to continue therapy.

The best answer for this question is C. The question is asking what the social must do. We cannot continue therapy with the client simply because teletherapy is legal in the state the social worker is licensed (A). The Code of Ethics 1.04(e) states that we must comply with laws governing technology not only in the state we practice, but in the state the client is located as well. This would not be considered client abandonment (B), as the client is the one moving and it is illegal to offer teletherapy because of the local laws in the state the client is moving. We must discontinue therapy services (C) based on our Code of Ethics and the local laws in the state the client is moving to. We can still help the client get connected to local resources to ensure continuity of care. We cannot allow the client to determine whether or not she wants to continue therapy with us (D), because continuing therapy is not a legal or ethical option given local laws and our Code of Ethics.

A social worker meets with a new client who was referred for issues of depression and anxiety. During the assessment, the social worker discovers the client has a long history of binging and purging multiple days per week, and is actively engaging in these behaviors. The social worker has never worked with clients with eating disorders, but thinks it is an area she could be interested in learning more about. What must the social worker do? A. Treat the client, consulting relevant literature and receiving consultation as needed B. Meet with the client for depression and anxiety issues and refer her to a separate therapist for eating disorder treatment C. Refer the client to someone with experience treating eating disorders D. Wait to begin treatment with the client until the client obtains appropriate training in the treatment of eating disorders

The best answer for this question is C. The social worker has no experience in treating clients with eating disorders, so consulting literature and receiving consultation as needed (A) is not enough for the social worker to be considered competent in treating eating disorders. Additional training and experience beyond this would be needed for the social worker to become a competent clinician for clients with eating disorders. A social worker should not meet with the client to treat one issue while referring them to a separate therapist for eating disorder treatment (B). Having one therapist is going to be in the best interest of the client, so referral is a better option than having the client see two separate therapists concurrently. Because of the the social worker's lack of experience in this area, the best option is to refer the client to someone with experience treating eating disorders (C) to ensure the client gets the treatment she needs. The client is in need of treatment now. It would be unethical (and not in the client's best interest) to have the client wait to receive treatment until the social worker obtains the necessary training to effectively treat her (D).

A newly licensed social worker has been meeting with a client for two months. The social worker is concerned with some patterns of disordered eating the client reported and is unsure of how to proceed. The social worker invites her supervisor who specializes in eating disorders to sit in on the next session. The client does not express any concern upon seeing another person in the room. The session is conducted and the therapist and supervisor then meet to explore a treatment plan and appropriate interventions. Having the supervisor sit in on the session can be described as: A. Ethical, because it was in the best interest of the client to have a specialist involved in her treatment B. Ethical, because it was recommended by the supervisor C. Unethical, because the social worker should not be treating a population she does not have experience with D. Unethical, because the social worker did not obtain the client's consent to have a third party in their session

The best answer for this question is D. While it may be beneficial for a specialist to be involved in the client's treatment (A), it is unethical to do so without the client's informed consent. Treatment options, including bringing in a specialist (or referring out to a specialist) should be discussed with the client. It does not state anywhere in the question stem that the supervisor recommends this (B). Further, even if the supervisor recommended sitting in on the session, to do so without the client's informed consent is still unethical. While it may be unethical to treat a client population that the social worker is not trained to treat (C), this is not what makes the scenario presented in the question unethical. Also, while the question stem states that the social worker is unsure of how to proceed with her client who is reporting disordered eating patterns, it does not state that the social worker has no experience treating clients with eating disorders. Having the supervisor sit in on the session is unethical because the social worker did not get the client's informed consent for this to occur (D). The fact that the client "does not express any concern" with the supervisor's presence in the room does not make this treatment decision ethical. If the social worker felt this would be a beneficial step, she should have presented this option to the client and obtained his or her informed consent.

A 50-year-old male client meets with a therapist on the advice of his husband. The client shares that he has been out of work for almost a year, losing his job after his company completed mass layoffs. He reports feeling discouraged by his job prospects, feels lost without a place to go each day, and feels increasing hopelessness with each passing month he is unemployed. He states, "I feel completely useless and am questioning the point of it all. I feel completely dependent on my husband and I know he's sick of being the sole breadwinner." Which of the following actions should the therapist take to assess this client? A. Explore job history, identify existence of somatic concerns, identify familial coping patterns B. Explore job history, determine current risk of self-harm, explore support systems C. Explore mental health history, identify existence of somatic concerns, explore coping mechanisms D. Explore mental health history, determine current risk of self-harm, explore coping mechanisms

The best answer for this question is D. The question is asking which actions the therapist should take to assess this client. With this type of question, it's possible several answer options include items we would want to assess, but we need to prioritize what is most important in this case. We've already noted that the client's expressions of hopelessness and helplessness should raise red flags regarding danger to self. The client is expressing thoughts and feelings that are indicators of potential suicidality. Client safety is our priority and we must immediately assess for risk of harm to self. If an answer does not include a focus on the client's risk of self-harm or suicidality, we can eliminate it. Therefore, answers A and C can be ruled out. This leaves us with answer B) Explore job history, determine current risk of self-harm, explore support systems, and D) Explore mental health history, determine current risk of self-harm, explore coping mechanisms. A strong consideration when assessing risk is the client's prior mental health as well as the coping mechanisms available to the client. These two items included in answer D would help the therapist better understand the client's level of risk based on prior mental health AND help the therapist identify strategies to manage safety. While there is nothing inherently wrong with answer B, the client's job history is not as important a factor to consider, making it the weaker answer choice between B and D. This question provides information that should raise a red flag regarding the client's safety and influence the therapist's priorities for assessment. First, the client reports he is feeling hopeless and helpless, and makes the alarming statement, "I feel completely useless and am questioning the point of it all." With this in mind, let's look at the answer choices and evaluate which answer choice is the best.

Which of the following BEST defines reframing? A. A technique in which the interviewer expresses the idea of what the client has just said so that relevant points are pulled together and emphasized. B. A skill that enables the social worker to seek specificity on what the client is thinking, feeling, and experiencing. C. The act of perceiving, understanding, experiencing, and responding to the emotional state of a client. D. A technique used to help client's understand and consider a problem or behavior from a different context or perspective.

The best answer here is (D). If we take a look at the other potential answers, they are actually all other techniques that are useful when working with client's and good to know for the LMSW exam. (A) best fits the term paraphrasing which can be used to illustrate active listening and a sense of understanding with the client. (B) defines clarification and is used to help the social worker understand what a client is trying to get across. Lastly, (C) defines empathy which is important in developing the therapeutic alliance and understanding how a client feels. All of these terms may show up on the LMSW exam, so it's good to keep them in mind as you study! When working with clients, we often notice that they report feelings or behaviors which are part of a complex schema of unquestioned beliefs. A lot of these beliefs are unhealthy and may be contributing to the client's negative thoughts or behaviors. Reframing can help a client step back from a behavior or feeling and consider the context or lens through which their reality is being created. A simplified way of understanding this for the LMSW exam is by remembering the phrase, "Let's look at this a different way." One example of reframing is by saying, "I wonder whether there have been times where you thought of this experience in a different way?" This can help clients see a problem from a different perspective and in return gain a different sense of meaning or understanding. According to The Social Work Dictionary, reframing can be defined as, "A technique used by therapists to help families (and individuals) understand a symptom or pattern of behavior by seeing it in a different context (Barker, 2003)."

Which of the following BEST defines negative reinforcement? A. The taking away of an unpleasant stimulus to increase certain behavior or response. B. The adding of a pleasant stimulus to increase a certain behavior or response. C. The adding of an unpleasant stimulus to decrease a certain behavior or response. D. The taking away of a pleasant stimulus to decrease a certain behavior.

The best answer here is A. The other possible answers are definitions of (B) positive reinforcement, (C) positive punishment, and (D) negative punishment. These terms are all concepts of operant conditioning, and are terms that could potentially show up on the LMSW exam. One way to remember these terms is by noticing that positive and negative reinforcement are all done to increase a certain behavior, whereas positive and negative punishment are all done to decrease a behavior. When I was studying for the LMSW exam, I found that an easy way to remember a lot of these terms was by thinking of not only the definition of the term, but an example of the term as well. One example of negative reinforcement is when we turn off the alarm clock in the morning. We hear the annoying sound and therefore press the off button (or if you're like me, the snooze button). The alarm will then stop making noise and you hopefully get out of bed. The negative stimulus or event is thus removed and the behavior (turning off the alarm and getting out of bed) increases. Another example is using wind shield wipers while driving in the rain. The rain makes it difficult to see, but if we use our wipers it makes the wind shield clear again and easier to drive. The Social Work Dictionary defines negative reinforcement as, "the strengthening of a response through escape or avoidance conditioning" (Baker, 2003).

The concept of gender roles is BEST defined as: A. An individual's sexual preference or orientation B. The degree to which an individual patterns oneself after members of the same sex C. The behaviors and personality characteristics often attached to an individual because of their sex D. The components, influenced by society, of attraction, behavior, and identity which make up an individual

The best answer here is C because it provides a comprehensive definition by including both the personality and behaviors exhibited by an individual. A is incorrect because it is referring to an individual's sexual identity and B is incorrect because it is referring to a person's gender identity. D is incorrect because the statement is discussing the concept of sexual orientation. The concept of gender roles is pretty interesting because there are so many different theories that define it. An object-relations theorist may focus on the effects that socialization has on gender roles whereas an evolutionary theorist views genetics as the basis for gender development. As you can see, it's pretty confusing, and everyone seems to have a different opinion! Gender roles also vary widely between cultures and therefore when working with client's it is important to determine what gender means to that person as an individual. Depending on a person's culture, where or how they grew up, or even their own individual preference, people all have their own beliefs about what role gender serves in their own life. This separation of gender roles is easily seen if you take a stroll down the toy isle in a store. The girls section is covered in pink princesses, whereas the boys section includes action figures and a lot of blue. It can be difficult for individuals who feel that they don't "fit" into the specific gender role that society has created for them. That is why when working with client's it can be useful to help them define what gender means for them rather than what they think it should mean. According to The Social Work Dictionary, gender roles is defined as, "The behaviors and personality characteristics that are attached, often inaccurately, to people because of their sex" (Barker, 2003).

When working with clients, we often notice that they report feelings or behaviors which are part of a complex schema of unquestioned beliefs. A lot of these beliefs are unhealthy and may be contributing to the client's negative thoughts or behaviors. Reframing can help a client step back from a behavior or feeling and consider the context or lens through which their reality is being created. A simplified way of understanding this for the LMSW exam is by remembering the phrase, "Let's look at this a different way." One example of reframing is by saying, "I wonder whether there have been times where you thought of this experience in a different way?" This can help clients see a problem from a different perspective and in return gain a different sense of meaning or understanding. According to The Social Work Dictionary, reframing can be defined as, "A technique used by therapists to help families (and individuals) understand a symptom or pattern of behavior by seeing it in a different context (Barker, 2003)."

The best answer here is C. C is correct because it better describes a quantitative research study where measurable data is being collected and analyzed. As I mentioned earlier quantitative research uses numerical data and tries to quantify something that is observable. Qualitative research is generally a more exploratory type of research where we are trying to gain insight into a certain phenomenon. This can often be explored through verbal data, such as interviews, focus groups, narratives, or participant observation. On the other hand, quantitative research gathers information by obtaining numerical data through questionnaires, surveys, and measurable data. This is the biggest difference between qualitative and quantitative research. For the LMSW exam it's good to know that qualitative research is a subjective research design and one that seeks to understand why something occurs. The Social Work Dictionary defines qualitative research as, "Systematic investigations that include inductive, in-depth, nonquantitative studies of individuals, groups, organizations, or communities. Examples include field study, ethnography, and historiography" (Barker, 2003).

Which of the following BEST defines triangulation? A. Avoiding sensitive issues by limiting contact with one's family. B. One's ability to separate one's own intellectual and emotional functioning from that of the family. C. When one individual feels distressed or powerless in relation to another person, they bring in a third person to act as a buffer. D. The transmission of emotional problems from a parent to a child.

The best answer here is C. The other terms encompass other family systems theory concepts which are also good to study for the LMSW exam. They include: (A) Emotional Cutoff, (B) Differentiation of Self, and (D) Family Projection Process. Triangulation occurs when two people have problems with one another and one person may "triangle in" a third family member or individual who acts as an ally. Bowen states that people respond to anxiety between each other by moving the focus to a third person which helps to decrease anxiety. While this may decrease anxiety though, it doesn't fully resolve the source of the anxiety. Instead, it works as a distraction. One example to help you remember this term for the LMSW exam is when a wife is frustrated with her husband. Instead of telling him, she may instead focus her attention towards her daughter. The wife therefore decreases her anxiety by ignoring the source of it (her husband), and making him an outsider while the wife and daughter are on the inside. The Social Work Dictionary defines triangulation as, "The process in which one individual who feels pressured, distressed, or powerless in relating to another individual brings into the relationship a third person to act as an ally or a distractor. For example, a mother who feels she has too little control over her children brings her father or a grandparent into the scene" (Barker, 2003).

Which of the following BEST defines magical thinking? A. The process of transforming unacceptable impulses or idealizations into socially acceptable actions or behaviors B. The understanding by a child that an object continues to exist even when it can no longer be seen C. The process by which unacceptable impulses are expressed as their opposites. D. A pattern of reasoning during which individuals attribute experiences and perceptions to unnatural phenomena

The best answer here is D. A and C are both defense mechanisms, with A defining sublimation and C defining reaction formation. B is another aspect of early childhood development and defines object permanence. D is the best answer because it illustrates the idea that an individual with magical thinking is attributing their experience or thoughts to causing certain events. According to Piaget's stages of development, magical thinking occurs during the preoperational stage which ranges from ages 2-7. A main component of this stage is symbolic function, which is when a child learns through the use of mental images, language, and other symbols that represent objects that aren't really present. Therefore, kids during this stage are very egocentric and don't understand cause and effect. As a result it is difficult for kids to differentiate between what is fantasy and what is reality. To help you remember this term for the LMSW exam one example is when a child believes that she fell because the sidewalk was mad at her. A second example is a child believing that a parent became sick because they said something mean to them the other day. It takes time for kids to develop the necessary reasoning skills to understand where fantasy ends, and reality begins. Magical thinking can also be seen in adults with schizophrenia and those with paranoid delusions. Examples of this is an individual saying that someone is controlling their thoughts or expressing a belief in paranormal activity. The Social Work Dictionary defines magical thinking as, "The pattern of reasoning and mental imaging in which an individual attributes experiences and perceptions to unnatural phenomena. Magical thinking is often seen in children younger than age 5 and those with schizophrenia. It is the idea that one's thoughts or desires influence the environment or cause events to occur" (Barker, 2003).

Which of the following BEST defines prevention? A. Actions taken to minimize and eliminate social, psychological and other problematic conditions B. The act of directly representing or defending others C. The process of teaching client's and communities about the nature of an illness or problem D. Actions taken by social workers in neighborhood-based agencies to bring information about the availability of services in their home.

The best answer here would be A. B would better fit the term advocacy. C and D put the social worker in more of a psychoeducation role. While psychoeducation can be a part of prevention, it does not best define the term. There are many different types of prevention that are good to know for the LMSW exam. Let's just take a quick look through all of these so that you are able to differentiate between each one. Primary prevention is actions taken to avoid conditions that result in disease or social problems. Secondary prevention includes taking actions that limit problems which have already occurred through early identification and treatment. Lastly, tertiary prevention is when a client is experiencing a problem and rehabilitative efforts are taken to restore function by building upon strengths. Phew, that's a lot of definitions. However, if you look at each of these as building blocks, where one builds upon the next it makes it a little bit easier to remember each one when you're taking the LMSW exam. The Social Work Dictionary defines prevention as, "Actions taken to minimize and eliminate social, psychological, or other conditions known to cause or contribute to physical and emotional illness and sometimes socioeconomic problems. Prevention includes establishing those conditions in society that enhance the opportunities for individuals, families, and communities to achieve positive fulfillment" (Barker, 2003).

All of the following statements describe defense mechanisms EXCEPT: A. Conscious behavior used by the client to protect the client from the influence of the therapist B. Justifying actions or thoughts to make them seem acceptable when unconsciously they are not C. Rejecting or attributing unacceptable aspects of one's personality to another individual D. The process of protecting oneself from anxiety, feelings of guilt, or undesirable thoughts

The best answer here would be A. If we look at the definition provided above we notice that B, C, and D all incorporate various aspects of defense mechanisms. On the other hand, A is discussing conscious behaviors or thoughts, whereas defense mechanisms are on a more unconscious level. That is why as clinicians we need to help client's identify the various defense mechanisms they may use and bring them to a conscious level.\ According to The Social Work Dictionary defense mechanisms can be defined as, "A mental process that protects the personality from anxiety, feelings of guilt, or unacceptable thoughts. Psychoanalytic theories consider such mechanisms to be unconscious" (Barker, 2003). There are many defense mechanisms including, but not limited to: denial, displacement, idealization, compensation, intellectualization, reaction formation, projection, rationalization, and conversion defense mechanisms. Many clients come to us with their walls up and it is our job to help them identify their defense mechanisms and bring them into awareness. While defense mechanisms protect clients from being vulnerable, they also protect clients from feeling and experiencing many good things as well.

Which of the following statements BEST defines life review? A. The process of looking back over one's life in order to analyze themes and address unresolved conflicts. B. A treatment procedure where a client discusses life events in a group setting. C. The process of looking back over one's life in order to address failures and regrets. D. A concept that describes a person's life-long pattern of behavior, predominant roles, and manner of interacting with others.

The best answer here would be A. While B describes some aspects of life review, this would better define the process of reminiscence which focuses on looking back on one's life and is often done in a group setting. C fails to describe the process of resolving conflicts, but rather focuses on an individual's regrets and self-determined failures. D better describes the concept of a life script which may be a theme that comes up during a life review, but this definition focuses more on the concept rather than the process itself.\\ Life review serves many various functions including a way to promote self-understanding, preserve personal and collective history, allow for identification of themes in one's life, and address past conflicts that may be unresolved. By going through this process with a therapist an individual is able to openly discuss events of their past with a more balanced perspective than one may have initially had. These events can then be reorganized and resolved with the help of a therapist in order to promote self-acceptance. While life review and reminiscence are interrelated in some ways, the LMSW exam would want you to recognize that while reminiscence is a look back over one's life, life review in particular focuses on understanding and addressing unresolved conflicts. The Social Work Dictionary defines life review as, "The process of looking back over one's own life, and analyzing it, uncovering the hidden themes, and understanding the meaning of the life. This occurs naturally among most older people, especially those approaching death. Conflicts that were unresolved during earlier years are addressed and dealt with. Reintegration occurs as conflicts are resolved. For some people the life review process is effective and helpful when a therapist facilitates it through a systematic questioning and listening process" (Baker, 2003).

Which of the following BEST defines outreach? A. The act of directly representing or defending others. B. Actions taken to minimize and eliminate social, psychological, or other conditions known to cause or contribute to physical and emotional illness and socioeconomic problems. C. Activities done in communities to bring services and knowledge regarding the availability of services to people in their own environment. D. The act of coordinating services for client's within an agency.

The best answer here would be C. A would better fit the role of an advocate which is another area that community social workers may fill. B better defines the act of prevention, and D is the role that a case manager would perform. All of these are good terms to know as you continue to prepare for the LMSW exam. Outreach is generally done at the local and community level and can be performed in a variety of ways. For clients, outreach can be performed by offering educational programs, assistance as needed, and also serving as a liason between the agency and the client. Outreach can also be done by promoting awareness within a community, organizing events, and working with local law makers to develop legislation. All of these activities, and many more, are a part of the act of outreach. The Social Work Dictionary defines outreach as, "The activities of social workers, especially in neighborhood-based agencies, to bring services and information about the availability of services to people in their homes or usual environment" (Baker, 2003).

Karl, a 46-year-old retail store manager, comes to therapy at the suggestion of his best friend. During the initial assessment, Karl tells the therapist that he is happily married to his wife Nicole and they have two children together: Nina, 9 and Taylor, 16. The reason Karl is seeking help is due to his ongoing frustration with his son. "He never listens to me or my wife. All he wants to do is hang out with his friends, be on his phone, and stay locked up in his room," Karl states. "At this point, we are ready to pull our hair out. Nothing we do works," he adds while requesting new techniques to help deal with Taylor. What initial intervention should the therapist consider in this case? A. Normalize Taylor's behavior as part of a normal adolescent stage of development B. Invite Karl's wife and son to come to therapy since both of them are such a large part of his presenting complaint C. Acknowledge Karl's struggle and comment on how frustrating youngsters can be D. Suggest that Karl come up with a short list of activities that his son enjoys and invite his son to participate in them

The best answer is C. (A) sounds very tempting, doesn't it? After all, there is a good amount of normalizing that we do as therapists and Taylor seems to be exhibiting normal adolescent behavior. It is a good answer indeed, yet picking it would mean that we miss our client's feelings entirely. Our client is telling us how frustrated he is with his son. Telling him that his son is being a typical teenager might make our client feel a bit bad, which is not clinically sound. (B) is also very tempting. It makes a lot of sense to invite his wife into the room with him, since it is the two of them that are having trouble dealing with their son. Inviting Taylor also makes sense, since the whole issue is about him. Wouldn't we want to include him in treatment? Perhaps yes, but not quite yet. This is a step that might come in the middle phase of treatment, but it is not suited for an initial intervention, since again, we miss the client that is sitting right in front of us. (C) is the answer that finally meets our client where he is. It is clear that he is very frustrated with his teenage son, and that is exactly where we are going to connect with him. Such connection will allow us to build rapport and to help the client feel understood and not judged. Bingo! That is a great place to start. It is out of that connection that the future interventions will flow. (D) is putting the cart before the horse. Here we miss the client's personal feelings and rush into making suggestions. You know how the security message on the airplanes encourages us to put the oxygen mask on ourselves first, and only then help those dependent on us? Connecting with Karl would be putting that oxygen mask on the father first. And that, in turn, will help him take better care of his family. Once Karl's feelings are attended to, he and the therapist can come up with solutions together.

A social worker has been meeting with a couple for 6 months to work on issues related to physical intimacy. During a recent session, one partner shares that during recent arguments she has slapped her partner, but notes that it has never left a mark. What should the social worker do?: A Develop a safety plan B Explore what is leading to the physical aggression C Continue seeing them as a couple and refer the abusive partner for individual therapy D Refer each of the clients to individual therapy

The best answer is D. Answer (A) sounds like a good idea, but this is not something you would do if both the victim and perpetrator are present. Safety planning is something you would want to do individually with the victimized partner. Answer (B) is also not something you would do with the perpetrator present. This could also easily lead to victim blaming if you try to identify what the victimized partner did that "made" the other partner engage in physical aggression. When physical violence is present, we do not continue seeing the couple until the physical violence has fully stopped occurring. So, it would not be appropriate to continue meeting with the couple while the abusive partner receives counseling (C). As soon as any physical (or emotional) abuse is reported between a couple, we want to refer each member of the couple to individual counseling with two separate therapists. If and when the physical violence ceases, the couple can return to their couples therapist to continue couples counseling.

Which of the following BEST defines the term hallucination? A. The sudden, temporary change in the normal functions of consciousness, identity, and memory. B. An individual's thoughts or feelings that are inappropriate to the current situation. C. Perceptual experiences of an imagined object or phenomenon that is not really present. D. An inaccurate but strongly held belief retained despite objective evident to the contrary.

The best answer to the above question is C. This is correct because "perceptual experiences" are referring to the sight, sound, smell, touch, and taste that an individual may experience with something that is not really present. A and B are incorrect because they better describe symptoms of dissociation disorder, and dissociation, which is a defense mechanism. Furthermore, D is defining the term delusion which can coincide with the hallucinations that an individual is experiencing. While these two symptoms can often feed off one another making it difficult to determine which came first, they are separate symptoms. It is most likely throughout our career that we will come across clients who experience hallucinations. There are many different causes of hallucinations including, but not limited to, drug use, psychosis, neurological disorders, and even severe sleep deprivation. The most common hallucinations are auditory, however, there are many other ways they can be experienced by an individual including sight, taste, touch, and smell. Command hallucinations are the most dangerous because the individual is being told to do something such as hurt themselves or someone else. Individuals who are experiencing hallucinations should receive medical and psychological attention in order to determine the causes and possible treatments, such as medication. The Social Work Dictionary defines hallucinations as, "An imagined perception of some object or phenomenon that is not really present. Often a symptom of a psychosis, it may involve hearing nonexistent voices (auditory hallucinations), seeing objects that are not there (visual hallucinations), smelling (olfactory hallucinations), tasting (gustatory hallucinations), and touching (haptic hallucinations) (Barker, 2003).

All of the following statements are characteristics of boundaries within the client-therapist relationship EXCEPT: A. Developing a framework that allows for a safe connection based upon the needs of the client B. Maintaining the social work values and ethics C. Allowing for a safe connection based upon what the client wants D. Understanding and recognizing the power imbalance that exists within the relationship

The best answer to the above question is C. While client's may at times push the boundaries based on what they want, it is important to keep in mind what the client actually needs and what will be most beneficial for them and their treatment goals. While we touched upon this briefly already, A is not the correct answer because the needs of the client are identified in this statement which is necessary to create a safe and effective treatment environment. B is not correct because the social work code of ethics state that these values must be upheld in order to avoid conflicts of interest, exploitation, and inappropriate boundaries. Lastly, D is not correct because it is important to understand the power imbalance that inherently exists within the therapeutic relationship. The client is coming to you for your knowledge and expertise (and often help!), which puts their trust in you to create a safe and appropriate environment. Boundaries in the social work profession have a lot of different meanings and can include the boundaries that are within families, boundaries with clients, and even those that we set between our personal and professional lives. Within the client-therapist relationship, professional boundaries can include fee for services, personal disclosure, limits regarding the use of touch, and avoiding dual relationships. Boundaries therefore allow for a safe connection to be created between you and the client, while keeping the client's best interest in mind.

A program director at a community agency receives a directive from the agency's board to cut operating costs related to field-based services. The director is concerned that a reduction in services will lead to an increase in homelessness and crime in the community. What action would BEST address both the board's directive and the needs of the community: A. Consider increasing the number of unpaid interns working under supervision to provide field-based services B. Reduce the number of worker's in the field, while increasing the workload of the remaining workers C. Open community centers where clients can come and receive services in a safe environment D. Appeal to the board to maintain the budget for field-based services and reduce costs elsewhere

The best answer to the question above is A: consider increasing the number of unpaid interns working under supervision to provide field-based services. Utilizing interns in a responsible way can decrease operating costs and continue to provide the community with necessary services. B is not the best answer because it would likely lead to an increase in staff-related problems like burnout, turnover, etc. C is not the best answer because opening community centers would be a costly intervention and clients might not be able to access the services. D is not the best answer because it ignores the question: for you to select an answer that best addresses the board's directive, to reduce field-related costs, while also addressing the needs of the community. If the question was asking what the administrative social worker should do FIRST, or NEXT, then D might be the best answer. While many of us will never inhabit the role of administrator, it's important to understand the role that administrative social workers play, since they often impact our clients in both direct and indirect ways. Administrative social workers have a variety of functions: program management, budgeting, resource development, staff development, program evaluation, and interorganizational relations. Social workers in these roles must think not only about the well-being of clients, but also about the well-being of staff members, the agency, and the community beyond.

A therapist is facilitating a support group for HIV positive individuals. After the third session, the therapist concludes that one group member is inappropriate for the group based on his personal convictions regarding gays and lesbians and repeated efforts to berate other group members regarding their relationships. What should the therapist do NEXT? A. Schedule an individual appointment with the group member to discuss termination and referral B. Encourage the group to respond to the client's efforts to berate them C. Inform the member that he will be referred to a more appropriate group D. Seek consultation regarding the therapist's countertransference

The best answer to the question above is A: schedule an individual appointment with the group member to discuss termination and referral. Since the therapist has determined that the client is not appropriate for the group, the best thing is to schedule time to meet individually with the client to let him know. B is not the best answer because the question states that the therapist has already come to the decision that the client needs to leave the group; asking the group members to respond to the client is no longer relevant. C is not a bad answer, but it's not as strong as A because it doesn't reference meeting with the client individually. D is not the best answer because there is no information in the stem indicating that the therapist is experiencing countertransference. So, what guides clinical decision making when you're working with a group of people and not just one? In some ways, it's very similar to the approach taken when working with couples or families; interventions should go through the group and take into account group process. In many cases, taking group issues outside of the group is counterproductive. An exception to this occurs when the therapist has made a decision about a group member's ongoing participation in the group. In this case, confronting the group member in group, or informing them of their termination in front of the group would be extremely shaming and inappropriate.

A 67 year-old woman approaches a therapist in a community center and requests treatment to address feelings of depression that have developed over the past year. Among other issues, she tells the therapist that shortly after retiring two years ago, her husband of 43 years passed away; she feels like "a third wheel" during social events, has stopped seeing many of her friends, and feels "useless" without a job. In order to help address these feelings, treatment objectives should include: A. medical referral and referral to a support group for widows B. life review and referral to a support group for widows C. life review and medical referral D. referral to a support group for widows and vocational counseling

The best answer to the question above is B. We can rule A and D, since they don't include the aforementioned life review technique. C is not the best answer because there isn't enough in the stem to indicate the need for a medical referral. If the client had presented with physical symptoms, such as sleeplessness, loss of appetite, weight loss, headaches, etc., then a medical referral would be justified, but there's not enough here. This doesn't mean that you wouldn't assess her for medical issues or ensure that she's seeing a healthcare provider appropriately, but the stem describes a psychosocial problem that needs a psychosocial answer. The support group referral will also help connect the client to other people with similar experiences, address feelings of isolation and potentially provide her with coping skills. So, what exactly is this "life review" thing? It's a process in which a person is encouraged to reminisce about their past in an effort to improve psychological health and come to terms with their life. A recent, relatively large randomly controlled trial showed that this intervention was quite effective in treating moderate depression symptoms in an elderly population (you can read about it here: http://www.ncbi.nlm.nih.gov/pubmed/21995889). It can include playing music that is meaningful to the client, looking at photographs or pictures, telling stories, and anything else that facilitates the sharing of memories and experiences.

A 35 year-old black woman engages in treatment with a white therapist to address feelings of depression related to a recent divorce and custody battle. In the initial sessions, the therapist and client connect easily and information for the assessment and treatment plan is gathered. However, in the fourth session the client becomes frustrated when trying to explain the dynamics of her relationship with her ex-husband. What should the therapist do FIRST to address this? A. Remember that black individuals often have more egalitarian roles in relationships B. Be aware of how the therapist's own cultural background affects understanding of the situation C. Acknowledge the client's frustration and clarify her explanation of the dynamics D. Interpret the client's behavior as typical resistance and address it appropriately with the client

The best answer to the question above is B: be aware of how the therapist's own cultural background affects understanding of the situation. Being aware of your own cultural background and biases as a therapist is the first step in understanding and helping your clients. A is a good answer, as it represents a generalization based on research, but is not the BEST answer as it wouldn't be done before the therapist considered his/her own cultural background and biases. Likewise, C is a good intervention, but the therapist should consider his/her own background first. D labels the the client's behavior as resistance, when a genuine misunderstanding may be taking place on the part of the therapist. While being aware of something may not feel active enough, it is often the first thing a therapist must do before moving forward with any given intervention — don't be afraid to select answers on the exam that seem basic if they make sense given the information in the stem. When you come across questions on your LCSW exam or MFT exam that reference a particular cultural group or a more general cultural issue, remember that while research does provide some generalizations regarding cultural groups, there are no "set standards" when it comes to treating clients. In my opinion, while it can be helpful to know and memorize treatment themes for different cultural groups, it's just as helpful to be able to identify the presence of a cultural issue and respond appropriately.

A therapist at a community center is tasked with creating a program to address the social-emotional needs of dual diagnosis clients who have recently transitioned from inpatient to intensive outpatient treatment. In order to develop a successful program, what should the therapist do FIRST? A. Review research on treatment with dual diagnosis clients B. Meet with the clients and gather information about the specific needs of the population C. Consult with agency administrators about budgetary constraints D. Develop a systematic method for evaluating the efficacy of the program

The best answer to the question above is B: meet with the clients and gather information about the specific needs of the population. A, C, and D are all reasonable actions, but would need to be done after the therapist has more information about the specific needs to the clients who will be served by the program. Program development, implementation, and evaluation are all performed by mental health practitioners who at some point studied for licensure exams (just like you!), so while this role may seem disconnected from the job you're performing now, you never know what your (licensed!) future may hold. When you encounter questions on the social work exam that have to do with program development, you can once again call on the experience you have working with individuals in order to find the best answer. When you're working with an individual, often the first step in designing and implementing a treatment plan is identifying the client's specific goals and issues so that you can appropriately address them. Similarly, in order to design an effective program, you need to understand the needs and wants of the population that will be served by the program, otherwise you may create a product or service that never gets utilized.

A 53 year-old woman has undergone a kidney transplant and is getting ready to be discharged from the hospital. Her 64 year-old husband is in a wheel-chair; the woman's doctor recommends that she be discharged to a rehabilitation facility. The woman requests a meeting with her social worker and states emphatically that both she and her husband want her to go home. What should the social worker do NEXT? A. Validate the woman's feelings and explore alternative placement B. Discuss the doctor's rationale for recommending a rehabilitation facility C. Meet with the physician and discuss the woman's discharge preference D. Proceed with discharge plans according to the woman's wishes

The best answer to the question above is C: meet with the physician and discuss the woman's discharge preferences. Because there is a clear difference in opinion, the social worker's first course of action should be to go back to the physician to discuss the woman's preference and try to come up with a plan to move forward that respects her self-determination and ensures her well-being. A is not the best answer because it's vague and coming up with yet another alternative would probably not help the situation (don't be swayed by the word "validate" at the beginning — this isn't always where to start!). B is not the best answer because it disregards the woman's self-determination. D is not the best answer because it may put her health at risk (if she cannot be adequately cared for at home) and it disregards the doctor's medical opinion. Even if you never work in a hospital or medical setting, at some point in your career it's likely that you'll be part of an interdisciplinary team; it's even more likely that at some point your client will have a different opinion than one of their providers and it will be part of your job to bridge that gap and walk the line between client self-determination and client well-being. Both the LCSW exam and MFT exam will be looking for you to balance this and work within the confines of a team. In general, if you come across a question that has to do with medical or hospital social work, keep in mind that a team is in play and that decisions (or changes in decisions) need to go through the team.

A 43 year-old man is referred to a therapist through his company EAP; he has been having difficulty at work following a contentious divorce and subsequent custody battle. In the initial session, he talks about his difficulty finding an affordable house close to his children, his sadness about having only partial custody, and his frustration at colleagues who don't seem to understand why he's been distracted. The EAP has approved 6 sessions of treatment. In order, the objectives for treatment should be: A. refer for legal assistance, teach stress management techniques, problem solve around housing issues B. problem solve around housing issues, teach stress management techniques, refer to single parents' support group C. refer to single parents' support group, refer for legal assistance, teach stress management techniques D. teach stress management techniques, refer to single parents' support group, refer for legal assistance

The best answer to the question above is B; relieving the client's stress related to housing may also decrease his sadness about the partial custody agreement (by giving him easier access to his children when it is his time to care for them). Teaching stress management techniques will also extend beyond the end of treatment and may assist the client in better dealing with workplace issues. The final step of referring the client to a support group may provide him with a longer term forum to express and resolve feelings related to his family situation. A, C, and D are not the best answers for a variety of reasons, but what they all have in common in the referral for legal assistance. While this may seem like a good choice because of the client's sadness and the mention of a contentious divorce, there's nothing in the stem to indicate that the legal situation is ongoing or that the client's stress would be relieved by this referral. Working with a client's EAP (Employee Assistance Program) doesn't have to be tricky — the treatment is typically very time-limited and should produce results that help the client immediately. When you see questions about time-limited interventions or working with an EAP, think about getting the biggest bang for your buck in the shortest period of time. Answers that involve long-term psychodynamic treatment or goals probably aren't a good choice; answers that will help the client after your termination (often linkages to community support or concrete problem-solving) are better choices. Make sure you know what the question is asking and focus on that.

A client and therapist work together for 6 months, at which time the client leaves treatment with no explanation. Several weeks later, the therapist receives a subpoena from a local law firm stating that the client will be the defendant in an upcoming trial and requesting information. What should the therapist do NEXT? A. Provide the information since the client-therapist relationship has ended B. Waive privilege and comply with the request C. Assert privilege and attempt to contact the client D. Contact the law firm and inform them that you have not had contact with the client in several weeks

The best answer to the question above is C: assert privilege and attempt to contact the client. The fact that the client has apparently dropped out of treatment has no bearing on whether or not the therapist should divulge information; we learned in our post on confidentiality (which can be read here) that it extends to situations in which we are no longer in contact with clients, including death. A is not the best answer because the fact that the client and therapist are no longer in contact has no bearing on the therapist's response. Likewise, B and D both violate the client's right to confidentiality in the absence of a threat to the public good or some sort of public danger. So, what is privilege in the context of the LCSW or MFT exams? Well, in the legal context it's shorthand for "privileged information," which the Social Work Dictionary defines as "the premise and understanding between a professional and client that the information revealed by the client will not be divulged to others without expressed permission." It's interesting to note that states are not consistent about the way in which this concept is interpreted, but in many cases, communication is considered privileged unless there is a "risk of public danger or a threat to the public good," (Barker, 2003). In most cases, when a therapists receives a subpoena, the first step is to assert privilege, which in practice means the therapist refuses to provide any information, including knowledge of the client. On the licensed clinical social worker exam, the most notable exception to this is when the request comes in the form of a court order, or a subpoena from a judge. In that case, the therapist is compelled to comply with the request or face a possible contempt charge.

A woman and her children seek case management services at a local agency after losing their housing. The woman meets with the intake worker and begins discussing her oldest son's recent problems in school; she says, "I don't think he's been taking his medication, but with everything that's happened, I'm more concerned with what we're going to eat or where we're going to sleep than his behavior." What should the intake worker do NEXT? A. Refer the woman's son to a psychiatrist B. Recommend family treatment to address the family's needs C. Complete a comprehensive needs assessment to prioritize objectives D. Link the woman to a shelter that can provide family housing

The best answer to the question above is C: complete a comprehensive needs assessment to prioritize objectives. The woman in the stem is presenting with multiple issues: housing, food, her son's behavior, and his psychiatric needs. The first step would be to gain an understanding of the multiple needs and prioritize them so that the woman and the case manager can begin addressing them in order of importance. A, B, and D are all good options, but they would only be appropriate after a needs assessment was completed. Don't automatically assume that case managers only "refer" clients out — don't get tricked into choosing an answer just because it starts with the word that you think should go with the question — use your amazing brain and THINK about which answer makes the most sense in this situation. If you see a question on your LCSW exam or your MFT exam in which clinical case management or coordination of services is mentioned, it's important to really locate the role of the therapist in that particular question. So, what is the role of the case manager or service coordinator? First of all, as with interactions with all clients, our first goal is to engage them and build some kind of working rapport. After that, service coordination is just that: identifying the needs of the client, locating appropriate services to meet those needs, coming up with a plan to link the client to those services, and then monitoring the client's progress and adjusting the plan or services as needed.

A woman self-refers to a social worker at a family agency for difficulties with her daughter. She tells the social worker that despite her best efforts, her 3 year old daughter is tantrumming "constantly". When the social worker asks for additional information, the woman says that the girl throws herself on the floor, cries uncontrollably, and tries to bite family members and classmates several times per day. What should the social worker do NEXT? A. Provide psychoeducation around normal child development B. Initiate individual therapy with the child C. Provide the mother with a referral for parenting classes D. Assess for stressors in the child's environment

The best answer to the question above is D. The stem gives us several clues that the child's behavior is beyond typical. As a clinician, I would initially want to know what else was going on in the child's environment: have there been any changes? How much stress is the child/family subject to? What kind of expectations are placed on the child? A, B, and C may all be reasonable interventions, but not until the therapist understands the context in which the behavior is occurring. Let's think for a minute about "normal" behavior for toddlers. Is it normal for a three year-old to have temper tantrums? Absolutely. Is it within the range of normal for a three year-old to bite another child or caregiver? Maybe. Biting can happen for a whole host of reasons, one of which includes the toddler's struggle to contain and express strong emotions — having language helps, but even verbal children can go through periods of biting. Often, the combination of behavior, frequency, and setting is what pushes what might be considered a typical behavior into the realm of a problem requiring intervention or treatment. Normal child development may be something that you want to review periodically over the course of your exam prep because it involves memorization of factual information and application of interventions based on those facts.

A therapist in private practice completes an assessment for a 42 year-old man and gives him a provisional diagnosis of Generalized Anxiety Disorder. The therapist recommends a medication evaluation and weekly therapy and submits the necessary documentation to the insurance company. Two weeks later, the therapist receives notification that the insurance company has determined that weekly therapy is not medically necessary and will not cover this service. What should the therapist do NEXT? A. Refer the client to an agency that provides low-cost/no-cost services B. Meet with the client and discuss a private-pay agreement C. Inform the client of the company's decision and provide the medication evaluation referral D. Contact the insurance company and advocate for the therapy to be covered

The best answer to the question above is D: contact the insurance company and advocate for therapy to be covered. A and B might both be good options, but only after you had advocated on your client's behalf. C is not the best answer because the stem tells us that weekly therapy has been recommended as part of the client's treatment; the medication evaluation alone is not enough, and sending the client away with that alone would be irresponsible. So, while insurance doesn't always seem exciting, it often presents an opportunity for the clinician to do something exciting on behalf of our clients: fight. As social workers, the first ethical standard in our Code is Commitment to Clients. We are bound to promote the wellbeing of our clients, and in some cases, this means going toe-to-toe with an insurance company that is refusing to cover treatment. MFT's have an almost identical ethical standard: to promote the welfare of clients. It has unfortunately become commonplace for insurance companies to reject claims, or to determine that services aren't medically necessary. But if you, the clinician, have completed an assessment and recommended treatment, you've already decided that treatment is medically necessary and it's your job to reiterate this to the insurance company.

A therapist begins working with a client around issues of career progress and conflicts with employees. The client spends the first two sessions talking negatively about a particular employee who is gay, saying repeatedly, "I wish I could fire him — I just don't want to be around those people, you know?" The therapist, who is also gay, finds himself hoping that the client won't show up for subsequent sessions. What should the therapist do NEXT to address the situation? A. Disclose the therapist's sexual orientation to the client and explore the impact on treatment B. Continue seeing the client without discussing the therapist's sexual orientation C. Manage the countertransference through journaling exercises D. Seek consultation to address the therapist's feelings

The best answer to the question above is D: seek consultation to address the therapist's feelings. A is not the best answer because self-disclosure on the therapist's part in this case may not be the best course of action, particularly if the therapist has negative feelings toward the client that have not been processed. B is not the best answer because if left unattended, the therapist's negative feelings will almost certainly adversely affect the client's treatment. C is not the best answer because the the therapist's feelings are already impacting treatment (in that the therapist is hoping he won't have to deal with the client) and so an intervention beyond personal journaling is necessitated. If you're interested in the Social Work Dictionary's definition of countertransference and a discussion about the term, see Emily Pellegrino's blog post here. Beyond the definition, what do the folks making the MFT and LCSW exams want you to know? Well, they want you to be able to identify situations in which a therapist is having feelings toward a client that may, if unattended, negatively impact the treatment. These feelings could be positive or negative, conscious or unconscious — it's important to monitor our work with clients and try to understand the feelings that come up in our work. On the MFT and LCSW exams, this real-life skill translates quite easily — if you see evidence of a therapist having feelings toward a client that are related to the therapist's own background or personal situation, you'll likely want to look for answers that involve managing and understanding these feelings. In many cases, this will be achieved through consultation with colleagues.

Which of the following BEST describes the process of free association in therapy? A. The process of temporarily considering a client's interconnected problems as separate entities so that solutions are more manageable B. The process of clarifying a client's feelings in order to encourage further expression of feelings C. The process of providing a client with a prompt that allows for specific thoughts or emotions to be expressed D. The process of encouraging a client to express any thoughts or emotions that come to mind

The best answer to the question here is D. A is incorrect because it better fits a process called partialization, which is used to prioritize a client's problems so that a solution can be more easily reached. B is incorrect because it better defines the use of reflection of content with a client. Lastly, C is incorrect because by providing a prompt for a client it takes away from client's ability to express whatever thoughts or emotions that come to mind. Also, the therapist isn't necessarily looking for a specific thought, but rather allowing the client to have free expression. Many times client's struggle to say what is on there mind. They may be judging their own thoughts, afraid of being judged, or even just feel uncertain as to what to say. Free association can be useful because it gives client's the chance to openly express their thoughts and emotions no matter how small or trivial a client may feel they are. Freud developed this with the idea that by expressing whatever came to one's mind it would allow for unconscious thoughts to become conscious, and thus allows for more insight to be gained. According to The Social Work Dictionary, free association is defined as, "A therapeutic procedure, most commonly used in psychoanalysis and other insight therapies, in which the professional encourages the client to express whatever thoughts or emotions come to mind. The client verbalizes at length, and the therapist gives no distracting external cues that could influence the material being presented" (Barker, 2003).

A therapist is meeting with a 14-year-old client who was brought to therapy by her parents. The parents inform the therapist that they are concerned for their daughter's well-being and suspect she is self-harming and has a history of suicide attempts. They inform the therapist that their daughter has met with a therapist in the past and was taking medication for depression and anxiety. The therapist conducts an assessment by asking the client about her current symptoms and goals for therapy. The therapist completes a suicide assessment and decides it is unnecessary to communicate with the client's treating psychiatrist or the former therapist. The therapist's actions are considered: A Below the standard of care because it is important to collaborate with the treating psychiatrist and gather information from the former therapist. B Below the standard of care because the law states it is the therapist's responsibility to collaborate and confer with other professionals. C Meeting the standard of care because the therapist conducted a comprehensive suicide assessment, which addresses immediate safety concerns. D Meeting standard of care because collaboration with other professionals is only an ethical obligation, but not legally required.

The best answer to this question is A. The situation described falls below the standard of care because a reasonable and prudent therapist would recognize the need to communicate with the psychiatrist, and as part of a thorough assessment would want to gather information from the former therapist. While this is always the case, the added risk of suicide makes it all the more important. Answer B may be tempting, because it also notes this is below the standard of care. However, there are no specific laws or regulations that spell out the need to collaborate or confer with other professionals. Answer C is incorrect because the therapist did not complete a comprehensive suicide assessment. Part of assessment can, and often will, include gathering information from other professionals currently and previously involved in providing care to a client. In this case, the therapist would want to speak with the psychiatrist as well as the former therapist. They will likely have information and guidance to share based on their work with the client. Answer D is incorrect because it implies that standard of care is based on legal requirements, which is an inaccurate description of the concept.

A therapist worked with a couple for several years following mutual infidelity. The couple separated after two years in treatment and is in the midst of divorce proceedings. The husband requests access to his records. What actions should the therapist take to address the legal issues presented in this case? a. Inform the husband that the records belong to both the husband and wife and would require a release of information from both. b. Request a written release from the husband and turn over all of the records, but redact information deemed detrimental to the wife's well-being or therapeutic relationship. c. Determine how access to records would affect the therapeutic relationship and the well being of the husband and wife. d. Inform the husband that records belong to both the husband and wife and request the wife sign a release.

The best answer to this question is A. The husband is requesting records, but the client is the couple and the therapist would need both members of the treatment unit to authorize release of records before doing so. Answer B is too limiting in what would be redacted. Without a release from her, the therapist would need to redact all information for the wife, not just information that could be detrimental. Answer C would be an option if an individual were requesting records, but that is not the scenario provided in this question. Answer D is incorrect because the therapist is requesting the wife sign a release, which is inappropriate. Answer D would be better if the answer had the therapist asking the wife what she would like to do in response to the request, but the therapist should not request the wife sign a release.

A therapist has been working with a 54-year-old woman who has two grown children from two separate marriages. The woman was referred for therapy through a domestic violence support group. Her second husband, whom she still lives with, struggles with alcohol abuse and has a history of being physically aggressive when under the influence. After ending up in the hospital as a result of a physical assault perpetrated by the husband, the woman spent several weeks in a shelter. She has since returned back to the house and tells the therapist that she wants to make it work with him and is hopeful he will change, though she acknowledges he continues to drink. What actions should the therapist take in this case? A.Direct the client to return to the shelter since the husband is continuing to abuse alcohol.B.Acknowledge the client's desire to make the relationship work and collaborate with client on safety planning. C. Acknowledge the client's desire to make the relationship work and provide education about the cycle of violence. D. Inform the client of safety concerns and encourage her to return to domestic violence shelter.

The best answer to this question is B. The question is asking what action we should take in this case, and based on legal and ethical obligations, we would look for the answer that manages the client's safety while also respecting their right to self-determination. Answer B allows us to meet the client where she is at—that she is hopeful things will get better—but also allows us to collaboratively safety plan with her should the husband become violent again. Answer A does not take into account the client's desire to stay in the relationship and will likely make the client feel disempowered. Answer C, while acceptable, is not as strong as B. If you must choose between psycho-education on the cycle of violence and safety planning, you would generally choose the latter. Answer D is better than A, but it is wrong because it ignores the client's stated desire to stay in the relationship and is pushing the therapist's will onto the client. A key aspect of domestic violence is power and control. The perpetrator will often use physical or emotional violence as a way to maintain power and control over their victim. With this in mind, it will always be important to empower clients rather than impose the therapist's own agenda, even if this means the client makes decisions that are considered unwise or unsafe. To do otherwise would put the therapist at risk of re-victimizing the client. Based on the information provided, which answer would you choose?

A therapist works with clients residing in a long-term living facility. One of the therapist's newer clients shares in a session that he is upset because he witnessed an employee rough handling and yelling at one of the residents during their daily activities. In response to the employee's actions, the resident appeared visibly shaken and began crying. He asks the therapist to please not say anything because he is concerned the employee will know he was the one to complain. Based on the information and concerns shared by the client, how should the therapist manage the ethical and legal obligations in this case? A) Report the client's concerns to management and follow the facility's guidelines for reporting abuse B) Ask the client for more detailed information regarding the incident before making a report and safety plan with the client. C) Report the abuse to law enforcement and local ombudsman and process report with client. D) Report the suspected abuse to a supervisor to address client's concerns and safety plan with the client.

The best answer to this question is C. This question is not only asking how we would manage our legal obligations, but our ethical obligations as well. Based on the information presented, there is reasonable suspicion that abuse is taking place in the long-term care facility. When abuse occurs in a long-term care facility, we must file a report with law enforcement and the local ombudsman. In addition, the second half of answer C addresses our ethical obligations; processing the report will allow us to address any safety concerns and trust issues with our client. Answer A is incorrect because it is prioritizing management's reporting requirements over the law, which may or may not match our legal mandate. Answer B is shifting toward investigation, which is not our role as therapist. Once there is reasonable suspicion, report what you know! Answer D, while addressing the client's concerns, again ignores our legal mandate. According to California law, therapists are required to report elder and dependent adult abuse or neglect when they have reasonable suspicion of abuse. Therapists are not required to be certain that abuse or neglect has occurred, nor do they need to investigate once the threshold of reasonable suspicion has been met. In addition, once we have enough information for reasonable suspicion, we must report to the appropriate authorities, even if we have concerns regarding the consequences our reporting could have on the client. Based on the information presented in this question, how would you proceed?

A hospital-based social worker meets with a new client who was admitted following a domestic assault perpetrated by her boyfriend. The woman shares that her boyfriend, with whom she lives, was upset because she was texting with a male coworker and went out for drinks with him after work. She shares that her boyfriend is very insecure and she should have known how this would affect him due to similar instances in the past. She tells the therapist that her boyfriend felt terrible about the incident, brought her flowers while she was in the hospital, and promised never to hurt her again. What should the social worker do FIRST? A Assist client in identifying alternative living arrangements due to risk of additional violence. B Provide psychoeducation regarding the cycle of violence and offer resources for victims of domestic violence. C Provide client with referral to anger management classes for her boyfriend. D Assess the client's relationship history with boyfriend.

The correct answer in this LCSW practice question is B. It is clear that domestic violence exists-the woman was hospitalized following the most recent incident and indicates similar instances in the past. The client appears to be unaware of the cycle of violence. It would be important to shed light on this dynamic so the client has an awareness of the likelihood of future violence and how to identify when it is more likely to occur. In addition, providing resources to the client would allow her to access support on her own terms. Answer A pushes the therapist's agenda, as the client has not indicated a desire to locate alternative living arrangements. Answer C is incorrect because the focus should be on the client, not her boyfriend. Finally, the actions described in answer D could be done after B, but the priority is helping the client understand the cycle she is engaged in with her boyfriend and providing resources.

A hospital-based social worker meets with a new client who was admitted following a domestic assault perpetrated by her boyfriend. The woman shares that her boyfriend, with whom she lives, was upset because she was texting with a male coworker and went out for drinks with him after work. She shares that her boyfriend is very insecure and she should have known how this would affect him due to similar instances in the past. She tells the therapist that her boyfriend felt terrible about the incident, brought her flowers while she was in the hospital, and promised never to hurt her again. What should the social worker do FIRST? A. Assist client in identifying alternative living arrangements due to risk of additional violence. B. Provide psychoeducation regarding the cycle of violence and offer resources for victims of domestic violence. C. Provide client with referral to anger management classes for her boyfriend. D. Assess the client's relationship history with boyfriend.

A clinical licensure supervisor is working with a supervisee who utilizes EMDR in her sessions with clients. The supervisor has no training or experience using EMDR, and relies on the supervisee's understanding of the practice to ensure it is being used properly. The supervisor's actions can BEST be described as: A. Unethical, because they are not properly trained and cannot provide adequate oversight or guidance. B. Unethical, because they should be trained in all therapeutic modalities to adequately provide supervision. C. Ethical, because they can utilize the supervisee's knowledge to ensure adequate supervision is provided. D. Ethical, because it is not required for a supervisor to be trained in the modalities utilized by their supervisees.

The correct answer is A In order to provide adequate supervision for an unlicensed supervisee, the social work supervisor should have knowledge and experience in the therapeutic modalities their supervisee is utilizing. To have no experience or training in the modality of therapy being used by a supervisee is unethical, as they will not be able to provide the necessary support and oversight to their social worker in training (A). (B) is incorrect because a supervisor is not expected to be trained in all therapeutic modalities. (C) and (D) are incorrect because providing supervision for a therapeutic modality a supervisor has no training or experience in is not ethical.

An 82-year-old client was admitted to a hospital after experiencing a fall down the stairs. The client is ready to be discharged from the hospital and wishes to return home where she lives independently despite the fact that she is still recovering physically from her injuries. Both the client's doctors and her adult children want the client to move into an assisted living facility where she can be better supported during her recovery, but the client is adamant about living independently. What should the social worker do? A. Work with the client to determine ways she can support her independence while maintaining safety B. Schedule a competency hearing C. Explain the benefits of assisted living to the client D. Schedule the client's discharge to an assisted living facility for the duration of her recovery

The correct answer is A, to work with the client to determine ways she can support her independence while maintaining safety. There is nothing in the question stem that indicates a need for a competency hearing (B). The client has already expressed her desire to live at home, so C and D are both going against the client's self-determination. Answer option A honors the client's self-determination while also addressing potential safety concerns that may arise during her recovery. A reason to conduct a Mental Status Exam would be if someone is having loose associations or not making sense in their speech or is experiencing tangential thoughts. But without a reason to do so, you don't want to choose that answer solely based on someone's age. Similarly, you don't want to assume that an older client has memory problems if nothing in the question stem indicates this. Lastly, do not assume a

Each of the following is characteristic of the preoperational stage of development EXCEPT: A. The child develops object permanence B. The child uses symbolic function C. The child can solve problems mentally D. The child engages in symbolic play

The correct answer is A. By the time children reach the Preoperational stage, they have already developed permanence. Children develop object permanence (A) during the Sensorimotor stage, so it is already well developed by the Preoperational stage. Object permanence is what allows the child to recognize that objects continue to exist even when the child cannot see them. For example, if you hide a toy behind your back, the child understands that the toy hasn't disappeared; rather, the toy is behind your back. Children develop and use symbolic function (B) during the Preoperational stage, learning to use and represent objects through the use of words and language. Children in the Preoperational stage of development develop the ability to solve problems mentally (C). During the Preoperational stage of development, children engage in symbolic play (D). For example, children "play pretend" during this stage of development. Children begin pretending to be people they aren't, such as teachers, mommies or daddies, superheroes, etc. They also begin to use objects as props that symbolize real life objects. While playing, for example, a child may pretend they are a teacher and use their stuffed animals and dolls as the students they are teaching.

A therapist working with incarcerated adults is meeting with a 54-year-old male client. This client has been sentenced to fifteen years in prison for an aggravated assault charge. His file demonstrates that he has a history of engaging in illegal activities. During the first session the client appears agitated, restless, and sweaty. He does not look the therapist in the eye and offers short answers to any question he is asked. Which of the following actions should the therapist take to develop a treatment plan? A. Refer client for medical exam to rule out organic contributors to his behaviors and gather history of client's aggressive and illegal behaviors B. Consult with criminal justice officials regarding client's psychosocial history and gather history of client's aggressive and illegal behaviors C. Refer client for medical exam to rule out organic contributors to his behaviors and assess client for appropriateness of psychotropic medication D. Consult with criminal justice officials regarding client's psychosocial history and assess client for appropriateness of psychotropic medication

The correct answer is A. Answer A reflects proper actions to be taken in this case. Since this client presents with physical symptoms, the therapist ought to send him for a medical evaluation to rule out the presence of a medical condition. For instance, people with untreated hyperthyroidism often appear agitated, restless and sweaty. In addition, we should gather more information regarding this person's history in order to better understand the focus of treatment e. Answer B can be ruled out since it does not contain the step of a medical referral. Answer C is correct in the referral for a medical evaluation, however, it is jumping the gun with assessing for the appropriateness of psychotropic medication. There is no indication for this in the stem. It is also not in our scope of practice to assess for medications. Answer D can also be ruled out since it does not contain the step of medical referral and it is out of our scope of practice for assess for medications.

A therapist is meeting with a family of five. The father, Darren, is a 45-year-old African American lawyer, who has two children from his previous marriage, Aaliyah, 15-years-old and Nia, 9-years-old. The mother, Aiko, is a 38-year-old Japanese entrepreneur who also has a child from her previous marriage, a 10-year-old boy named Riku. The family states that it has been a little over a year since they moved in together and in that time the step-siblings never got along. "They fight and pick on each other all the time", said mom, "and they compete to get our attention." In addition, Aaliyah has been caught drinking and smoking marijuana at school. In response, her dad took away all of her privileges for an indefinite period of time. Aiko does not agree with that approach and is trying to work with him on implementing a plan where Aaliyah gets to earn her privileges back. Moreover, Riku continues to struggle with going back and forth from his mom's house to his dad's house. "I was so used to a certain routine", he states, "but now I have to go over to the other house, even on days I do not want to. Plus, I forget my homework at one house or the other and it is all very annoying.". What factors should the therapist take into consideration in creating a treatment plan in this case? A. Sibling Rivalry; Varying parenting styles; Visitation plans; Maladaptive coping mechanisms B. Sibling Rivalry; Grief and loss after divorce; Visitation plans; Maladaptive coping mechanisms C. Cultural differences; Different parenting styles; Visitation plans; Maladaptive coping mechanisms D. Sibling Rivalry; Different parenting styles; Visitation plans; Development of new relationships in the family

The correct answer is A. Answer A covers all of the issues affecting the family that are clearly mentioned in the vignette. Thus, it is the best answer. Answer B has the "grief and loss" part in it, which was not expressed in the stem Answer C mentions cultural differences, and while the question stem notes the parents are different ethnicities, the issue is not mentioned in the description of the issues discussed by the family Answer D lists the development of new relationships, an issue that did not come up in the stem

A married couple who recently immigrated from Argentina bring their 15-year-old daughter to see a counselor at a community clinic. Neither of the parents speak English; however, their daughter feels very comfortable communicating in both Spanish and English. What are the therapist's responsibilities at the onset of treatment? A. Obtain informed consent from the daughter since she is old enough to consent on her own B. Take additional steps to ensure parents' comprehension of the informed consent contract C. Document in the record the fact that parents do not speak English D. Allow the family to take the informed consent papers home so they can take their time in translating and filling out necessary paperwork

The correct answer is B Answer A can easily be knocked out. Only having the daughter consent for treatment would disregard the role of her parents. They are clearly involved and it is always best practice to include parents in the treatment of a minor whenever possible. Disregarding them is both culturally and clinically insensitive. Plus, we would only exclude the parents from the informed consent process with good cause. Answer C is tempting, especially during a law and ethics exam. It is correct to document the fact that both parents do not speak English and we will do so, but that would not be the first or most important thing we do. Initially we must address the issue of informed consent since we are required to obtain it before proceeding with treatment. Answer D is incorrect because it puts the burden of having to translate the documents on the client. It is best practice to send clients home with a copy of informed consent, but only after they have understood and consented to it. Answer B is the strongest answer choice since ethically, it is the therapist's responsibility to provide informed consent in the language the client can understand. Thus, it is up to the therapist to either provide clients with paperwork in Spanish or to secure a professional interpreter.

A 16-year-old male is suspended after repeated offenses of bullying a classmate. While meeting with the principal the student states, "EVERYONE makes fun of that kid! You just don't see it!" What defense mechanism is the client using? A. Sublimation B. Rationalization C. Internalization D. Denial

The correct answer is B, Rationalization. Sublimation occurs when an individual changes socially unacceptable impulses into socially acceptable behaviors. In a situation like this, sublimation may look like the 16-year-old male channelling his need for power into the role of "protector" and standing up for students who are picked on. Internalization would occur if the 16-year-old male had seen his parents or an older sibling engaging in bullying behavior and took that on as a part of himself and his identity. Denial would involve him denying engaging in the behavior at all, saying something like "I never bullied him!" The 16-year-old is engaging in rationalization by making an otherwise unacceptable behavior justified by applying logic or reason (in this case, the idea that "everyone else is doing it") to the behavior. Trying to learn and apply all of the defense mechanisms can feel overwhelming. We recommend trying to think of personal or client examples for each of them to help make them stick better in your mind. What have you done to learn all of the defense mechanisms? Comment below with what has worked for you!

A social worker has been meeting with a 15 year old female for the past two years around issues of anxiety and depression. The social worker learns that her client's mother, who suffered from Bipolar Disorder and saw her own therapist, recently committed suicide. The social worker posts on a public Facebook group for social workers, "A teenage client lost her mother, Cassandra, to suicide on October 21st. Cassandra suffered from Bipolar Disorder and saw a counselor herself. This serves as a reminder of the work that still needs to be done to prevent these tragedies. My heart is heavy today." This use of technology is: A. Both legal and ethical B. Illegal and unethical C. Legal, but unethical D. Illegal, but ethical

The correct answer is B, both illegal and unethical. There are several legal and ethical issues presented in this scenario that are of concern. First, this is posted in a public Facebook group, so anyone could see it, including the client and her family. Second, the social worker provided a good bit of identifying information: the mother's first name and the date of her death. That, coupled with the likely ability to identify what state the social worker practices in, is enough to do a google search and identify the person. On top of that, we know the person saw a therapist and suffered from Bipolar Disorder. This is private information, which is not the public Facebook world's business! Further, once you identify who the mother is, it would be fairly simple to find out who the client is as well (especially given that most obituaries list the deceased's surviving children by name). In the real life scenario that inspired this question, the former TDC user who shared this story was able to identify the person the social worker posted about in less than a minute. Pretty scary. This is clearly an ethical breach of client privacy and confidentiality. What may surprise some of you is that this is not only unethical, it is also illegal. Why? Since anyone reading this post can identify the mother and therefore the client based on the information posted by the social worker, this constitutes a legal breach of the client's private health information. It is now public knowledge that she 1. sees a social worker and 2. suffers from anxiety and depression. If the social worker is covered under HIPAA, they could be facing some hefty fines, not to mention discipline (and possible license revocation) from their state licensing board.

A therapist working at a community mental health agency is meeting with a 43-year-old Caucasian male. The client reports he is unemployed and can only afford treatment with a sliding scale. In addition, he shares a history of traumatic abuse and loss, both in his childhood and young adult years. During the initial interview, the therapist notices that client appears to have a runny nose, dilated pupils and his mood appears to be dysphoric. The client complains that he is feverish and his muscles are aching. Based on the presenting picture, what interventions should the therapist consider? A. Inquire whether client is going through an amphetamine withdrawal and refer him to a detox facility if the answer is affirmative B. Inquire whether client is going through an opioid withdrawal and refer him to a detox facility if the answer is affirmative C. Inquire whether client is going through an amphetamine withdrawal and refer him to an intensive outpatient facility if the answer is affirmative D. Inquire whether client is going through an opioid withdrawal and refer him to an intensive outpatient facility if the answer is affirmative

The correct answer is B. Physical symptoms described in the stem are a better fit for the opioid withdrawal, not amphetamine withdrawal. Thus, answer A is not a good fit. Answer B is correct, since the symptoms the client is experiencing point to an opioid withdrawal. If this is what the client is going through, the immediate action to take would be to refer him to a detox facility. Answer C is incorrect, since we have determined that the client is likely going through an opioid withdrawal. A detox facility would be a better referral than an intensive outpatient in this case, since opioid withdrawal can be dangerous and should be done under supervision. Intensive outpatient treatment facilities focus more on long-term recovery, which would be an important step, but only after a detox facility. Answer D correctly identifies an opioid withdrawal problem; however, as noted above, a detox facility would be a better referral than an intensive outpatient in this case.

A school social worker meets with a 13-year-old girl who begins crying in session as she discusses an argument she had with her parents last night. She explains that after she talked back to her mom, her dad hit her. She goes on to say that "it hurt really badly." What should the social worker do FIRST? A. File a CPS report B. Determine the type and severity of the punishment C. Develop a safety plan D. Contact the client's parents

The correct answer is B. The question stem raises some red flags for abuse. The client says 1. that her dad hit her and 2. that it "hurt really badly." While many people jump to filing a CPS report (A), we actually don't have enough to do so yet. While investigating is not our job, determining the type and severity of the punishment (B) is NOT the same thing as investigating. Investigating involves interviewing the child, parents, etc. to establish whether or not an accusation of abuse or neglect can be substantiated or not. Again, inquiring about the type or severity of punishment a child receives is NOT the same as investigating whether or not abuse has occurred. What we are doing with answer option B is gathering information to determine whether a report needs to be made or not. "It hurt really badly" may or may not warrant a report. We need to find out what happened that "hurt really badly." If the client's dad spanked her with an open hand and it didn't leave a mark, it is not considered abuse-even if it hurt really badly. If we find out her dad hit her and it 1. left a mark, 2. was with a closed hand/fist, OR 3. used any type of object, then we would need to do A and file a CPS report. Developing a safety plan (C) is not where we would start. We need to prioritize determining what type of punishment occurred to figure out whether a CPS report needs to be made. We would not start by contacting the client's parents (D). This could occur after doing B, depending on what type of punishment took place. If we identify that abuse took place, we would do A before doing D.

A therapist has been working with a 19-year-old female client who was brought to therapy five years earlier for an eating disorder. When the client began therapy, her parents consented to treatment and engaged in numerous collateral sessions with the individual therapist. The family also participated in ongoing family therapy. Following a sustained period of symptom stabilization, the mother calls the therapist because she is concerned the daughter is exhibiting troubling behaviors. She asks the therapist if the daughter specifically discussed regressive behaviors in recent sessions. How should the therapist respond? A. Inform the mother that the daughter is legally an adult and the therapist must maintain confidentiality B. Inform the mother that the daughter is legally an adult and she can only provide information the client has authorized the therapist to share C. Break the client's confidentiality if the therapist believes the client is engaging in regressive behaviors D. Break the client's confidentiality if the therapist is concerned for the client's safety

The correct answer is B. You were likely to get the answer down to two, and answer A was probably in the running for the best answer-if not the answer you ultimately chose. However, answer A is incomplete and should be eliminated. The first part of answer A is correct, the daughter is legally considered an adult. However, the parents have historically been involved in her treatment and this answer excludes the possibility of sharing any information-it is too extreme. Answer C is an easier answer choice to eliminate. While therapists are legally permitted to break confidentiality in certain instances, a client engaging in regressive behaviors (too vague a term) is not one of those instances. Answer D is another possible choice, and it is true a therapist is legally permitted to break confidentiality if a client is a danger to themselves. However, there is nothing in the question stem to indicate safety concerns severe enough to warrant breaking confidentiality. Answer B is the strongest answer choice. The first part of the answer is correct; the client is legally considered an adult and has a right to confidentiality. The second part of the answer acknowledges the therapist may share information with the parents, but disclosures are limited based on the scope of the authorization signed by the client.

A therapist meets with a new client who was referred for treatment by his primary care physician. The client presents as agitated and tells the therapist that he believes the government is spying on him. He shares that he's noticed a man standing near his apartment for the past few days and intends to confront him and make sure he knows he's "messing with the wrong guy." What action should the therapist initially take in this situation? A. Refer the man to a psychiatrist since he appears to be exhibiting symptoms of paranoid B. Conduct a risk assessment to determine if the therapist should engage law enforcement C. Conduct a comprehensive assessment to identify the goals of treatment D. Challenge the client's understanding of the situation to determine if his thinking is based in reality

The correct answer is B. Answer A is incorrect because it is not the first step we would take when a client alludes to potentially harming a reasonably identifiable person. We could refer the client to a psychiatrist, but this would not be the initial step taken by the therapist. Answer C is also not the priority based on the information presented. Similar to answer A, we would want to complete a comprehensive assessment to determine goals of treatment. However, this would take place after we assess for potential danger to others. Answer D could pull you in, since the client's thoughts may or may not be based in reality. However, similar to answers A and C, this is not the priority. Answer B is the correct choice. The client shared information that requires further assessment to assist the therapist in deciding how to proceed. Therapists must take action under our duty to protect whenever a client presents a serious threat of physical harm to a reasonably identifiable other. In this case, they would need to involve law enforcement and may also take reasonable action to inform the intended victim of the client's threat. This is the first step; the actions included in the other answer choices could follow.

While meeting with a long-term client, a 28-year-old graduate school student, the therapist learns that the relationship the client is in is abusive. The client tells the therapist that her partner was very warm, communicative and kind at the beginning. With time, however, he became increasingly jealous, possessive, and began belittling her. Eventually their fights became physical in nature. "I am so confused," states the client, "I know he is a very good person underneath. I know his behavior is unacceptable;he is just wounded and I know he means well. All my family and friends want me to leave him, but I care for him so much. I am so confused. What do you think I should do?" Taking into account a strong and trusting relationship, what action should the therapist initially consider? A. Educate the client on the nature of partner relational violence and develop a comprehensive safety plan B. Acknowledge the difficult nature of the situation and explore client's ambivalence C. Educate the client on the nature of partner relational violence and gently note that her friends and family have her best interest at heart D. Acknowledge the difficult nature of the situation and emphasize feelings of love and understanding the client has for her partner

The correct answer is B. This is a perfect example of a clinical situation where as therapists we might feel compelled to offer our own opinion and guide a client in a certain direction. This is especially likely since the client is asking for advice. However, ethically, we must not push the client in any given direction. So, the best answer here would be (B). In answer (B), the therapist acknowledges how tough the situation is and explores the client's feelings about loving this person, yet not being OK with his behaviors. Answer (A) is a little bit premature. We can certainly educate the client on the nature of partner relational violence, but we need a bit more information before coming up with a safety plan. So we would do (B) before we would do (A). Even though answer (C) has the therapist gently focusing the client's attention towards her friends' and family's feelings, it can be easily perceived as pushing the client to leave her partner. Since there is a strong and trusting relationship between the client and therapist, it's important to be extra mindful of impact our words can have on a client. The same can be said for answer (D). The client can easily perceive it as encouraging her to stay and work on this relationship. And such a decision would not be up to us to make.

Clinical A social worker in private practice receives a referral for a 32 year old woman who reports ongoing difficulties with social and romantic relationships. During the initial appointment, the woman expresses frustration about a recent breakup and states that her ex-boyfriend "got tired of the highs and lows." When the social worker asks her to clarify, the woman reports going through frequent periods of feeling depressed as well as periods in which she feels "super happy, super productive, just super!" She says "I've always been this way, I don't know why I can't find someone who can deal with it." What is the most likely diagnosis for the client in this case? A. Bipolar II B. Cyclothymic Disorder C. Mood Disorder NOS D. Adjustment Disorder

The correct answer is B. The stem tells you that the woman experiences frequent periods of what sound like depressive and hypomanic symptoms, and that these symptoms have been ongoing and are causing impairment in her social life. A is not correct because we do not have the Major Depressive Episode or Hypomanic Episode needed for Bipolar II. C is not the best answer because we have enough information for Cyclothymic Disorder and D is not correct because the symptoms described do not fit Adjustment Disorder. So let's talk briefly about differentiating between Bipolar II and Cyclothymic Disorder. Bipolar II is characterized by the presence or history of a full-fledged Major Depressive Episode and the presence or history of a Hypomanic Episode. If a person has ever had a Manic episode or a Mixed episode, they do not have Bipolar II! Cyclothymic Disorder might be viewed as a watered-down version of Bipolar II — the person has, for at least 2 years, experienced numerous periods of hypomanic symptoms and periods of depressive symptoms that do not meet the criteria for a Major Depressive episode; it's important to note that during this 2 year period, the person has not been without the symptoms for more than 2 months. There are situations in which a person could have Cyclothymic Disorder and Bipolor I or Bipolar II, but for the purposes of the test, you will be thinking about differential diagnoses (as opposed to co-occurring disorders). So, if the question describes a Major Depressive Episode and symptoms of hypomania, think Bipolar II; and if the question describes a person who has long-term symptoms of depression and hypomania, think Cyclothymic Disorder. When you're studying, try this: read a question and without looking at the answers (cover them up, if need be) write down, or say out loud, what your top diagnostic choice would be, and if that isn't available, your second choice. Now look at the answers - is your top choice there? How about your second choice? This should help get you in the habit of using information from the stem to develop a diagnostic impression.

A social worker meets with a new client presenting with ongoing issues of anxiety, depression, and interpersonal difficulties. The client shares that she felt like her last therapist didn't care about her because she was only willing to speak with her during scheduled calls and appointments and didn't answer texts and calls in between sessions. What is the MOST important thing for the social worker to do: A. Explain that calls and texts between sessions go against the Code of Ethics B. Discuss the social worker's policies for calls and texts between sessions C. Set a limit to the number of calls and texts allowed per week D. Explore the client's feelings around the prior therapists boundaries

The correct answer is B: to discuss the social worker's policies for calls and texts between sessions. A is incorrect because the Code of Ethics does not state it is unethical for calls or texts to occur between the client and social worker. While the social worker may do C, it is not as important as discussing the social worker's policies for calls and texts. Similarly, while exploring the client's feelings about the prior therapists boundaries may occur (and even could come FIRST if that is what the question were asking) it is not MORE important than discussing the current social worker's policies.

A nursing home social worker works and meets with an 82-year-old woman who is a new resident. Towards the end of their first session, an employee comes in informing the client that her daughter has arrived to visit her. The client becomes upset and repeatedly states "please don't let her in here. Don't let her near me." What should the social worker do NEXT? A. Contact the client's daughter to inquire why she doesn't want to see her B. Inform the daughter she needs to leave and escort her from the premises C. Explore with the client why she doesn't want her daughter to come in D. Make an Adult Protective Services report on suspicions of abuse

The correct answer is C, explore why she doesn't want her daughter to come in. We cannot contact the client's daughter to inquire why the client doesn't want her to come in (A), as this would be breaking client confidentiality. Our NEXT step would not be to inform the daughter that she needs to leave (though this could happen at some point), as we would first want to talk with the client about why she doesn't want her daughter there. More so, escorting the daughter off of the premises would likely be unnecessary and outside our role as the social worker. While we will do D if the client reports that her daughter has abused her in any way, we would not make a report just yet. There could be other reasons for her not wanting to see her daughter (for example, an ongoing strained relationship, the client not wanting her daughter to see her in a nursing home, etc.). The best place to start is by inquiring why the client doesn't want her daughter near her.

A young married couple presents for counseling due to ongoing disagreements about roles within their marriage. The wife explains that she "never signed up to be his mom" and resents being expected to do all of the cooking and cleaning. The husband states, "I'm not asking for anything different than what my parents had. As the head of the house, I expect to be respected like my mother respected my father." What defense mechanism is the husband using? A Introjection B Intellectualization C Identification D Reaction Formation

The correct answer is C, identification. Introjection (A) occurs when a person internalizes an idea or voice of another person-often an authority figure. So if it said the husband just internalized his father's idea that "women do the housework" this would be introjection. While this has occurred, more than this has occurred. Remember, introjection and identification are very similar and on a continuum; introjection often leads to identification (as has happened in this scenario). Intellectualization (B) is when a person removes themselves emotionally from something stressful by focusing on reasoning/thinking to avoid feeling. This is not occuring in the scenario above. Identification (C) occurs when a person not only takes on a belief or voice of another person, but also begins to identify with that individual. In this case, the husband has not merely taken on the idea that women should do the housework; rather, he sees himself as the head of his household, like his father. He is identifying with his father. Because of this identification, he expects to be treated like his father, with his wife respecting him and treating him as his mom treated his dad. Reaction formation (D) is when a person acts opposite to their unacceptable thoughts and emotions. We do not see the husband acting opposite to his thoughts or emotions in this scenario.

A social work supervisor meets with one of her supervisees for supervision. During this meeting, the supervisee shares they have become sexually involved with a client. They share they want to refer the client to another social worker in order to pursue a relationship with them. What is the FIRST action the supervisor should take? A. Immediately report the social worker to the board B. Assist the supervisee in transferring the client to a different social worker C. Discuss the ethical violations that are occurring with the supervisee D. Terminate her supervisory relationship with the social worker

The correct answer is C, to discuss the ethical violations that are occurring with the supervisee. While A, B, and D are all possible actions that the supervisor could take at some point, we should always start by speaking with the social worker first. The social worker is engaging in unethical behavior, so the supervisor needs to address the ethical violations the social worker is engaging in. The supervisor may report the supervisee to their board (A), but it wouldn't occur before talking directly to the supervisee. The supervisee should absolutely end their relationship with the client. Even once that occurs, the client should be transferred to a different social worker (B). But again, this wouldn't happen until first speaking with the supervisee about the ethical violations. If the supervisee isn't willing to engage in ethical practice, they may decide they're unable to continue providing supervision The supervisor offers direction to the supervisee as they take their knowledge of social work theory, skills and competencies, and understanding of ethics in social work and apply it to their individual practice setting.

A school counselor is running a group on social skill building for high-school students. After the fourth week of one of the participants comes up to the therapist after the group to share her feelings about the group. "I am not getting anything new from this group. All of the things you are teaching us I already know," she states. How should the therapist respond to such disclosure? A. Bring this issue up at the next group meeting and ask the client to think of an activity that reflects her desired level of challenge B. Refer the client to a more advanced group and process the reason for the referral at the next group C. Ask the client to bring this issue up at the next group meeting and process the group members' reaction D. Discuss the matter with this client individually and bring it up at the next group session with the rest of the group

The correct answer is C. Answer A has the therapist bringing up the issue in the group, when the best course of action is to have the client address this issue from their personal view. This answer also places the burden of coming up with an activity onto the client, and it is therapist's responsibility to come up with appropriate activities. Answer B is jumping the gun. It is too soon to refer this person out. We would first attempt to remedy the situation in the group. Answer C reflects the proper intervention for this situation, asking the client to bring the issue back to the group and allowing an opportunity for the concerns to be processed. Answer D is not the best answer since the conversation regarding this issue should take place with all groups members together.

A therapist is meeting with Gary, a 33-year-old event manager. Gary shares that he is at a loss as to how to communicate with his girlfriend. "Nothing I do is good enough for her. She gets mad if I tell her how I feel. She gets mad if I shut down. I clearly need tools to learn how to talk to her better," he states. In addition, Gary tells the therapist that he has had a history of depression throughout his adult life. Recently, however, it has gotten worse and he is barely able to get out of bed. Gary reports having a psychiatrist and taking Lexapro for the past few years. In order to stay within the scope of practice, the therapist should make which of the statements? A "It seems like your medication dose needs to be increased. Why don't you talk to your psychiatrist about it?" B "It seems like you are on the right dosage of medication and the problem lies in you being relationally unhappy." C "It might be best for you to tell your psychiatrist that your depression has gotten worse. They will be able to determine the role, if any, that your medication is playing." D "It might be best for you to tell your psychiatrist that your depression has gotten worse. Your body might have developed tolerance to Lexapro and you might need to switch medications."

The correct answer is C. Let's take a look at the answers: Since the question is asking us to stay within our scope of practice, it is important to remember that offering advice regarding psychotropic medication is outside of our scope of practice. Only a licensed MD is able to do so. Thus, we have to refer our client back to his psychiatrist and not render any of our own opinions regarding medication in the process. The only answer that does so is (C). In answer (A) the therapist talks about a possible medication increase and that lies outside of our scope of practice. In answer (B) the therapist states that the client is on the right dose, which is also not within our scope of practice. In answer (D) the therapist talks about the client's possible tolerance to Lexapro, with him potentially needing another medication. Since we are not medical professionals, we cannot make such determinations or even such suggestions. Thus, the only legal reply we can make is (C).

A social worker is studying the effects of how different doses of an SSRI affect levels of depression as measured by the Beck Depression Inventory. Which of the following is the dependent variable? A. Type of SSRI B. Dosage of the SSRI C. Levels of Depression D. Beck Depression Inventory

The correct answer is C. The type of SSRI (A) is not discussed in the question stem. The dosage of the SSRI (B) is the independent variable (remember, this is the variable being manipulated that will then impact the dependent variable). Levels of depression (C) are dependent on the dosage of the SSRI, making this the dependent variable. The Beck Depression Inventory (D) is the type of scale being used to measure levels of depression but is neither the independent variable nor the dependent variable.

A 15-year-old high school student is referred for individual therapy by his school counselor. The mother and father attend the first session with their son and consent to treatment. The parents dominate the session and express concern that their son suddenly appears to be struggling with severe anxiety. They tell the therapist that he was extremely active in sports and excelled in school, but recently his anxiety has caused him to drop off the basketball team and his grades have dropped. After four sessions, the client opens up and shares that he believes the anxiety is a result of all the pressure his parents place on him. The mother contacts the therapist and asks for a comprehensive update regarding her son's progress. Which of the following actions should the therapist take in response to this request? A Inform the mother that the therapist is not able to discuss the client's progress without his permission. B Provide the mother with a comprehensive update regarding the son's progress since the parents consented to treatment. C Discuss the mother's request with the client and determine what information he would like the therapist to share and request a release of information. D Determine what information can and cannot be shared with the parents based on the therapist's understanding of implications to therapeutic relationship.

The correct answer is C. When working with minors, it's important to separate consent from confidentiality. In this question, the minor is old enough to consent to treatment and therefore can determine what information can be shared with his parents. Answer A is a tempting answer because the therapist is properly telling the mother that information cannot be shared. However, it is incorrect. We would need a release from the minor, not just his permission, before we can have this conversation. Answer B can be knocked out quickly. We cannot provide the comprehensive update just because the parents consented to treatment. Remember, consent and confidentiality are two separate issues and should not be confused. Answer D is incorrect because it indicates the therapist is determining what may or may not be shared with the parents. This would be a stronger answer if the minor were under the age of 12. However, since the boy is old enough to consent to his own treatment, he gets to make this determination. Answer C is the strongest answer choice provided. In this answer, we directly address the request with the client and allow him to make the decision of what to share. We would then need a release of information to determine what information can be shared by the therapist with the parents.

A 15-year-old high school student is referred for individual therapy by his school counselor. The mother and father attend the first session with their son and consent to treatment. The parents dominate the session and express concern that their son suddenly appears to be struggling with severe anxiety. They tell the therapist that he was extremely active in sports and excelled in school, but recently his anxiety has caused him to drop off the basketball team and his grades have dropped. After four sessions, the client opens up and shares that he believes the anxiety is a result of all the pressure his parents place on him. The mother contacts the therapist and asks for a comprehensive update regarding her son's progress. Which of the following actions should the therapist take in response to this request? A. Inform the mother that the therapist is not able to discuss the client's progress without his permission. B. Provide the mother with a comprehensive update regarding the son's progress since the parents consented to treatment. C. Discuss the mother's request with the client and determine what information he would like the therapist to share and request a release of information. D. Determine what information can and cannot be shared with the parents based on the therapist's understanding of implications to therapeutic relationship.

A therapist meets with an 83-year-old woman who is brought for individual therapy by her son and daughter. The son explains that he, his sister and their other sibling who lives out of state are becoming increasingly concerned for their mother's safety. The daughter explains that their mother still lives in their childhood home and continues to drive, but all of the siblings agree that she needs to move to an assisted living facility and should stop driving. The woman brushes off her children's concerns and states, "I might be old, but I'm not useless. My kids are confused and think they are the parents now. I told them I'm fine on my own and they persist. I told them I don't want to see a therapist, and yet here I am." Which of the following actions should the therapist take based on the case presented? A. Acknowledge children's concerns for their mother and explore mother's resistance to changes B. Validate the mother's feelings and determine appropriateness of continuing therapeutic services C. Determine appropriateness of continuing therapeutic services and assess for safety concerns D. Validate the children's concerns and identify appropriate treatment goals

The correct answer is C. Answer A can be eliminated because the client in this vignette is the mother, not her children. In addition, the therapist is aligning with the children to the detriment of building a therapeutic alliance with the woman and respecting her right to self-determination. This answer choice ignores the woman's statement that she does not want to see a therapist, something that must be addressed. Answer B seems like a really good answer and is likely one of the two you narrowed your answers down to-in fact, you may have picked this answer. However, the children indicate safety concerns, and this answer does not address them. All parts of this answer are technically correct, but it is not the strongest option available to you. Answer D, similar to answer A, also overlooks the woman's expressed lack of interest in receiving therapy and takes on the children's agenda. Ethically, the therapist should honor the woman's decision of whether or not she would like to engage in treatment. Answer C is the strongest answer choice available to you. It allows us to assess possible safety concerns, something that is noted in the vignette when the children say they are "becoming increasingly concerned for their mother's safety." In addition, it honors the mother's right to self-determination and whether or not she would like to engage in the therapeutic process.

A therapist meets with the wife of a 90-year-old man. The wife informs the therapist that her husband is spending several weeks in a skilled nursing facility's rehabilitation unit following a massive heart attack. The client is concerned that her husband is not receiving adequate care because he appears weak and unclean. She shares that his bedpan overflowed a few days earlier and the nurse did not bother to clean up the mess until several hours had passed. The client would like to have him discharged and hire in-home care. How should the therapist proceed? A. Honor the client's self-determination and assist her in identifying in-home care. B. Assess further for potential elder abuse to determine if a report is required. C. Inform the client a report is mandated and provide verbal and written report to both law enforcement and the local ombudsman. D. Consult with colleagues to determine if this information rises to the level of reasonable suspicion of abuse.

The correct answer is C. Answer A is incorrect because it is not the priority in this case. This may be done eventually, but it does not address our legal mandate of reporting elder abuse and neglect. Answer B is incorrect because the therapist needs "reasonable suspicion" when determining if a report is mandated. In this case, the client shared that her husband was unattended to for hours while sitting in his own urine. This rises to the level of neglect; we do not need to assess further. Answer D is incorrect for a similar reason as B; we have enough information to warrant a report, so consultation is not required. Answer C is the correct choice. The information shared by the client provides the therapist with reasonable suspicion that her husband is being neglected. Since the abuse has taken care in a long-term care facility, and does not constitute physical abuse, the therapist must report to law enforcement and the local ombudsman.

A therapist has been meeting with a client for individual therapy for a year. The client has been in a long-term relationship with a partner who struggles with Major Depressive Disorder. The client's partner has a history of attempted suicide and substance abuse. During a session, the client shares that she believes her partner has increased use of alcohol in recent days and is suicidal. She is scared and uncertain what she should do. What should the therapist do in this case? A. Inform the client that the therapist must break confidentiality to manage their partner's safety risk. B. Inform the client that the therapist must break confidentiality because of their duty to protect. C. Inform the client that the therapist will maintain confidentiality and offer resources for the client's partner. D. Maintain confidentiality since the therapist's duty to protect is only triggered when it is their client who is at risk.

The correct answer is C. When it comes to duty to protect, a therapist is only obligated to intervene when their client is the one who poses the danger to self or others. In fact, the therapist can only break confidentiality if it is their client who presents as a danger to self. Therefore, answers A and B can be eliminated. We are left with answers C and D. It's important to consider what the question is actually asking when deciding on the strongest answer. If the question asked about our legal obligation, the correct answer would be D. Legally, we would maintain confidentiality. However, the question is broader and therefore our answer should encompass more than just our legal obligation. Answer C includes the therapist's legal obligation, which is to maintain confidentiality. Answer C also addresses the clinical issue that is raised by the client's expression of fear and uncertainty by providing her with resources.

An 80-year-old client meets with a social worker due to recent conflict with his adult children who are urging him to move into an assisted living facility after his wife of 60 years passed and after he began using a cane. His children express ongoing concern that as he ages, he will be unable to care for himself and meet his basic needs while living alone. The client reports that he is just as able to care for his needs now as ever before and states, "there is no way anyone is going to force me into a nursing home." What is the BEST way for the social worker to respond? A. Facilitate a discussion of the pros and cons of living in an assisted living facility and offer a family session B. Discuss the differences between a nursing home and assisted living facility C. Validate the concerns of the client's children and complete an assessment to determine the client's ability to live independently D. Acknowledge the client's right to make this decision for himself and identify goals of treatment

The correct answer is D Since the question is asking what is BEST, we want to prioritize around importance. A is incorrect because the client stated he does not want to move into a facility. Since there are no details in the question stem that indicate a need for the client to move into an assisted living facility, we want to honor his self-determination. Additionally, the man is our client, not his children. So we want to first help him identify the treatment goals he wants to work on before offering a family session. B is incorrect because again, the client has already stated he doesn't want to live in a facility. So this is not a discussion that would need to take place at this time. C is incorrect because the client is in the room with us, not his children. Further, there is no information that indicates the children's concerns are valid. There is also no reason to complete an assessment to determine his ability to live independently at this time. D is the best answer because it both honors the client's right to self-determination AND acknowledges that he is the client.

A couple attended therapy for two years and after achieving their goals they terminated services. The couple has an amicable relationship and is co-parenting their children, but determined it would be best to divorce. The therapist receives a subpoena from the husband's lawyer to release records as part of the divorce proceedings. The husband also faxes the therapist a written authorization to release records. The therapist attempts to contact the wife, but is unable to reach her. Which of the following actions should the therapist take to manage the legal issues involved in this case? A. Release the records since therapist attempted to contact wife and the couple has an amicable relationship. B. Call the husband's lawyer and inform the lawyer that the therapist has not been able to successfully reach the wife C. Call the therapist's professional liability insurance company's legal team for purpose of consultation D. Invoke the wife's privilege until therapist receives release from wife or a court order

The correct answer is D. The first thing being tested in this question is, who is the holder of privilege. In this case, the holder of privilege is the couple. This means the husband and the wife are equally responsible for deciding how the subpoena will be handled. With this in mind, we can easily eliminate answer A. We cannot release the records without receiving written consent from the wife. This holds true regardless of the relationship between the couple. They could be best friends and have an intact marriage and this would still be the case. Answer B is not as clear-cut. However, we would not make contact with the lawyer and discuss our efforts to reach the wife. We would only respond to the subpoena, in writing, noting that we are invoking/asserting privilege insofar as it exists. We would not even acknowledge the wife was our client! Answer C is another tempting answer, but it's unnecessary at this time. We don't need to seek consultation when it's clear what steps we need to take, which brings us to the correct answer. Answer D is the strongest option available. If we do not know how the holder of privilege wants to respond to a subpoena, we would uphold their right to keep communications privileged.

A therapist meets with an 18-year-old woman who arrives at the session with her 2-year-old son. The woman explains that she moved out of her parents' home about eight months ago and subsequently moved in with the father of her child. She reports that her partner is a great father, but the couple's relationship is volatile and sometimes becomes physically violent. The woman states, "He is very controlling and questions my every action with our son. If I try to defend myself, we end up in a yelling match that often ends with him hitting me." What initial actions should the therapist take when considering the legal and ethical obligations in this case? A Inform the client that the therapist must break confidentiality and report child abuse since the minor is being exposed to domestic violence. B Provide psycheoducation regarding the cycle of violence and discuss alternative living arrangements. C Provide psychoeducation regarding the cycle of violence and develop a safety plan for the client. D Determine the client's goals for therapy and collaboratively develop a safety plan.

The correct answer is D. Answer A is incorrect because we do not have reasonable suspicion of child abuse. A minor in a home with active domestic violence is not sufficient reason to break confidentiality and make a report. We would want to see an indication of child abuse to warrant a report. Answer B is incorrect because it is unclear the client is interested in pursuing alternative living arrangements. This answer does not honor a client's self-determination. Psychoeducation would be appropriate, but the second part of the answer makes B wrong. Answer C is also incorrect because therapists do not create safety plans for their clients. Again, psychoeducation would be a possible answer, but the second part of C is incorrect. Answer D is the best answer available. It's unclear what the client wants from therapy. It would be important to gather this information to develop a treatment plan and guide therapeutic interventions. In addition, the second part of the answer is strong because it is collaborative and addresses the safety concerns presented in the question.

A social service agency hires a social worker to evaluate the effectiveness of a program the agency implemented last year. The program works with adolescents age 12-17 who are at risk of becoming involved in the juvenile justice system and aimed to prevent entrance into the juvenile justice system. What should the social worker do FIRST in evaluating the effectiveness of this program? A. Set goals and objectives for treatment B. Determine who the target population is C. Share outcome results and recommendations D. Identify what measures were used to determine progress towards goals

The correct answer is D. The question stem has already informed us of what the goals of the program are (A) and who the target population is (B). While the process of program evaluation will allow us to share results and recommendations (C), this is generally one of the last steps, not the first. This leaves us with answer option (D). Once we know the target population and what the goals and objectives are, we next want to look at what measures were used to determine what progress has been made towards those goals. For example, was a standardized assessment tool used? Was client self reporting utilized? Was information gathered from the juvenile justice system's records?

A new client presents for an intake session with a social worker. The client has a black eye, her arm in a sling, and severe bruising around her neck. When the social worker inquires about the injuries, the client states, "I just tripped and fell. It's not a big deal. I don't want to talk about that." What should the social worker do NEXT? A. Challenge the client that such injuries are not due to a fall B. Safety plan with the client C. Continue the intake assessment D. Provide a DV shelter referral

The correct answer is D. Provide a DV shelter referral. A is incorrect because we are not going to challenge what our client shared with us during an intake session. Safety planning requires the participation of the client. If she is not acknowledging violence is occurring, we cannot safety plan. Safety planning is appropriate when a client is discloses there is violence occurring, but isn't ready to leave the person. C is incorrect because we cannot ignore the safety issue. While we want to respect the client's right to not discuss what happened, we also want to ensure she has the resources needed should she decide to seek help or leave her partner. If someone is in a DV situation, but says they don't want to talk about it (or denies there is a problem), then safety planning or psychoeducation are not options, as they are going against the client's self-determination. When the client is denying there is a problem or says they don't want to talk about it, a DV shelter referral is a good option to address the safety issue (which we can't ignore) without encroaching on their self-determination. A DV shelter referral can be given quickly and discreetly, it provides the client with a resource, and they can choose what they want to do with it (if anything).

A therapist specializing in art therapy has been working with a 19 year-old male for two years when the client dies suddenly in a car accident. The client's mother, who had previous contact with the therapist when the client was a minor, calls the therapist crying and asks if the therapist has any of her sons drawings that the mother could have. How should the therapist respond to this request? A. Explain that her son had not signed a release of information for this disclosure B. Maintain the client's confidentiality according to professional standards C. Release artwork that the client created while the mother had contact with the therapist D. Empathize with the mother's request and consult with a colleague about how to provide her with the artwork

The correct answer to the question above is B: maintain confidentiality according to professional standards. A is not the best answer because it provides the mother with information that should be kept confidential — we don't know if the client had informed his mother that he was in ongoing treatment, we only know that treatment began when he was a minor. C is not the best answer because as far as the question is concerned, the therapist doesn't have a current release of information — it doesn't matter if there was a release of information at one time — if it's expired, it's expired. D also goes too far; while emotionally the therapist might want to try to find a way to honor the mother's request, the first responsibility is to the client and the client's right to privacy and confidentiality. It might seem like a case in which an exception should be made, but that would likely be the therapist's desire to make the mother (or him/herself) feel better in the face of this tragedy coming through. There is no legal or "compelling professional" reason to disclose confidential information in this case. Standards of confidentiality with a living adult client are pretty clear, right? You maintain the client's confidentiality unless there is a "compelling professional reason" for disclosure, which include the prevention of "serious, foreseeable, and imminent harm to a client or another identifiable person, or laws or regulations that require the disclosure without the client's consent," (NASW Code of Ethics, 2008). But what happens when a client dies? Do they lose their right to confidentiality? What about in the situation above, where the parent at one time DID have potential rights to access the information? Neither AAMFT or CAMFT specifically deal with this issue in their respective codes of ethics (as far as I could find, but please feel free to correct me if I'm wrong!). The NASW Code of Ethics, however, addresses this issue very clearly: "Social workers should protect the confidentiality of deceased clients consistent with the preceding standards." It doesn't matter if the person has been dead for 3 days or 30 years: it's part of our ethical mandate to protect their confidentiality. Please visit this website for a digital copy of the NASW Code of Ethics: http://www.naswdc.org/pubs/code/code.asp.

An unemployed therapist begins volunteering with a community organization providing free mental health services to homeless individuals and their families. The therapist meets with a new client, a 19 year-old male, and learns that the client has culinary skills and the desire to become a chef. The therapist's extended family owns a restaurant and the therapist believes they may be able to offer the client an internship that would later lead to a job. What should the therapist do NEXT? A. Consult with the program organizer to discuss linking the client to the job opportunity B. Maintain the client-therapist relationship and support the client in identifying appropriate job opportunities C. Validate the client's motivation and assist the client in contacting the restaurant to set up an interview D. Refer the client to a job placement agency and provide the agency with the restaurant's information to maintain boundaries

The correct answer to the question above is B: maintain the client-therapist relationship and support the client in identifying appropriate job opportunities. A and C are not the best answers because connecting the client with a family-owned business constitutes a dual relationship and should be avoided, regardless of consultation. D is not the best answer because it not only sets up a dual relationship between the therapist and client but also involves the therapist being dishonest with the client (making the connection secretly). As good as it might feel in the moment to link the client to an opportunity that you have available, it runs the risk of changing the therapeutic relationship and hurting the client in the long run. Boundaries around and within the therapeutic relationship should be clear — that's what makes it a safe space for clients to explore and work on difficult issues. So, what do the ASWB, BBS, and AAMFT want you to know about boundaries? Well, for one thing, they want to make sure you know what constitutes a dual relationship and avoid it in all possible cases. So what exactly is a dual relationship? The Social Work Dictionary defines it as "the unethical practice of assuming a second role with the client, in addition to professional helper...Dual relationships tend to exploit clients or have long-term negative consequences for them," (Barker, 2003).

A therapist receives a referral for a 6 year-old girl and her foster parents. In the course of the assessment, the foster parents indicate that the child was in play therapy for a year prior to the referral. The therapist would like to speak with the former provider; what should the therapist do NEXT? A. Have the foster parents sign a release to contact the play therapist B. Ask the foster parents to provide verbal consent and call the play therapist C. Contact the client's foster care social worker to determine legal guardianship D. Petition the Court for access to the play therapist's records

The correct answer to the question above is C: contact the client's foster care social worker to determine legal guardianship. This is the best first step in making sure that the consent is signed by the appropriate person. A is not the best answer because in many cases foster parents cannot sign releases of information; likewise, B is not the best answer because a verbal consent to release information is almost never a best first step — it should only be used in emergency situations. D is not the best answer because it is WAY more than what is called for, and may not even be possible. Studying for the LCSW exam or MFT exam isn't just about passing a test — it's about preparing to be an independent practitioner. Understanding the ins and outs of releases — who can sign them, what they typically cover, etc., is one way you can protect yourself and your clients when you're practicing under your own license. Children in foster care present a very particular situation — they're children, so an adult has to sign all releases, and in most cases the court or child welfare agency typically assumes legal guardianship. It's important to understand your individual state's laws around this, but in general, the child welfare agency or court must consent for treatment and sign all releases for children who are in foster care.

A social worker meets with a 16-year-old girl and her parents due to increasing parental-child conflicts. The parents describe their daughter's behavior as "out of control" and the daughter describes her parents expectations as "unfair and unreasonable." The parents explain that they will let their daughter go out with friends on the weekends only if she maintains a 4.0 grade point average. This is best described as an example of: A Negative Reinforcement B Positive Reinforcement C Negative Punishment D Positive Punishment

The correct answer to this question is B. Negative reinforcement (A) would involve taking something away to reinforce the desired behavior. So, if the question stated that the parents would remove her curfew if she maintained a 4.0 grade point average (the desired behavior), that would be negative reinforcement. This is positive reinforcement (B) because the parents are adding something (allowing her to go out with friends on the weekends) if she maintains a 4.0 grade point average (the desired behavior). Negative punishment (C) would involve removing something to decrease the frequency of an undesired behavior. So, if the question stated that anytime the daughter gets a grade below an A on a test or assignment, she is not allowed to go out with friends for a week, this would be negative punishment. It is taking something pleasant away (going out with friends) in order to decrease the frequency of the undesired behavior (getting below an A). Positive punishment (D) would involve adding something undesirable in order to decrease the frequency of an undesired behavior. So, if the question stated that anytime the daughter gets a grade below an A on a test or assignment, she must do an extra chore, that would be positive punishment. It is adding something unpleasant (doing a chore) in order to decrease the frequency of the undesired behavior (getting below an A).

A therapist in a family services agency begins an intake with parents and their two adolescent children. They are seeking services due to their teen daughter's recent truancy and increasing arguments about homework and household chores. A therapist using a structural approach would MOST likely use which of the following interventions to address the family's issues: A. genogram B. paradoxical directive C. enactment D. circular questioning

Well, I didn't choose one of the clearly "structural"-sounding interventions (gotta keep you on your toes!). The answer to the above question is C — enactment. Enactment is an intervention technique used in structural therapy in which family members are asked to role-play relationship patterns so that maladaptive patterns can be identified and altered consciously. Genograms are associated with Extended Family Systems Therapy (Bowen); paradoxical directives are associated with Strategic Family Therapy (Haley/Erickson); and circular questioning is associated with Milan Systemic Family Therapy (Selvini-Palazzoli). There are likely some therapy modalities that you're more familiar with, so when you're studying, emphasize the modalities that feel trickier to you and consider focusing on no more than one modality per day in between other topics/tasks. If I tried to study Structural Family Therapy, Strategic Family Therapy, Family Systems Therapy and Milan Family Systems Therapy on the same day, my head would be swimming with "S" terms and I'd never be able to separate them! Structural Family Therapy is only one of several (or in the MFT's case, many) treatment modalities that you are likely to see on the exam. This method was developed predominantly by Salvador Minuchin and focuses on, you guessed it, the structure of the family in both its conceptualization of problems and its approach to treatment. Minuchin believed that all families have a structure that determines how members relate to one another, manage conflict and deal with family problems; he also focused on boundaries between family members and is responsible for the terms "enmeshed" and "engaged" that many therapists use, regardless of their orientation. The terms that go with Structural Family Therapy sound structural to me — they call forth images of something physical, like a building: alignment, hierarchy, inflexible, reframing. If you can create associations like to this to help you absorb concepts and ideas, it will help you recall and apply them when you're sitting for the exam.

A 27 year-old male client has been working with a therapist for 4 months around interpersonal difficulties. During a session, the therapist confronts the client regarding a pattern of behavior that appears to be contributing to the presenting problem. At the next session, the client arrives and reports that his relationship problems are resolved and he no longer needs treatment. What should the therapist do FIRST? A. Proceed with termination and help the client process his feelings B. Offer the client referrals for community resources and proceed with termination C. Explore the client's readiness for termination and support his self-determination D. Reflect on the previous confrontation and explore the client's feelings after the last session

Well, in this case, D is the best answer. While you might end up doing A, B, or C eventually, the FIRST step would be to bring up the previous confrontation and encourage the client to explore the feelings he had in response to the therapist's intervention. If you skipped D and went to one of the other interventions first, you run the risk of reinforcing a pattern of interaction that may be contributing to the client's problems, and you miss the opportunity to help the client create a new way of being in relationship with another person. If you attempted to execute D and the client still maintained his stance, then you might have to move on to one of the others, but don't skip over the opportunity to repair a therapeutic rupture like this! So, how do you know when a client is ready to terminate? Sometimes it's dependent on a specific number of sessions, sometimes it's dependent on achievement of particular treatment goals, and sometimes people just need a break, even if they're not done with the work yet. Ideally, termination is an entire phase of treatment that helps the client consolidate the gains they've made and anticipate future problems. Sometimes, though, clients may use the idea of termination to avoid a conflict in treatment, or to deal with uncomfortable feelings that have come up. So what do you do then? The social workers in the crowd may all be thinking about that "self-determination" piece — and it's true, we're ethically bound to respect the client's self-determination, but this doesn't mean that we just go along with everything the client says, right? Again, one of the ways we can intervene with clients is to model ways of dealing with conflict and uncomfortable feelings.

Which of the following statements BEST defines empowerment? A. The act of directly representing or defending others B. The process of assisting individuals, families, groups, and communities to experience personal and social change, and develop influence toward improving their circumstances C. An ethical principle that recognizes the rights and needs of client's to be free to make their own choices and decisions D. Achieving the full development of one's potential

While I've already given it away, the best answer here would be B. A would be a better fit if we were describing advocacy. With empowerment we aren't necessarily defending our client's as much as we are assisting them to become their own defenders and develop their own change. C is incorrect because empowerment isn't really viewed as an ethical principle, but rather a process of change. Lastly, D includes one aspect of empowerment, but it doesn't incorporate all the components that the test would be looking for. While many have more recently described empowerment as a "buzz" word, I think it still holds a large place in our work. Many of our client's come to us feeling powerless or out of control with their lives. They have spent many years telling themselves or hearing that they aren't good enough whether it is by their family, friends, or even society. However, through our work I think we can empower our client's by helping them develop the tools and coping skills to build the life they want. There are many ways to do this including, but not limited to, helping client's find the appropriate resources, validating how they feel, assisting them in developing positive relationships, and building upon the many strengths that they already have. The Social Work Dictionary defines empowerment as, "the process of helping individuals, families, groups, and communities increase their personal, interpersonal, socioeconomic, and political strength and develop influence toward improving their circumstances" (Barker, 2003).

Which of the following BEST defines introjection? A. When unacceptable aspects of one's own personality are rejected or attributed to another person or entity. B. When an individual takes aspects or feelings from another person or object and directs them internally. C. Behaving or thinking in ways that are opposite of the original unconscious trait. D. The redirection of thoughts, feelings, and impulses that are deemed unacceptable and thus transferred to another thought, feeling or impulse, that is more tolerable or acceptable.

With all that being said, it should be clear now that the best answer here is B. The additional choices are actually definitions of other defense mechanisms. These include A as projection, C as reaction formation, and D as displacement. Even as I write these I keep mixing them up! It's easy to confuse one for another and therefore shows why it's important to learn the differences between each definition before heading into the exam. I think it can be really easy to get mixed up with defense mechanisms since many of them are just slightly different when you look at their definition. The Social Work Dictionary defines introjection as, "A mental mechanism in which the individual derives feelings from another person or object and directs them internally to an imagined form of the object or person" (Barker, 2003). An example of this is if a child grows up with a verbally abusive parent. Over time as that child grows into an adult he/she may begin to take on the negative qualities, values, and feelings of that abusive parent. In this case introjection helps the individual feel more in control and takes away the feelings of fear and helplessness that they may have experienced as a child. On the other hand, introjection can be used in a positive manner by taking in the values of a person that we may admire and incorporating those qualities into ourselves as well.

Which of the following statements BEST describes the assessment process that occurs during the beginning stages of treatment? A.The process of determining what services are best for a client B. The process of understanding a problem, what causes it, and how the client can decrease or resolve it C. The process of exploring the nature of a problem and how the client currently manages it D. The process of establishing rapport with a client

With this definition in mind, the best answer to the above question is B since it is the most comprehensive answer between all the choices. While A, C, and D, all occur during the assessment process, the question is looking for the best definition and therefore one that is all encompassing. The assessment process is really important because it is often the first point of contact that a client and social worker have together. During the assessment, the social worker is able to gain a better understanding of the client's presenting problem and what the client is hoping to obtain from treatment. The Social Work Dictionary defines assessment as, "The process of determining the nature, cause, progression, and prognosis of a problem and the personalities and situations involved therein" (Barker, 2003)

A therapist in a private practice has been working with a 19-year-old male for three years when the client commits suicide. The client's mother, who had previous contact with the therapist when the client was a minor, calls the therapist crying and asks if she can have access to her son's records as a way to, "understand what he was going through." How should the therapist respond to this request? A. Explain that her son had not signed a release of information for this disclosure. B. Maintain the client's confidentiality according to professional standards. C. Release limited records from the time period that the mother had contact with the therapist. D. Empathize with the mother's request and release the full record to the mother.

With this in mind, the correct answer to the question above is B: maintain confidentiality according to professional standards. A is not the best answer because it provides the mother with information that should be kept confidential — we don't know if the client had informed his mother that he was in ongoing treatment, we only know that treatment began when he was a minor. C is not the best answer because as far as the question is concerned, the therapist doesn't have a current release of information — it doesn't matter if there was a release of information at one time — if it's expired, it's expired. D also goes too far; while emotionally the therapist might want to try to find a way to honor the mother's request, the first responsibility is to the client and the client's right to privacy and confidentiality. It might seem like a case in which an exception should be made, but that would likely be the therapist's desire to make the mother (or him/herself) feel better in the face of this tragedy coming through. There is no legal or "compelling professional" reason to disclose confidential information in this case. When working with client's who are living adults, it's much more clear what the limits of confidentiality are. You want to maintain the client's confidentiality unless there is a "compelling professional reason" for disclosure, which includes the prevention of "serious, foreseeable, and imminent harm to a client or another identifiable person, or laws or regulations that require the disclosure without the client's consent," (NASW Code of Ethics, 2008). But what do we do when a client dies? Do they lose their right to confidentiality? What about in the situation above, where the parent at one time DID have potential rights to access the information? According to the NASW Code of Ethics, social workers should continue to protect the confidentiality of clients, even after the client has passed away. As practitioners, we can't disclose confidential information unless we have received the proper legal authorization to do so (such as a subpoena from a judge). When a disclosure of confidential information has been properly authorized, the least amount of information should be given in order to fulfill the purpose of the disclosure (Reamer, 2010).

Which of the following statements BEST describes countertransference within the client-therapist relationship? A. The projection of the client's feelings regarding past experiences onto the therapist B. The therapist's emotional response to a client as a result of past experiences, including both conscious and unconscious feelings C. A defense mechanism used by the client where unacceptable aspects of the client's personality are attributed to the therapist D. The therapist's understanding of a client's symptoms or behaviors from a psychodynamic perspective

With this information in mind it should be clear that B is the best answer to the question. We can rule out A and C because both of those statements are referencing the way the client feels and how that is projected onto the therapist. When looking at a question regarding countertransference it is important to keep in mind that it is the way the therapist feels in reaction to the client, not the other way around. Lastly, even though D incorporates some good aspects, such as how we can better understand the client through our own countertransference, it doesn't provide the best definition possible. During my graduate program, countertransference frequently seemed to be a hot topic that came up when we discussed work with our clients. It was always interesting that we each had different reactions or feelings about clients, even if they presented with similar problems. According to The Social Work Dictionary countertransference is defined as, "A set of conscious or unconscious emotional reactions to a client experienced by the social worker or other professional, usually in a clinical setting. According to psychodynamic theory, these feelings originate in the professional's own developmental conflicts and are projected onto the client" (Barker, 2003). Therefore, whether we have a positive or negative regard for a client, our feelings may be rooted in our countertransference reactions. These reactions will affect the client whether we mean for them to or not and as such it is something that we continually need to be aware of in order to separate our "stuff" from the client's. By doing this, we allow ourselves the opportunity to better understand the client by being more empathic and present in our work.

A school therapist evaluates a 6 year-old student and concludes that the child is likely suffering from both ADHD and a Learning Disorder. The therapist meets with the family and provides a referral to a psychologist in the community for further testing. Several days later, the psychologist calls the therapist, thanks her for the referral, and suggests an ongoing relationship in which the psychologist gives the therapist a percentage of the testing fee in this and future cases. The therapist should NEXT: A. Ensure that no conflict of interest exists before moving forward B. Consult with school administration about this arrangment C. Refuse the offer D. Report the psychologist to the licensing board

is the best answer to the question above: whether you're an MFT or a social worker, whether you're in private practice or working for an organization or agency, accepting fees for a referral is unethical. Even though the therapist in this case has provided a clinical service to the client, the financial arrangement that the psychologist is suggesting would involve the therapist accepting compensation when no service is being performed. A and B are not the best answers because regardless of the therapist's use of consultation or consideration of conflicts of interest, accepting kickbacks for a referral is considered unethical. D is not the best answer because the therapist's NEXT task would be to refuse the offer. Understanding your professional code of ethics can help you PASS your exam, but more importantly, it will help keep you and your clients safe once you are licensed! I was surprised to find that there are a couple of pretty significant differences in the ethical guidelines regarding financial arrangements for social workers and MFT's. Social workers are ethically bound to consider the client's ability to pay when setting fees, while MFT's are bound to "conform to accepted professional practices," (AAMFT Code of Ethics, 2012). The AAMFT Code of Ethics specifically discusses situations in which therapists may use collections agencies or legal means to recoup fees, while the NASW Code of Ethics does not address this topic. Both professions, though, share the same standards regarding bartering, accepting/giving compensation for referrals, and accurately representing the services rendered. The complete NASW Code of Ethics can be found here: http://www.naswdc.org/pubs/code/code.asp The complete AAMFT Code of Ethics can be found here: http://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx

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